Pride (In the Name of Love)

When Louise Brown was born via in vitro fertilization (IVF) in 1978 in England, her birth marked not only a major turning point in assisted reproductive technology (ART), but also opened up an entirely new possibility for gay and transgender Americans who were previously unable to have biological children within their partnerships. Less than a decade later, Jill Rudnitzky, the first baby using gestational surrogacy, (where the carrier is not genetically related to the child), was born in suburban Ann Arbor, Michigan— signifying even more possibilities for non-traditional pregnancies. This advance in technology meant a completely new way of conceiving children for so many who had once thought this prospect nothing more than a pipe dream. The change was huge, but also presented many new questions. Most notably: how accessible is fertility treatment, really? And who can attain it?  

Well, for same sex couples, there are countless added barriers to biological parenthood. Part of this problem stems from the fact that infertility for LGBTQ couples is different from the typical definition of medical infertility, which tends to rely on heterosexual activity as a determining factor in gaining a diagnoses. The World Health Organization, for example, considers infertility “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” 

Of course, this definition fails to encompass couples that have sexual intercourse that cannot result in a pregnancy, and also fails to account for single heterosexual individuals, or any individual without one long-term sexual partner, for that matter.  Some bioethics researchers have taken to using the term social infertility to describe infertility that falls outside of the previously understood definition. 

Regardless of the term used, several U.S. states have already incorporated this concept of social infertility into their definitions of infertility. In Illinois, for example, infertility legislation more broadly encompasses different types of prospective parents by simply including: “a person's inability to reproduce either as a single individual or with a partner without medical intervention” in the condition’s definition. 

The reason this inclusive definition matters is because fertility treatment is notoriously expensive in the United States, and securing insurance coverage for the process is especially tricky in the case of social infertility, even through federally funded healthcare. Such was the case for Marine Corps Veteran Miguel Aguilera, an Iraq and Afghanistan vet, who believed he qualified for IVF as part of his health benefits after sustaining combat injuries. 

But Mr. Aguilera is gay. When he inquired about fertility treatment, the Department of Veterans Affairs (VA) informed him this benefit applied to same sex, married couples, not gay men, the rest of the LGBTQ community, unmarried heterosexual couples, or any single individuals— regardless of their sexual orientation. 

 Mr. Aguilera was devastated that sexuality and marital status dictated his benefits in this way. This restriction presented an enormous barrier to fatherhood, considering the exceptional out-of-pocket cost fertility treatment would thus incur. The process can easily cost upwards of $100,000 for gay men who need both an egg donor and surrogate to have a biological child, according to the Family Equality Council, an organization advocating for LGBTQ families. “The whole process made me feel like giving up my dream of becoming a parent,” Mr. Aguilera told the New York Times.

He isn’t alone in this struggle. Only 20 states have infertility insurance laws, requiring insurance to cover at leastsome forms of infertility treatment. Michigan is not one of them, despite the fact that less than 40 years ago, the first everbirth via gestational surrogate occurred right here in the Great Lakes State. 

Even when states do have laws requiring infertility insurance, this doesn't necessarily mean there aren’t plenty of loopholes.  For example, businesses that are self-insured and personally provide employees with healthcare are not beholden to these guidelines. And only  eight of those 20 states extend their coverage to IVF in particular; others focus on “fertility preservation” laws, which typically do not take the broader definition of social infertility into account, instead prioritizing heterosexual fertility over same-sex couples. 

 For many gay parents, then, biological parenthood is still more dream than reality. NBC spoke with Los Angeles- based dads Erik and Adam McEwen who became dads to twin girls through IVF in 2018. The process of becoming parents cost the couple $65,000— a bill that included fertility treatments, legal fees and hospital care for their newborn daughters. And, for the McEwens, this cost did not include finding a compensated gestational surrogate, because Erik’s sister in-law volunteered to be their surrogate. Without her support, Erik commented, “I don’t think we could have done it…mainly because it costs so much money…That’s just something that would not have been possible.” 

Still, there are advocates fighting to make family building more affordable for all Americans. One organization at the forefront of the movement is Men Having Babies, a New York-based non-profit dedicated to helping gay men become fathers via surrogacy. The organization’s founder, Ron Poole-Dayan, spoke to this goal. “True equality doesn’t stop at marriage. It recognizes the barriers L.G.B.T.s face in forming families and proposes solutions to overcome these obstacles,” Mr. Poole-Dayan told the New York Times.  

Another non-profit dedicated to this mission is Connecticut-based Affordable Families, which aims to “alleviate the financial barriers facing anyone who would like to become a parent and requires medical assistance.” 

Affordable Families and Men Having Babies both cite legislation reform as a key part of gaining equal access to affordable fertility care. For more information on their missions and legislation-specific reform, check out these resources:  

Fertility Insurance Mandates & Same-Sex Couples

Gay Parenting and Surrogacy News and Updates

Infertility Insurance Coverage by State

--Sabrina Nash, MFA’s summer advocate (research)