Updated 8th November, 2021: On 7th November, Whitney and Megan Bacon-Evans announced they are launching discrimination action against the NHS, specifically their local Clinical Commissioning Group, Frimley. The CCG’s policy states that female same-sex couples must self-fund 12 rounds of artificial insemination, 6 of which must be IUI in a private clinic. This puts same-sex couples, single women and people with wombs in a position where they have to pay thousands of pounds to access NHS treatment.

In a statement, the Bacon-Evans’ said that “we are doing this in the hopes to help create a future where LGBTQ+ families are treated as equal. If found to be unlawful, this could positively impact the lives of tens of thousands, or even hundreds of thousands, of LGBTQ+ people embarking on their path to parenthood now and in the future to come. It is time for discrimination to end and for there to be equal treatment with heterosexual couples in the healthcare system.”

They have launched a crowdfunder to cover their legal fees. You can support them here.

This story was originally published 15th December, 2020

This year Whitney and Megan Bacon-Evans decided, after 12 years together, that they were ready to start a family. As longtime celesbians within the YouTube community, they were more acquainted than most with the process of LGBTQ+ conception. They knew, for example, that they wanted to do at-home insemination, using a kit from the American brand Mosie Baby. They wanted to feel comfortable and connected to the conception process and were getting really excited about the possibilities.

Soon after they began their research, they faced the knotty, confusing and oftentimes discriminatory world of fertility-related legislation in the UK.

“We quickly found out that it’s illegal for sperm from sperm banks to be shipped to your house in the UK,” Whitney tells R29. This was banned in 2005 when sperm donors were no longer able to be anonymous. “That instantly took away a loving, comforting setting in our home.”

The given reason for this ban is to protect you from legal issues surrounding the parenthood of the child further down the line, by ensuring that you and your partner, not the donor, are the legal parents. But Megan points out that “if you’re married then you have rights anyway and if you’ve got proof that you purchased sperm from a sperm bank, that should be okay. I really think it’s a way of making money off of us, and it’s just really disheartening.”

Megan and Whitney had no choice but to go to a private fertility clinic, which meant facing another barrier. If you’re in a straight cis couple, you have to try to conceive for two to three years before potentially getting NHS funding for IVF. Megan and Whitney’s NHS CCG (Clinical Commissioning Group) requires same-sex couples and single women to have at least six rounds of intrauterine insemination (IUI) or donor insemination (DI) through a private fertility clinic before potentially receiving NHS funding for one round of IVF. IUI is thought to have a much lower success rate than IVF (although this is based on data primarily from straight couples already struggling to conceive). On the other hand, cis straight couples need only to try to conceive for two years and then inform their GPs.

And so, to be potentially supported by the NHS, Megan and Whitney had to spend. A lot.

They had to buy sperm from the sperm bank at around £1,000 per vial, with one vial per round of IUI. Then there are other mandatory costs. “In order for us to have artificial insemination, we’ve had to pay to have our egg levels checked and our uteruses scanned, our doctor’s consultations to talk about it and my tubes checked,” says Megan.

“When you add it all up we’ve spent around £8,000 and we haven’t even had our first round of IUI.”

For LGBTQ+ people in the UK, there are several routes to starting a family. The most common are IUI, IVF, surrogacy, adoption and foster care. Each comes with varying costs, potential barriers and emotional difficulties.

Trying to get a picture of what you can access is shockingly complicated. Matt Taylor-Roberts is the managing director of the LGBTQ+ charity Proud2BParents, which supports LGBTQ+ parents, children and parents-to-be. He notes that the different routes are regionally dependent. “We see a lot more surrogacies down south than we do up north but that is slowly increasing. Adoption is throughout the community, as is fostering, but there’s always concerns around being discriminated against by local authority.” The north/south divide is dictated not by preference but by what is available; Matt says there is more support for trans male pregnancies up north, and a greater number of surrogacy agencies from the Midlands down.

There isn’t actually any data on how many LGBTQ+ people are having children. According to a 2019 Office for National Statistics report, the number of same-sex couple families has grown by more than 50% since 2015, with more than four times as many same-sex married couple families in 2018 compared with 2015. However we have no idea whether those families are formed from newly conceived children, adopted or fostered children, or children from previous relationships, as this information is not recorded.

