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 like insemination, surrogacy, or IVF compared to other options, like adoption.
Fertility care, from start to finish, is really designed for a cisgender-heterosexual couple who have tried to get pregnant on their own but were unsuccessful, added Monseur, who founded Q+ Family Building Clinic at Stanford University, “the first academic program in the United States entirely dedicated to LGBTQ+ family building.”
It’s something Hayter recognized early in the process. Hayter said she felt like the fertility care experience catered to straight couples who had tried to get pregnant on their own but faced hurdles.
But that wasn’t her experience.
“When Leah and I walk in, this is where we are starting,” she said. “We are excited to be there.”
Queer couples already encounter heteronormative assumptions about families and medical bias. That difference in experience is part of why it’s important for queer couples to get specialized care, Monseur said.
Victoria and Vanessa Stallworth, a lesbian couple in Texas, had to change their fertility provider because of those barriers. Victoria, who goes by Vicci, said they frequently had to correct the paperwork to include that there was no “father” in their fertility process.
“Our first clinic had wonderful staff and great support, but it still felt like we were trying to fit ourselves in a box not quite made for us,” Vicci Stallworth told RNG in an email.
When they switched clinics, they felt the language in paperwork was more inclusive and they felt even more supported.
Still, the Stallworths felt the financial struggle first-hand. The couple tried both IUI and IVF, and found the process to be financially burdensome.
“There was a lot of upfront investment before we even started trying to conceive,” Vicci Stallworth said in her email. “When it was time to purchase donor sperm, my jaw dropped when we realized the price we would pay per vial was good for one attempt.”
One vial of donor sperm can cost between $400 to $2,500 per vial, with an average price around $1,000 to $1,500. The Stallworths had to decide how many vials to purchase upfront, with the fear that they might run out and their chosen donor would no longer be available.
They attempted multiple trials of IUI but had to stop due to financial constraints.
When the Stallworths finally decided to try IVF, Vanessa’s insurance, like many others, required an infertility diagnosis for benefits to kick in.
“[The insurance] required us to prove we had been trying to conceive for at least 12 months,” Stallworth said. “We would have to provide paperwork of 12 documented IUIs to be considered for IVF. That would also mean 12 vials of donor sperm.”
Instead of paying upward of $30,000 before getting their insurance benefits to kick in, the Stallworths took out a loan to self-pay for their first round of IVF.
Regulatory changes are “happening slowly”
A patchwork of policies is trying to level the inequitable access to fertility care between straight and queer couples. Only seven states and Washington, D.C. have insurance laws that explicitly require the inclusion of LGBTQ+ people.
“It’s happening primarily on a state-by-state basis,” Monseur said. “I think it’s happening slowly, but it is happening.”
In late May, Connecticut passed a law mandating private insurance plans cover fertility care for queer couples by expanding the definition of infertility to a need for medical intervention including donor sperm and eggs, or donor embryos. It’s slated to go into effect on January 1, 2027.
In September 2024, California passed SB 729, which requires health insurance policies to cover infertility services, including IVF. The law broadened the definition of infertility to ensure LGBTQ+ individuals are explicitly covered. Coverage applies to large group plans and covers a maximum of three egg retrievals and unlimited embryo transfers.
“There are still many state insurance laws that exclude LGBTQ families and single people from getting affordable fertility care and many other states that have no insurance laws at all,” said Karla Torres, senior human rights counsel at the Center for Reproductive Rights, in an emailed statement to RNG. The center helped shape the recently passed Connecticut law.
“Access to fertility health care should not depend on your relationship status or who you love,” she added. “All families deserve support.”
Lawsuits have also forced change.
In December 2025, a federal judge approved a landmark preliminary settlement requiring Aetna to cover fertility treatments for same-sex couples. This included artificial insemination and IVF for LGBTQ+ couples, marking the first case requiring a health insurer to apply this policy nationally across all of its enrollees.
But there’s still more work to be done, Monseur said.
“I would like to see across the country, people actually have insurance coverage to go through this process,” Monseur said, “Including coverage for the purchase of what’s necessary: donor eggs, donor sperm, or cost to offset the high cost of working with a gestational carrier.”
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Clinics, too, contribute to sky-high costs
Clinics themselves also contribute to the affordability gap in fertility care.
Monseur said providers and clinics can take several concrete steps to reduce costs without compromising outcomes.
Clinics can offer to do cycles without infertility medications, Monseur said.
“If their medications are not indicated, it’s cheaper to not use medicine,” they said.
If a couple needs to use medication, clinics can point patients to generic drugs, mail-order pharmacies, or medication assistance programs to reduce costs. “You could also do less ultrasounds, so you really just time the insemination based on the natural cycle, and doing kind of over-the-counter ovulation predictor kits,” Monsuer added.
A typical IVF cycle would involve multiple ultrasounds to monitor follicular development in ovaries. Each one often costs around $400, and a patient would require several of them for monitoring. But over-the-counter ovulation kits, which may be less effective but are still reliable options, can be used instead, which cost about $20-$40.
Monseur also highlighted a lesser-known FDA-approved device called the INVOcell, which allows for a sperm and egg to be combined in a device and placed in the vagina to create embryos.
INVOcell says its device is between 40 and 50 percent less expensive than traditional IVF—with a $6,500 price tag compared to the $13,000 of IVF—however the price varies by clinic.
Research on INVOcell found that about 55 percent of transferred quality embryos resulted in a live birth, which the researchers described as comparable to traditional IVF. The device could help couples avoid the more common but costly laboratory setting where embryos are created and tested.
“You’re not reducing success, but you’re just decreasing cost,” Monseur said.
Starting over
A year after taking out a loan for their first round of IVF in 2022, the Stallworths completed an egg retrieval and four embryo transfers. Three were unsuccessful and one ended in a loss.
Only after Victoria Stallworth switched jobs where her insurance came with fertility coverage were they able to try again in 2023. They were able to complete an additional IVF retrieval and froze 13 embryos between the two of them at a new, queer-inclusive fertility clinic.
“My first frozen embryo transfer was successful,” Stallworth said, “And became our beautiful, sassy Sutton.”
After the Stallworths switched to the policy from Victoria’s employer that covered their fertility care, a class action lawsuit prompted Vanessa’s insurer—the initial holdup in their IVF process—to change its policies to include the same coverage for LGBTQ+ individuals that it did for straight couples.
“We were so glad,” Stallworth said, “It makes us happy to know that others walking our same shoes will now have access to the fertility coverage that they deserve.”
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