When starting a family, sometimes you need a little help. But you're far from alone in this journey. In fact, the U.S. Society of Assisted Reproductive Technology (SART) reports that between 2010 to 2019, 83,946 babies were born in the U.S. with in vitro fertilization (IVF) or other assisted reproductive technologies like the use of an egg or sperm donor. Infertility used to be an enormous roadblock to having a baby, but the help of assisted reproductive technology (ART) has enabled many to fulfill the dream of having a family.
If you're a member of the LGBTQ community and ready to start your family, there's no reason to wait. Get started here – we've got your guide on what to expect with fertility testing and working with an inclusive fertility clinic.
LGBTQ Fertility Vs. Infertility
According to the Centers for Disease Control and Prevention (CDC), infertility means not being able to get pregnant after one year of trying to conceive. For those 35 years or older, that timeline gets shortened to six months of trying to conceive. That's because, according to the American College of Obstetricians and Gynecologists (ACOG), fertility starts to take a dip by your mid-thirties.
For a person or couple contemplating or already in fertility treatment, it is much more than just a timeline. There's an entire emotional and physical component that can leave you feeling exhausted, depleted, and often completely hopeless.
What is often more puzzling about infertility is why it's happening in the first place. There are many causes of infertility, including issues with ovarian function resulting in conditions like polycystic ovary syndrome (PCOS) or irregular menstrual cycles, fallopian tube obstructions, fibroids, or a structural problem with the uterus.
Hormonal and genetic disorders, age, excessive alcohol use, and weight gain can also contribute to infertility. Sometimes, however, infertility is not a consequence of a physiological condition. When this happens, it is frequently referred to as social infertility. (Although many LGBTQ+ individuals resent this term, which we'll explain below.)
Debunking the Stigma of Social Infertility
Social infertility refers to a couple, or individual, who is infertile because they are not able to reproduce through sexual intercourse. It becomes a diagnosis based on their circumstances rather than a physical condition. (Though, of course, a person can deal with infertility and social infertility simultaneously.)
In recent years, there has been a push to expand the definition of infertility to include social infertility to help with insurance coverage for fertility services. This would consist of LGBTQ infertility - couples looking to use a surrogate or assisted reproductive technology (ART), single people who freeze their sperm or eggs and want to have a child on their own, and others who wish to start or expand their family but can't.
Insurance carriers have previously denied covering these claims because of the term social infertility. There is an assumption that this type of infertility is a choice when that isn't the case. LGBTQ individuals didn't choose their sexuality and because of that, should not be excluded from being able to afford or have access to services that can help them have a baby. Social infertility faces the same physical and emotional hurdles as infertility. In fact, for some of the LGBTQ community, it may be worse. Those who resigned themselves to never having a family or child see the opportunity right in front of them but aren't able to grab it because of the financial restrictions that come with classifying social infertility.
That's why groups such as the Family Equality Organization advocate against restrictive state laws and red tape to help make surrogacy and ART services easier and more accessible for the LGBTQ community.
Getting Started With LGBTQ Fertility Testing
If you're interested in starting a family, finding an inclusive fertility clinic is a good idea. Together, they'll be able to walk you through the tests you'll need, how to navigate your insurance coverage, and support you through the process.
• Anti-Mullerian hormone (AMH) test: To look at ovarian reserve and potential egg count.
• Follicle-stimulating hormone (FSH) test: To diagnose potential fertility difficulties like PCOS or premature menopause.
• Luteinizing hormone (LH) test: To help pinpoint ovulation.
• Estradiol (E2): Levels of this hormone are essential for the health and growth of the uterus, fallopian tubes, vagina, and outer genitals.
• Progesterone: Used to help confirm if ovulation has occurred.
• Semen analysis: Checks sperm count, motility, and sperm health.
• Genetic carrier screening: This can help determine whether you or your partner have specific genes that may predispose a child to certain genetic disorders.
• Hysterosonogram: A particular type of ultrasound that uses a saline solution to evaluate the uterus and its shape.
