Photo: Whitney and Megan Bacon-Evans
It's time to start a conversation about the practical and financial costs facing many LGBTQ+ people who want to have children.
In this article, we explore how improving access to IVF will remove barriers for those looking to conceive, particularly lesbians, bi women and some trans people.
Where we stand
Stonewall and DIVA’s 2021 LGBTQI+ Insight Survey 2021 found that 36% of respondents who had children experienced barriers or challenges when starting their family. One in five of those stated that the greatest barrier or challenge was the high cost of private fertility treatment.
Currently, the National Institute for Health and Care Excellence (NICE) guidelines state that funded access to IVF in England is only available to women ‘who have not conceived after two years of regular unprotected intercourse or 12 cycles of artificial insemination (where six or more are by intrauterine insemination)’.
To put that into context: female same-sex couples can’t access NHS-funded IVF treatment unless they’ve had at least six rounds of intra-uterine insemination (IUI), which may or may not be funded by the NHS. While lots of couples will conceive using IUI, the costs quickly rack up for those who don’t. Let’s start to add up the costs:
- IUI costs between £350-£1,600 per cycle at a private clinic, and same-sex female couples usually have to pay for 6-12 IUI cycles privately before they can access NHS services.
- 76% of clinical commissioning groups (CCGs) in England require a minimum of three cycles of private IUI to be self-funded, and 29% of CCGs require between 10 and 12 cycles of private artificial insemination before accessing NHS-funded IVF.
- Since local CCGs choose how to delegate NHS funding, accessing IVF has become a ‘postcode lottery’ – meaning couples living in different areas could face additional hurdles when trying to conceive.
This policy creates significant practical and financial barriers for prospective parents, particularly lesbians, bi women and some trans people. Including additional costs, a couple who needed to fund twelve IUI cycles could have to spend up to £25,000 before being eligible for NHS care. For many, this cost is impossible to afford.
What needs to change?
Ensuring equitable access to NHS funding for IVF will mean that starting a family won’t be so inaccessible for our communities.
We know that better access to fertility services can be achieved – in Scotland, up to six cycles of IUI are funded for all couples, provided they meet the nationally agreed NHS criteria. In 2018, 70% of IUI cycles and 40% of IVF cycles for female same-sex couples were funded in Scotland. In Wales, 14% of IUI cycles and 31% of IVF cycles were funded in the same year. Clearly, there’s a lot of progress to be made across all areas of the UK.
Whitney and Megan Bacon-Evans are a lesbian couple highlighting the human impact of the current restrictions: “We were shocked and devastated to discover the discrimination that lesbian couples and bisexual women face in starting their family. Our local NHS Clinical Commissioning Group (CCG) 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. As we have chosen a sperm donor from a sperm bank, our only option is to have artificial insemination in a private fertility clinic.
“Female same-sex couples are being forced to pay tens of thousands of pounds in artificial inseminations in expensive private clinics to prove that they are infertile before they are eligible for any fertility treatment on the NHS. However, cis heterosexual couples can qualify for IVF on the NHS if they have not become pregnant after two years of unprotected sex. While this is a long time, it is at no additional financial cost."
LGBTQ+ people deserve the same help to become parents as everybody else. We must ensure that lesbians, bi women, and other LGBTQ+ people who want to conceive should have equitable access to NHS-funded care.