The only data we have on LGBTQ+ families is via the Human Fertilisation & Embryology Authority (HFEA). Unfortunately its data only records people having IUI or IVF, categorises people with wombs as women and only looks at same-sex partnerships. In 2018, HFEA data shows that there were 4,750 IVF and DI cycles for women with female partners, compared to 66,975 for those with male partners. Of those cycles, there were 318 live births from donor insemination and 576 live births from IVF cycles. All this tells us though is how many children were born, not the number of people pursuing fertility treatment. Furthermore, it doesn’t include a breakdown of trans or non-binary people going through clinics, untracked at-home insemination or document bisexual people in opposite-sex relationships.

The Financial Cost

What we do know is that starting a family can be expensive. As well as the cost of sperm and the mandatory tests, each round of insemination costs between £800 and £1,300. Most CCGs require you to complete at least six rounds of IUI before NHS funding consideration for IVF. This will cost between £4,800 and £7,800. Private IVF is more expensive and costs between £3,100 and £4,000 per round according to the support network for queer parents, The LGBT Mummies Tribe, with medication (depending on what you need) costing between £600 and £2,500 per round.

For people without wombs (or who have no desire to carry), surrogacy is becoming more popular – but this option comes with its own costs and legal issues, depending on which route you choose.

In the UK, the law states that no payment can be made to a surrogate. It is, however, legal for the intended parents to cover the surrogate’s reasonable living expenses (like loss of earnings, travel or childcare). Surrogacy UK suggests a cost range for expenses from around £7,000 up to £15,000. If you want to pursue gestational surrogacy (which includes IVF instead of working with a friend or a surrogate mother carrying her own child), it can cost £50,000 to £60,000 in the UK. This includes embryo creation, fertility clinic fees, surrogate expenses, surrogacy agency fees, legal fees and additional expenses like life insurance and wills.

Even for adopters, where there is no upfront cost beyond the normal preparation for a child, financial considerations come into play. Leigh and Bee from Yorkshire are two lesbian mums who’ve recently adopted. They didn’t face any unforeseen expenses but they did struggle with the gendered parental leave in the UK. Despite both being mums, they had to choose who would be the primary adopter (which is linked to maternity leave) and who would be the partner (linked to paternity leave). In order to make sure they could afford the distribution of leave, the couple were forced to define their family by gendered lines. In the end Bee became the primary adopter and Leigh became the partner, thanks to Bee’s work’s generous parental scheme. “I’ve taken shared parental leave,” says Leigh, “through Bee’s work. She gets nine months full wage and she’s then given me three months that I can use as parental leave. And I get the two weeks paternity leave.”

Although data is scant, many of these costs are increased by the fact that LGBTQ+ people appear far less likely to get NHS funding. The HFEA report found that NHS-funded IVF cycles were more common for patients in heterosexual relationships (39%) compared to patients in female same-sex relationships (14%) and single patients (6%), varying considerably by nation. It’s hard to say how proportional this is to the number who apply for funding – when Refinery29 sent Freedom Of Information requests to the NHS CCGs and trust, neither recorded this information. However, given that same-sex couples are increasingly likely to seek IVF, it suggests that many are bypassing the NHS restrictions by paying upfront for the treatment with the higher success rate. And despite DI/IUI being so much more commonly used by same-sex couples or single patients, heterosexual couples had the highest NHS funding for DI (16%), though they were least likely to use DI (3% of treatments). DI funding was 13% for patients in same-sex couples.

A big factor is the inconsistency between CCGs in England. CCGs are NHS organisations which are responsible for planning and designing local health services as well as controlling their budgets. While Whitney and Megan’s CCG required six rounds of IUI prior to consideration, other CCGs offer no funding at all.

That’s what Laura-Rose Thorogood, founder of The LGBT Mummies Tribe, faced when she and her wife started their family. They knew their CCG wouldn’t cover them so they decided to pursue IUI. Her wife did five rounds of IUI for their daughter and Laura-Rose did two rounds of IUI for their son, but they’ve had to go the course of IVF for their third child due to unforeseen fertility troubles. After many struggles, Laura-Rose is now pregnant with their third and estimates that they’ve “probably spent in excess of about £50,000”.

Laura-Rose acknowledges it was a choice to have a big family, and one they were lucky to afford. They also know that the cost can vary hugely: “There are couples we know that spent £5,000, then there’s couples that we know have spent £10,000 to £40,000 because they’ve had issues or multiple children. It really gets excessive.” The way that cost is framed for LGBTQ+ people can increase the emotional burden of the process.

Everyone I spoke to for this article emphasises that they’re not dismissing the painful plight of struggling with infertility. But they can’t help but notice that the rules are stacked in cis het couples’ favour. “We know [straight] people who haven’t tried for two years and said they went to their GPs and they got away with [accessing NHS funding],” says Megan. On the other hand, if you’ve been trying to conceive through at-home insemination with a friend who’s a sperm donor, that isn’t considered ‘trying’. You still have to go down the IUI route first.

