If you and your partner both have ovaries and want to have kids, there are many, many decisions to make along the way: IUI or ICI? IVF or reciprocal IVF? Who carries? Where do you get sperm? Even after knowing how you’ll inseminate, you still have to choose between using fertility medications (like Clomid) or trying your hand at conceiving medication-free.
As we’ve heard from members of the Modern Community, our online space for real-talk support about all things fertility, people have a lot of questions about the often complicated process of conceiving as an LGBTQ+ couple — and answers aren’t always easily accessible. And when they are accessible, the unique nuances from person to person (the state you live in, the insurance you have… the list goes on) aren’t always taken into account.
So, we asked five LGBTQ+ community members about how they’ve made their own decisions, what they’ve learned from the process, and what advice they have for other LGBTQ+ couples.
Before we dive in... a refresher on the options
Below is a quick rundown of some of the acronyms, terms, and fertility treatment options you’ll come across when planning for kids as an LGBTQ+ couple — or as any couple or individual using assisted reproductive technology (ART) to conceive:
- Intrauterine insemination (IUI): IUI involves sperm placed directly inside the uterus, with the help of a doctor or midwife. IUI can be medicated (with drugs like Clomid or the “trigger shot”) or unmedicated. The costs of IUI vary depending on insurance coverage (which we’ll get more into a bit later), but without insurance, FertilityIQ puts the cost at anywhere from $500-$4,000 per cycle — depending on factors like medications used, ongoing doctor’s appointments, and the number of inseminations during that cycle.
- Intracervical insemination (ICI): ICI involves sperm inserted directly into the cervix. Unlike IUI, ICI can be done at home — there are even kits on the market that provide disposable syringes for the insemination. Each round can cost $200-$350. (Since ICI is primarily done without doctor supervision, not all healthcare providers will recommend it.)
- In-vitro fertilization (IVF): In an IVF cycle, the fertilization of an egg will happen outside of the body using donor sperm. Including the cost of treatment and medication, according to FertilityIQ, IVF can cost as much as $20,000 per cycle without insurance.
- Reciprocal IVF: Reciprocal IVF allows two partners who both have uteruses to be biologically involved in conception. One person’s eggs are retrieved so they can be fertilized by donor sperm and implanted into the other’s uterus.
- Anonymous donor sperm: The sperm is purchased through a sperm bank, where it undergoes lots of tests (genetic testing, sperm analysis, and more) along with the donor (STI, overall health) — meaning you don’t have to deal with that aspect of the process. Anonymous donor sperm is typically frozen. Donor sperm can range from $500-$1,000 per vial, according to FertilityIQ.
- Known donor sperm: When using a friend or family member’s sperm, you and the donor will have to undergo testing without the assistance of a sperm bank. (It’s worth noting that using the sperm of someone you know can sometimes add personal or legal complications to the process.) Known donor sperm will typically be freshly retrieved, or you can freeze it at a sperm bank.
IUI is the treatment of choice (to start)
After spending a year and a half researching the options for insemination (and saving up for them), Courtney Y., 29, and her wife decided on using a known sperm donor for IUI. “Since our insurance doesn’t cover any part of the process, any testing, or any consultation, we knew IVF was off the table as a first option,” she explains.
Saving on the costs of donor sperm from a sperm bank allowed them to spend more on in-office IUI. “It is important to us to make the best decision financially and emotionally for us today and in the future,” Courtney Y. says.
“It feels like an unfair decision to have to choose between spending money on sperm versus spending money on having a doctor help.” — Courtney Y.
Cari, who’s 33, has done five rounds of unmedicated IUI — as well as one round of at-home insemination. She and her wife were initially interested in reciprocal IVF, but their doctor explained that IUI might be a faster first step: “My doctor was like, reciprocal IVF is going to take time ... we should do that later when you have time to plan ahead. If you want to get pregnant now, we should just do this now,” Cari explains. Based on the tests she and her wife took with their doctor, unmedicated was the way to go for the first few rounds — if they don’t conceive after this latest round, the next step will be medicated IUI with Clomid.
