Queer Couples Are Being Priced Out of Pregnancy
Laura Tendall / Dec 29 / Health Services
In England, being queer can create a barrier to having a family. This statement may seem glaringly obvious - we all know how babies are made. It’s understandable then that this is something many LGBTQ+ people have had to come to terms with - if we want kids, we may have to find alternative pathways.
It’s totally possible - we learnt about it in Biology. Besides, the inability to conceive naturally is common whether queer or not. In fact, around 1 in 7 couples in the UK may grapple with infertility. Intrauterine insemination (IUI), in vitro fertilisation (IVF) and surrogacy, are all options, as are adoption and fostering. Technological advancement means that assisted reproductive technology has become increasingly favoured - whilst adoption and fostering can be valid and fulfilling routes to parenthood, there are many reasons why they should not be passed off as the default solution for couples who are unable to conceive naturally.
Unfortunately, though, many of us are unaware of the discrimination that LGBTQ+ couples experience when it comes to fertility treatment in the NHS, both in terms of cost and care.
Given the complex and inherently emotional nature of this issue, instead of adding further opinion to the discourse, I am going to focus on presenting the facts as plainly as possible.
A Baby to Break the Bank?
Healthcare services in England are informed by the National Institute for Health and Clinical Excellence (NICE), who set out evidence-based recommendations for healthcare professionals. These guidelines ask that couples ‘prove’ infertility before accessing NHS-funded treatment.
For cisgender heterosexual couples, this means having 2 years of unprotected sex without conceiving. (This rule may also apply for couples with opposing gametes where one or both partners are transgender, though, for transgender men, gender dysphoria might influence the desire to carry a pregnancy, and, in cases where patients undertake hormonal or surgical transitions, fertility preservation via egg or sperm freezing presents its own challenges and requires prompt consideration.)
For female same-sex couples (or any couple where both partners have female gametes), ‘proving’ infertility means going through between 6 and 12 cycles of self-funded IUI treatments, also without conceiving. With a success rate of just 15%, multiple attempts are often necessary. This can end up setting couples back up to £30,000, as each of these cycles can cost up to £2,300 or more. In contrast, whilst the 2-year wait for cisgender heterosexual couples can be long and distressing, it holds no financial cost.
Even after these prerequisites are met, eligibility to receive NHS-funded IVF treatment is not standardised, and final decisions are instead made locally by Clinical Commissioning Groups (CCGs). Despite NICE recommending that clinics offer 3 free attempts at IVF, over 80% of CCGs fail to follow this – in many areas of the country, patients are restricted to 2, 1, or even none. This ‘postcode lottery’ is likely to put particular pressure on female same-sex couples. In areas where access to NHS-funded IVF treatment is not sufficient, the cost of self-funding will only inflate the figure that these couples have already incurred. Charges for self-funded IVF treatment are not regulated and, with clinics free to set their own price, each cycle can cost over £5,000. What’s more, because the success rate of IVF for patients in female same-sex relationships is just 31%, much like with IUI, multiple attempts may need to be budgeted for.
Whereas 39% of IVF cycles for cisgender heterosexual couples are NHS-funded, for female same-sex couples, this number is just 14%. Stonewall’s Senior Policy Officer Jessica Holden notes, “questions should be raised regarding the disparity in funding for IVF cycles, to address the current inequalities and provide equal access to fertility treatment for female same-sex couples". Being queer is not the same as being medically infertile, yet current guidelines do not take this into account.
For male same-sex couples (or any couple where both partners have male gametes), and for female same-sex couples who are unable to carry a pregnancy, surrogacy expenses are equally high - NHS funding is not provided and paying in the region of £30,000 is not uncommon.
Calls for Courtesy
In addition to cost, heteronormative systems mean NHS staff often fail to appropriately and attentively care for the queer community. A quarter of LGBTQ+ people report feeling their healthcare provider didn't understand their needs. Youtubers and wives Whitney and Megan have spoken out about their experience attempting to access fertility treatment as a lesbian couple, revealing that their GP had ‘no idea’ what fertility treatments were available to them. They state: "We are asking for formal training with NHS staff on all LGBT+ issues. We've heard stories of some doctors saying 'who's the real mum or where's the dad?'"
The couple also voice how they felt when they learnt they’d have to forgo an intimate conception in order to access safe, medically-screened sperm: “We were devastated when we found out that we cannot do home insemination with sperm purchased from a sperm bank. We wanted to be able to ‘give it a go’ at home in a loving environment like so many other couples get to do. But our only option is being forced to go to private clinics, being treated [as] medically infertile and with extortionate fees.”
An Endeavour for Equality
In July 2019, Health Secretary Matt Hancock pledged to review LGBTQ+ access to fertility treatment, stating that sexuality should not affect access to IVF. There have been no updates since.
In recognition of this, in November 2020, Whitney and Megan launched a campaign to stop the ‘gay tax’ on fertility treatment, as well as demanding more respectful and considered care. Using the hashtag #fertilityequality, the campaign requests that the government: complete the review into LGBTQ+ access to fertility treatment, reconsider the ban on home insemination, ensure all CCGs adhere to NICE guidelines to fund 3 IVF cycles, collect data on LGBTQ+ families, and introduce formal training on LGBTQ+ issues for all NHS staff. They are hoping to gain 100,000 signatures in order to warrant a parliamentary debate - to support, sign and share the petition and write to your MP.
With excessive costs disproportionately impacting the queer community, many LGBTQ+ couples simply can’t afford to have a family. Those on lower incomes and from ethnic and racial minorities are especially affected. In reference to this discriminatory system, the British Pregnancy Advisory Service state: “This status quo is antithetical to the most fundamental principle of the NHS, that care should be provided according to each patient’s clinical need and not their ability to pay. This mantra is enshrined in the NHS constitution, but it is sadly not manifested in the provision of fertility services.”