Providing funding only to those who can prove they’ve tried and are unable to conceive reduces someone to their ability to procreate and ignores the facets of who they are as a person. This inability to accommodate LGBTQ+ people’s needs and experiences beyond their fertility can have a range of impacts which make the process harder or even traumatic to manage.

The Emotional Cost

Maisie and Becca, young wives in Manchester, were unable to get any fertility support from the NHS. As Becca is a trans woman who has not yet started hormones (she’s been on the waiting list for the Gender Identity Clinic for years), they were understood to be fertile until proven otherwise and therefore ineligible. This meant they only had two options if they wanted a biological child: they could try to conceive while Becca is waiting for hormones, or they could push back Becca’s hormonal transition until they are older and wait.

If prospective parents have money, the number of options opens up: you can freeze sperm and pay to store it for between £175 and £450 a year, then have IUI or IVF when you choose. But this was not something Maisie and Becca could afford, so they decided to try and have children themselves. Maisie tells me that “it was a massive decision because the actual process when you have severe gender dysphoria, it’s a very upsetting and awkward thing to do.” They both found the process hard to cope with. “I struggled with massive amounts of guilt and still struggle with guilt for us both having to go through that when really it’s not something that she should have had to do,” Maisie tells R29. Likewise, Becca found the process intensely dysphoric and still wrestles with how that impacts her. “The emotional impact of this is not okay,” says Maisie. “Sometimes Becca gets really upset and angry, saying ‘I feel like I have fathered a child. But I am not a father, I’m a mother.’”

Even if you are able to access it, the path to NHS funding can be fraught. Jazmin and her partner Carla live in Hull and started trying to conceive in 2017 with at-home insemination using a vetted donor. After months of trying, they went to their GP in 2018 and then specialist after specialist. In 2019 they found out that Jazmin had ‘unexplained infertility’ and they would be eligible for funding for a specialist gynaecology doctor. But they could only apply successfully if Jazmin was a single parent applicant – as a same-sex couple, they “didn’t fit the criteria”. When they asked why, they were told it was because they had previously tried at home.

“Carla felt pushed aside, like she wasn’t a part of this journey. That our journey as parents would be a single journey. She felt like she was stopping us moving forward. It was a sad time,” Jazmin explains.

They learned in December 2019, after Jazmin applied as a single parent applicant, that she would receive funding. Although their IVF was cancelled thanks to COVID, they are now pregnant after restarting in June. They have never understood why they couldn’t get funding as a couple. “Apparently, it was due to home artificial insemination,” said Jazmin. “But deep down we knew it was because we were two women, as my records never changed.”

The pace at which a queer couple have to keep trying leaves no room for grief. If you miscarry or lose a child, you often don’t have time to process that loss. Maisie and Becca now have a 1-year-old son but it wasn’t their first child. They lost their daughter at 22 weeks. “It was especially crushing because we knew then if we wanted a baby we’d have to try again,” says Maisie. “But after your child has literally died, it’s very hard to want to.” Laura-Rose points out how difficult it can be to process grief when you’re the non-carrying parent too. Before their daughter was born, her wife miscarried and Laura-Rose was made to feel like a spare part. “Emotionally I was scarred and grieving too. It’s really traumatic but because you still want that baby you’ve got to get back on the saddle and try again. It feels like you don’t even get time to grieve.”

Negotiating all these different hurdles can put huge pressure on a relationship and force people down routes they might not have otherwise chosen. As part of The LGBT Mummies Tribe, Laura-Rose supports many people who have pursued at-home insemination because they can’t afford the clinics and couldn’t get funding. While there are some who go down that route by choice and find trusted, vetted donors (like Jazmin and Carla), there are many others who feel they have no other option.

A consequence of not being able to send sperm from sperm clinics to home addresses in the UK means that people will look to other sources and not understand the legal ramifications around parentage or the birth certificate. “There’re so many people we support at the moment who’ve split up because it’s been so traumatic for them, or the donors then decided to become involved,” says Laura-Rose. This can lead to parent alienation or non-biological parents having no rights over their child. “But if it was a heterosexual relationship, the father would be on the birth certificate. It’s archaic and wrong.”

People with wombs who are desperate to carry a child are immensely vulnerable to exploitation. “We have heard from a doctor that women do effectively get raped,” says Megan, “because they’re so vulnerable and desperate to have a child [that] these men manage to convince them that the only way is to conceive naturally, and then they do it. It’s just sickening.”

