When Becky Hayter and Leah Makarevich decided to start their family, they knew they wanted to do reciprocal in vitro fertilization (IVF). The process, which consists of one partner’s eggs being retrieved, fertilized with sperm, and implanted into the other partner’s uterus, allows both partners to have a role in the biological development of the fetus in pregnancy.  

But almost instantly, Hayter said, they ran into a major hurdle—a $50,000 price tag. Neither woman’s insurance policy, both of which included fertility care coverage, would cover the procedure. The insurance policies both required a diagnosis of infertility, defined as an inability to get pregnant after 12 months of unprotected penile-vaginal intercourse, in order for the IVF benefits to kick in.

The couple would have to pay out of pocket if they wanted to get pregnant.

“It was crushing in the moment,” Hayter said, “Getting put in your face this big dollar amount. But we had to figure it out, what other choice did we have?”

“There’s not a lot of attention to how queer people utilize medically assisted reproduction, not part of the standard training, not a lot of information on websites,” Dr. Brent Monseur, a reproductive endocrinologist at Pacific Fertility Center in San Francisco, told Rewire News Group.

Lesbian couples, like Hayter and Makarevich, can use a number of processes to get pregnant, including intrauterine insemination (IUI), IVF, or reciprocal IVF. 

But in a recent survey administered by Progyny, 68 percent of LGBTQ people with employer fertility benefits still could not access fertility care because their insurance policies required an infertility diagnosis to access benefits. 

“It’s hard because infertility isn’t the actual issue,” Hayter said. “We just don’t have access to those things that we need to build a family.” 

But without that diagnosis, many queer couples’ only option is to pay the full cost themselves, “which is really expensive, especially with higher tech,” Monseur said. 

Higher fertility costs and heteronormative assumptions

In the U.S., the average cost of one IVF cycle is $23,474. For lesbian couples, the cost can substantially increase to more than $50,000 per cycle, due to add-on costs of donor sperm and reciprocal IVF that many insurance plans do not cover due to their lack of infertility diagnoses.

“I spent thousands of dollars just on consultation calls at different fertility clinics just to get different costs from clinics,” Hayter said.

That extra cost keeps lower-income queer couples out of assisted reproduction care, limits the number of cycles, or tries, that queer couples undergo, and may result in parents opting for a smaller family than they originally wanted or planned for. 

In a 2024 study done by Williams Institute at UCLA School of Law, about 60 percent of same-sex couples preferred parenthood through a medical pathway........

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