Family Building with IVF: The Financial Side

Family-building takes commitment for LGBTQ+ people. Unlike many heterosexual, cisgender couples, queer life partners looking to welcome children can't simply leave things to chance or wait for the course of their lives to deliver a bundle of joy. Parenthood for queer couples – or for LGBTQ+ individuals looking to become solo parents – involves extra effort, including planning around the legal and financial elements that are part and parcel of family-building.

While adoption and fostering are valuable avenues to the parenting experience, those who wish for offspring to whom they are genetically connected will likely find that fertility intervention is necessary. This can take the form of intra-uterine insemination, or IUI (in which sperm is placed in the uterus – that is, the womb – of a prospective parent), or in vitro fertilization, or IVF (in which sperm and egg are united under controlled laboratory conditions and the resulting embryo is implanted in the womb of the parent or surrogate).

Such fertility interventions are increasingly being used by queer singles and families who wish to embrace parenthood. But dreams of family-building entail some complex realities, among them the fact that IUI and IVF are expensive.

For those who turn to the clinics of The Prelude Network – North America's largest and fastest-growing network of IVF clinics, with more than 95 locations in the U.S. and Canada – there's not only the support that comes from providers who are specifically welcoming to, and respectful of, queer families, but also the benefit of the financial services providers with which the network partners.

"Obviously, the finance part is oftentimes a difficult aspect of this to navigate, which is why we're lucky as a network to have financial counselors that help guide patients," Dr. Tumi Kuyoro of the Advanced Fertility Center of Chicago notes.
The experts partnering with The Prelude Network include PatientFi, which offers flexible financing; Bundl Fertility, which offers a guarantee program so that family-building doesn't need to grind to a halt if there are any setbacks; and Future Family Financing, which provides "customized financing and one-on-one nursing support."

For couples – or individuals looking to become solo parents – the blood tie to a genetically-related child can make the additional expense worth it. Egan Orion, the Executive Director of Seattle PrideFest, explains that "adoption can be quite expensive as well," and he "chose IVF because, though it was a little more expensive, it was a little more of a straightforward path" to fulfilling his dreams of fatherhood.

A key component for many when it comes to financing IVF is insurance, but mandates for insurance to cover such procedures vary from state to state. Even where insurance is available to non-heterosexual and non-cisgender prospective parents, the out-of-pocket costs can be staggering. Boston-based attorney Annika Bockius-Suwyn noted that while Massachusetts has "an insurance mandate – meaning, to some extent, fertility treatments have to be covered – there's different hoops you have to jump through" for IVF, such as a required number of IUI treatments before coverage for the more medically intensive, and expensive, IVF procedures kicks in.

Among the irreducible costs of fertility care are the triad of ingredients for pregnancy: Sperm, egg, and a womb. "With queer families we're assuming that, at the very least, you're probably going to have to buy either eggs or sperm," Bockius-Suwyn notes. "That cost is not covered by insurance; that would be then out of pocket.

"The process to get eggs is much more expensive" than obtaining sperm, Bockius-Suwyn points out, "so there's such a wide range of what [procuring gametes] would cost. If you're doing a known donor – having a friend donate sperm – then the costs are very low. You can do that at home for very cheap."

But even with this low-cost approach, Bockius-Suwyn points out, there's the expense of the highly-recommended legal footwork that's involved. Issues of parental rights and responsibilities can become complex if they are not legally laid out in advance. "The courts really like to see an agreement in place ahead of time," Bockius-Suwyn notes, "because otherwise they get very uncomfortable about things that don't happen in a doctor's office."

IVF is inevitably more expensive because sourcing donated eggs is more difficult than obtaining donor sperm. IVF also entails rounds of pharmaceutical stimulation to the ovaries to release eggs, and those treatments are costly.

The lawyer shares her own story to illustrate that even when a couple is using their own eggs and womb expenses mount up quickly. "My wife and I did reciprocal IVF, which is considered elective, and therefore only the doctors' visits themselves were covered, and some of the tests," Bockius-Suwyn says, referring to an option in which a couple opts to have the fertilized egg of one partner implanted in the womb of the other partner.

"We paid out of pocket for everything else," the attorney goes on to say. "My wife did the egg retrieval, which cost $20,000 or $25,000," with the implantation costing another "five or ten thousand dollars.

"You have to either be able to know up front that you can get a loan to cover that," Bockius-Suwyn says, "or that you have the income to cover that." If not, she noted, "you become very limited in what you can actually seek for family planning."

A family needing a surrogate will find that the surrogate's months of pregnancy inevitably incur costs. "In some states you can pay [surrogates] a wage in addition to reimbursing their expenses," Bockius-Suwyn notes. Moreover, "You're going to need lawyers to do your surrogacy agreement, because you've got to have an agreement before there's a zygote out there, and that can be tens of thousands of dollars if you're doing surrogacy and [donor] egg."

Such agreements are crucial bulwark against the possibility, however remote, that a surrogate might decide to contest where the baby ends up, especially if the egg donor and the surrogate are the same person. To a court, the blood tie between a surrogate and a pregnancy created using her own egg "doesn't feel like surrogacy or an agreement that these two other people are the intended parents," Bockius-Suwyn warns, advising that prospective parents needing both eggs and a womb are better served by sourcing those things from different individuals, despite the additional cost that this entails.

The need for both those things was unavoidable for Egan. "The fact that I don't have a uterus, and I'm gay, and I wanted to have biological children [meant] IVF was really the only reasonable path for me to take," he says. There were many upsides: "You can do genetic testing on the embryos. You can freeze and store them" if planning multiple children over a span of years. If not, then, Egan says, one can "donate [an extra embryo] to another couple... it does give you a lot of control over how you want to proceed in in having kids."

But whatever options one chooses to embrace, there are what Bockius-Suwyn calls the donor agreements. These are standard for such fertility interventions. "For IVF or IUI where one of the parents is not genetically related, you could do a pre-birth order," the attorney notes, "and that's based on The Uniform Parentage Act, which has been adopted by several states across the country." From an abundance of caution, though, Bockius-Suwyn says, "we're recommending adoptions – confirmatory adoptions, second-parent adoptions, whatever you want to call them – because adoptions have the Full Faith and Credit Clause" of the United States Constitution to back them up. That means greater peace of mind if one uses a surrogate from another state, as Orion, a resident of Washington state, did; the surrogate for his son lived in the neighboring state of Idaho.

"If you're doing surrogacy, a lot of the surrogacy companies will find you the surrogate and do the legal work there," Bockius-Suwyn notes, "but they will want you to have estate planning documents in hand before the they'll do the surrogacy." Those documents include "a will that [specifies] guardianship for the baby that's going to result.

"Everyone needs a health care proxy and power of attorney" as well, the lawyer advises. "Here in Massachusetts, those cost anywhere from $1,500 to $7,500, which, on top of [everything else], is not exactly cheap."

Parenthood is a deep and life-altering commitment in many ways, but the dream of welcoming children into a happy, loving home is so deeply a part of the human experience that, for many, life would not be complete without it. The financial commitment is considerable – but knowing how to prepare for the financial side of the journey, and becoming educated about what resources are available, is a crucial first step that can make the journey more possible.