At first, Chad, who’s 33, and their wife wanted to do reciprocal IVF: “But we were hoping to do this with both of our eggs at the same time, in hopes of having twins,” they explain. They switched to IUI once they learned that exact procedure hadn’t been done before and could result in pregnancy loss. “We decided on IUI after my wife had her hormones tested and found she had an above average egg reserve for her age,” Chad says. They went the medicated route to up their chances — even though, based on the tests, their doctor said medication wasn’t necessary. Right now, they’re in the “two-week wait” after round one of IUI — they’ll try IVF next.
Courtney B., 30, tells us that she and her wife are in the early stages of planning for kids — they’ve recently completed their first round of IUI, which made the most sense for them financially. “[My wife is] less inclined to carry, so I'm giving it a go for this first round,” she says. After taking the Modern Fertility Hormone Test and learning that all of her hormone levels were within range, Courtney B. and her wife chose to start with unmedicated IUI.
COVID-19 threw a wrench in the timing of Courtney B. and her wife’s plans. “We were aiming for our first attempt in March, and then COVID hit and our doctor's office closed,” she says. “If I had ovulated two days earlier, I may have made the cut-off. Fast forward to June and I had the IUI, but got my period a few days ago. We'll try again with a medicated IUI in a few weeks.” After that, though, they’re thinking about other ways to conceive: “We're really interested in reciprocal IVF too, but ideally once I've been through a successful pregnancy — also, once we make some more money.” They’re also open to adoption.
The ICI alternative during COVID-19
Autumn, 35, started the process of trying to conceive with her partner using fresh donor sperm for IUI conducted by a midwife. “By using a midwife, we didn't have to get the medical establishment involved,” she says. Finding a way to conceive that didn’t involve the traditional healthcare system was important to Autumn after the seven months she spent in and out of doctor’s offices and hospitals to address symptoms that turned out to be caused by a pituitary tumor. During that period, she had two tumors removed — “one from my jaw and one from my pituitary gland that was likely affecting my fertility,” she explains.
As much as they’d like to do another round of IUI, because of COVID-19, using a midwife isn’t really an option right now. “While we would like to do IUI, many midwives are not doing this right now due to the pandemic, and we are also at high risk for COVID-19,” Autumn explains. They see at-home ICI as their best bet — they’ve already done a “test run” for getting the sperm and doing insemination in the back seat of their car.
Costs and insurance are the biggest frustrations
For many of the LGBTQ+ community members we spoke with, costs and insurance were major obstacles to trying to get pregnant. “The most frustrating piece, which is probably obvious, is the amount of money it costs,” explains Courtney B. (Our Modern State of Fertility 2020: Career and Money echoes this: Finances were high on the list of reasons why 49% of the people we surveyed were delaying kids.)
The high costs of fertility treatments are compounded by the fact that many insurance policies require LGBTQ+ couples to try to get pregnant for a year before coverage kicks in. “The medical definition of ‘infertility’ that so many insurance companies use completely neglects the fact that same-sex couples are biologically infertile,” Courtney Y. explains. “Our insurance didn't even cover our STD testing or initial consultations at the fertility clinic.” And that’s with fairly decent insurance, she adds.
Cari is also frustrated with her employer’s insurance policy. She and her wife were annoyed — though not really surprised — when they discovered the policy’s limitations and imbalance. At Cari’s company, same-sex and opposite-sex couples both have to try to get pregnant for 12 cycles before coverage kicks in… even though same-sex couples rely on fertility treatments from the beginning. “At roughly $2,700 a ‘try’ each month for LGBTQ+ couples, that could be $32,000 before there’s any coverage,” she explains.
“Unfortunately, the world isn't fair — especially to minority groups and especially when it involves healthcare.” — Cari
… But those aren’t the only challenges LGBTQ+ couples face
Courtney Y.’s state has laws in place that require the parent who doesn’t carry the child to adopt: “In the eyes of the law, same-sex conception still requires extra work to ensure parents have the correct rights — something hetero couples never even have to think about,” she explains. Similarly, where Courtney B. lives, “You can't do an at-home IUI or else the laws get murky around second-parent rights,” she explains. “So, we're working with a reproductive endocrinologist and doing the IUIs at her office. Due to COVID restrictions, only I am allowed in the room, which is tough. But my wife and I decided we didn't want to wait any longer.”