This lack of support can compound the trauma. Even if you are not bothered by the donor or the legal issues, there is still emotional damage. “Not only have they had to do that to maybe get pregnant,” says Megan, “but the rest of their life they are emotionally scarred. If the government could just get their act together, they wouldn’t be forcing them down this route.”

A key factor in these inequalities is the postcode lottery dictating your access to IVF or IUI. In England, fertility services are provided by a mixture of NHS and private services, with roughly 35% of treatments funded by the NHS – the lowest of all four UK nations (HFEA, 2020). In Scotland, however, all couples have access to three rounds of IVF if they meet nationally agreed NHS criteria, while Wales and Northern Ireland each have a more restrictive national policy, offering two full cycles and one cycle respectively. 

In England the policies around IVF funding are dictated by the 135 CCGs around the country. According to a recent report by the British Pregnancy Advisory Service, 108 CCGs (80%) fund fewer than the three cycles recommended by the National Institute for Health and Care Excellence (NICE), with 86 of these (64% of CCGs) only funding one cycle of IVF per individual/couple. Just 23 CCGs fund the three cycles recommended by NICE. On top of that, 73 CCGs (54%) do not routinely contribute any funding to patients who must undergo artificial insemination in order to verify their infertility. As Gwenda Burns, Chief Executive of the National Fertility Charity put it to R29: “The postcode lottery is cruel and unjust. Access to fertility treatment should be dependent on your medical need, not your postcode or pay packet. “

Moreover, the birthing industry isn’t built to accommodate LGBTQ+ people. Gendered terminology, lack of acknowledgement or support for the non-biological parent and dismissive practices add up to make queer people feel less welcome in perinatal and neonatal services. That these inequalities still exist isn’t malicious – they are just built into society’s fabric. AJ Silver is a queer doula who runs The Queer Birth Club. They point out that discrimination is far from ancient history: Section 28 was introduced by Margaret Thatcher in 1988 and the World Health Organization didn’t declassify same-sex attraction as a mental illness until 1992.

“The majority of birth workers were alive or even working when these [LGBTQ+phobic] legal or diagnosable conditions [were] still part of our culture,” says AJ.

It’s no wonder, then, that many birth workers don’t even know they aren’t being supportive of LGBTQ+ people. And this problem exists within both the NHS and the private sector.

“People may choose to go to private services but it doesn’t mean that you’re still not going to experience any systemic or individualised phobia or anti-LGBT rhetoric in that building,” AJ says. “I think you’re still at risk, no matter how much money you throw at it.”

LGBTQ+ people trying to start a family in the UK are continually made to feel othered and less than. While some costs are understandable, they are unfairly weighted against LGBTQ+ people and paying does not guarantee an escape from potential discrimination or even trauma.

The solution is not easy. The NHS is already stretched thin and no one expects a pot of gold to appear. But there are things that can and should change. Many people believe that LGBTQ+ people shouldn’t be offered any support at all. After a recent interview on Channel Four where Laura-Rose brought up the inequalities LGBTQ+ people face, she was viciously trolled. But no one is asking for priority – only equality. “If they can’t pay for all of us to have NHS funding, they should means-test it,” says Laura-Rose. “Provide it to those in areas of social deprivation and people of low income under a certain cap.” If you can afford to pay for it, you understand and appreciate that you’re the lucky ones, making space for those less lucky.

Happily, there are many people campaigning who are already making a difference. Whitney and Megan have started their Fertility Equality campaign, which has four key goals: a review of the fertility sector by the government (and within that a look at the effective ban on at-home inseminations); pushing the government to enforce that CCGs fund three rounds of IVF as stipulated by NICE guidelines; proper collation of data; and formal training for NHS staff on how to deal with LGBTQ+ families.

There are people like AJ, whose organisation is helping both private and NHS birth workers to give better individual care to LGBTQ+ people, and Proud2BParents, which is also training health professionals across perinatal services to better support the community. Laura-Rose is working directly with NHS England and Improvement, and is involved in two NHS CCG fertility ART (assisted reproductive technology) reviews, alongside campaigning for better mental health support for LGBTQ+ families. She and her wife are also stakeholders on the Maternity Transformation Programme Council to directly impact the maternity services for the LGBTQ+ community.

Change is not going to happen overnight. It won’t happen in time for many people whose fertility cannot wait for funding. But it is coming. By supporting these campaigns, pushing back against discrimination and making LGBTQ+ people more aware of the costs they could face, we can shift the state of fertility services in the UK.

As AJ says: “It won’t be within my lifetime that we have true acceptance and proper care for LGBT people. But it is something I think is moving in the right direction.”

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