• Hysterosalpingogram: A diagnostic X-ray test that uses dye to examine the uterus and fallopian tubes.
Even if the results of your LGBTQ fertility testing come back abnormal, this doesn't mean your family planning screeches to a halt. Sometimes, it's as simple as lifestyle modifications or medication to help resolve any hormone imbalances before retesting.
Understanding Your Insurance Coverage
Good news: When it comes to LGBTQ fertility testing, insurance typically covers most tests.
What gets tricky are the next steps. Depending on the results of your tests and how you want to proceed with starting a family (such as gestational carrier, IUI, IVF, etc.), coverage depends on the type of insurance you have. Not all insurance companies cover fertility treatments for LGBTQ couples and individuals because of the definition of infertility. If a person has social infertility versus clinical infertility stemming from a physiological condition, insurance may not cover treatment because it is not deemed "medically necessary."
Thankfully, advocates are starting to push back against insurance companies in the hopes of changing the existing regulations. For example, in 2021 The National Women's Law Center (NWLC) and civil rights law firm Emery Celli Brinckerhoff Abady Ward & Maazel (ECBAWM) filed a class-action lawsuit against insurance company Aetna, alleging discriminatory practices against LGBTQ policy-holders seeking fertility treatments. This led to Aetna announcing immediate coverage would be granted to LGBTQ individuals who were getting fertility treatments. In New York, a law was also passed requiring insurance companies to cover fertility services for same-sex couples, helping those in the LGBTQ community who want to start or expand their families to do so without risk to their livelihood.
It can be confusing to know how your insurance works, and other factors, such as where you live, come into consideration. The Family Equality Organization has a list of resources that can help, such as state LGBTQ family law guides.
Working With an Inclusive Fertility Clinic
As an LGBTQ individual, an inclusive fertility clinic can provide the support and resources you need to pursue your family goals.
The U.S. has roughly 450 fertility clinics scattered throughout the nation. As of 2019, out of the over 330,000 ART cycles performed at these clinics, almost 78,000 live births have been recorded. This is a highly positive success rate. Thanks to modern science, ever-evolving technology, and caring, knowledgeable providers, starting a family quickly became a reality for many who thought it could never happen.
While success is possible, it is crucial to have an open and trusting relationship with the providers in your fertility clinic. By seeking out an inclusive fertility clinic, you can rest assured you won't just be another nameless file or patient case. Your story matters and they will recognize how your situation is different from many standard infertility cases. An inclusive fertility clinic will listen and include you in the process of starting a family.
Starting a Family Through Fertility Treatment
If you are a member of the LGBTQ community, your dreams of having a family should not be hindered or ignored. A trusted medical team at an inclusive fertility clinic will understand your goals and help you try to reach them.
Research published in F&S Reports found that live births between lesbian couples who received an IUI with donor sperm compared to heterosexual couples who received an IUI with partner or donor sperm had comparable success rates, with lesbians having a slightly higher pregnancy and birth rate and lower chances of miscarriage.
This is all to say, LGBTQ couples and individuals have the same options as the heterosexual population when it comes to fertility testing and treatments. You have to know where to look to get started.
• Start by browsing the Family Equality Organization for resources and a directory targeted at family-building.
• Find an inclusive fertility clinic and set up an informational meeting.
• Ask questions at the informational meeting and lots of them! This can help you determine if they are a good fit for you, provide them with your background information, and set up a plan to help you reach your family goals.
LGBTQ infertility is infertility, and by working with a team that understands this, you can get the proper LGBTQ fertility tests you need for the treatment that will be more effective. Whether this means an IUI, IVF, egg donor, sperm donor, surrogacy, or something else, ART services are more accurate than ever, providing more options and possibilities for those looking to start or expand their family.
If you're ready to take the leap to start or expand your family, we want to be here to help you achieve it. Visit Institute for Human Reproduction to dive in with us and get started today. Schedule your consultation.