Courtney B. adds that, on top of the larger issues she’s encountered while trying to get pregnant, “invasive, though well-intentioned, questions around the process” have been frustrating. “The questions we have to consider and the process we have to go through is an intimate one, and most people don't seem to get that and let their curiosity get the best of them,” she explains. “I keep in mind a baby is at the end of this journey and the hoops we have to jump through will be worth it.”
A supportive community makes things easier
According to Courtney B., “Hearing stories of other LGBTQ+ couples has been a gift.” She turns to the Modern Community, @wovenbodies on Instagram, and a website sharing the perspectives of non-carrying parents for resources, information, and support.
Cari and Chad have also leaned on the Modern Community for answers to their questions. “It's just really nice to talk about these things, and it’s really nice to feel like your experience is helping somebody else,” Cari explains. Chad agrees: “Being able to have my questions answered by Nurse Jill [during weekly office hours in the Modern Community] has been such a treat.” (In the Modern Community, we have a dedicated #LGBTQ+ channel — the thread that inspired this article got 150+ comments!)
Autumn believes in the importance of a specifically LGBTQ+ community. “Being queer and trying to get pregnant sometimes made me feel isolated from a lot of online TTC chatter,” she explains. “Having a group of queer folks who were also dealing with things like how expensive frozen sperm is, or invasiveness of surrogacy, or any of the hundreds of other hurdles queer people must jump in order to get pregnant, was really nice.” Even the community members who’ve gotten pregnant continue to be a part of her support system as she takes the next steps toward trying to conceive. “By having resources that are made by queer folks, it really helped me not feel so alone,” Autumn says.
Advice for other LGBTQ+ couples
“Don’t overwhelm yourself with info, choose a couple of trusted sources, and don't be afraid to talk to people about it. Shared experiences are so helpful,” says Cari.
“Make sure you communicate before and throughout the process,” says Courtney B. “As long as the two of you are a strong team with a strong foundation, the rest will follow.”
“Everyone has different help, financial situations, needs, and wants,” says Courtney Y. “Enjoy the journey and ride the waves. Try not to put too much pressure on you and your partner when it comes to timelines, money, and expectations.” She adds: “And about the timelines... start planning a couple years in advance.”
“We are not alone, however we decide to grow our families,” says Autumn. “The political idea of queer parenting may seem new, but families are created and grown in innumerable ways throughout history.” Autumn views her experience treating her brain tumor as “what it took to get me to even be able to contemplate trying to let go of the outcome.” As a result, the process has been a lot more joyful for Autumn and her partner.
“It is beyond helpful knowing your hormone levels and having an ultrasound done of your ovaries to get a view and count of your follicles,” Chad says. “I would also recommend knowing whether or not the carrying person's fallopian tubes are open and flowing the way they should.” Most importantly, according to Chad: “Do this process with love and patience. It will happen for you one way or another.”
And, finally... resources for planning for kids as an LGBTQ+ couple
If you’re in an LGBTQ+ couple and hoping to conceive in the near or far future, finding the right healthcare provider and support system can help you figure out the best plan of action for you and your partner. Below, we’ve listed a few resources for doing just that — as well as additional information for navigating the different paths to parenthood.
LGBTQ+-affirming healthcare providers:
- GLMA: Health Professionals Advancing LGBTQ Equality
- OutCare Public LGBTQ Healthcare Resources
- CDC: Lesbian, Gay, Bisexual, and Transgender Health Services
- Let's talk fertility resources for LGBTQ+ people
- Queer and lesbian fertility: Planning kids as a cisgender woman in a same-sex couple
- Transgender fertility: How kids are still possible when you’re trans, gender nonconforming, or nonbinary
- Resolve New England: LGBT Family Building Resources
- Family Equality: Trans Family Building