Written by Rhiannon Davis. Reviewed by Laura-Rose Thorogood & Jenny Wordsworth.

We started OVUM because we believe that everyone who wants to have children should have the opportunity to do so. We want to put a stop to the fertility inequality that still exists for LGBTQIA+ people* who want to start their own family. 

We’ve spoken to the LGBTQIA+ community, we’ve spoken to thought leaders in the space, we’ve consulted our doctors and we’ve done our research to create this guide to help female same-sex couples who want kids find their best path. Thanks so much to our partners,  LGBT Mummies, for partnering with us and doing incredible work for the LGBTQIA+ community. We’re lucky enough to have worked with them on pulling this together. 

Disparities in Fertility Offerings

The Human Fertilisation and Embryology Authority (HFEA) reported that in 2008, 27% of treatment cycles for female same-sex couples were for IVF, and in 2018, 45% were for IVF. And whilst this data seems to trend positively, 90% of fertility patients are still heterosexual couples and there are huge disparities in funding. In a 2020 report 39% of IVF cycles for heterosexual couples were funded by the NHS, but only 14% of IVF cycles were NHS funded for those whose sex recorded at birth was female.

Funding availability for fertility treatments is decided by local Integrated Care Boards (ICBs) and can vary hugely across areas. A BPS investigation in 2021 found that 76% of Clinical Commission Groups (now ICBs as of 2022) required same-sex female couples to self-fund a minimum of 3 artificial insemination cycles. We state ‘minimum’ here because this could go up to 12 depending on your area (at a total cost of up to £50,000), as was the case for Whitney & Megan Bacon-Evans. Whitney & Megan spearheaded a campaign for fertility equality, taking the NHS to court, culminating in their local ICB board reviewing fertility treatment rules for same-sex couples and the government announcing in 2022 that the Women’s Health Strategy for England would work towards providing equal access for female same-sex couples across a 10 year plan, funding intrauterine insemination (IUI) plus IVF if needed (this varies from region to region). These changes have only been implemented in 4/42 ICBS so far. 

So, how do I or we get started trying to conceive when LGBTQIA+?

Check your Fertility and Understand your Options. 

First up to bat, get tested. Even if one partner or co-parent is more interested in carrying the baby or is a better candidate due to health or age, it's a smart idea for everyone involved to have their fertility tested initially. Infertility can happen to anyone, irrespective of sexual orientation or gender identity. Endometriosis and PCOS, diseases that can impact fertility, affects 10% of those whose sex was recorded female at birth. If you know you have a condition that may impact your fertility, let your Doctor know. 

This may impact your plan and which person carries. 

Next, up, sperm!

There’s a lot to consider when it comes to finding the ideal sperm donor. Can you know their hair colour? What about their medical history? But the biggest question is, where do you even get sperm?

What can you find out about your donor?

If you are using a licensed clinic and a donor through a sperm bank, you can find out the following information: 

• Ethnicity
• Genetic and Health History
• Physical Characteristics: height, weight, eye colour, and hair colour
• Date and Place of Birth: the year and country they were born in
• Children Information: if they had any children at the time of donation, including how many and their gender
• Relationship Status: their marital status
• Occupation and Interests: their job and hobbies
• Personal Note: Immediate and extended family characteristics, health and interests, reason behind donating, along with possible written testimonials, photos and voice recordings.

💡Good to know: In the UK, it’s illegal to pay more than £35 in expenses for sperm donors, and they can only donate for a maximum of 10 families. Your child can access donor information after they turn 18 (if the donor donated after April 2005). 

Making a plan

So you’ve checked your fertility, now what? IUI, IVF, WTF?! With so many potential paths to conception, how do you determine which one is best for you? We’re focusing on partnerships where one of the couple, co-parents or people involved choose to carry here, but other paths, such as surrogacy and adoption, are also available. 

Artificial Insemination (IUI) vs. In Vitro Fertilisation (IVF). IUI involves directly inserting sperm into the uterus, while IVF involves fertilising an egg with sperm in a clinical setting and then implanting it into the uterus.

IUI

IUI/artificial insemination/Intrauterine Insemination is usually the first port of call for people using donor sperm before considering more advanced techniques like IVF.

The IUI procedure is relatively straightforward. During the procedure, a fertility specialist will insert a thin, flexible tube called a catheter through the cervix into the uterus and releasee sperm that has been prepared in the lab. This timing is usually coordinated with ovulation to optimise the chances of conception. One of the main benefits of IUI is that it is less invasive and often less expensive than IVF, making it a more feasible option for many people.

Although LGBTIQIA+ people often pursue fertility treatments primarily due to the need for donor sperm rather than underlying health conditions, some research suggests they might experience higher clinical pregnancy or live birth rates compared to heterosexual people using assisted reproductive technology (ART). However, the literature on this topic remains inconsistent.

Costs of IUI can range from £700 to £1,600. 

IVF

Another commonly used fertility treatment. IVF is a fertility treatment that offers a viable path to parenthood for same-sex female couples or any LGBTQIA+ person or people. The process involves retrieving eggs from one partner, fertilising them with donor sperm in a laboratory, and then transferring the resulting embryo into the uterus. For couples using donor sperm, IVF provides a more controlled environment for fertilisation and allows for the selection of high-quality embryos, which can increase the chances of a successful pregnancy. 

IVF is particularly beneficial for those who have faced challenges with other fertility treatments, have underlying fertility conditions (e.g. endometriosis)  or who wish to maximise their chances of conception. IVF also allows all partners or co-parents to be actively involved in the process—one person can provide the eggs while the other can carry the pregnancy, or people can be involved in selecting embryos for transfer. Though IVF can be more costly and complex compared to less invasive methods like IUI, it often offers higher success rates and is a valuable option for those looking to start or expand their families.

Privately, an IVF cycle can cost upwards of £5,000, with additional expenses for medications, consultations, and tests potentially increasing the total cost.

See here for a full guide to IVF from OVUM Founder Jenny.

Optimising your nutrition ahead of fertility treatment

Good nutrition plays a crucial role in boosting fertility. Embracing a Mediterranean diet, rich in vibrant fruits, vegetables, hearty whole grains, and heart-healthy fats, has been linked to improved fertility outcomes. Although maintaining an ideal diet can be challenging, don't stress over perfection. Consider OVUM as your fertility safety net, helping you fill any nutritional gaps and support egg quality, all while you enjoy a delicious and balanced diet.

Legal Rights and Parenthood for LGBTQIA+ people

In the UK, the legal landscape for LGBTQIA+ families has specific protections and requirements. It's important to understand how these apply to your situation.

• Understanding Your Rights. If you are married or in a civil partnership at conception, both partners are automatically recognised as the child’s legal parents, provided you conceive through a licensed fertility clinic. This means both of you will be listed on the birth certificate without any additional legal steps. However, if you’re not married or in a civil partnership, only the birth mother or parent has automatic legal parentage. The non-birth mother or parent can still be recognised as a legal parent if both of you sign the appropriate consent forms at the clinic before treatment. For those conceiving at home or using an unlicensed clinic, the non-birth mother or parent would need to adopt the child to gain legal parenthood.
• Navigating Legal Issues with a Known Donor. Using a known donor can introduce additional legal complexities. In the UK, if conception takes place through a licensed clinic, the donor has no legal parental rights or responsibilities. However, if you conceive outside a licensed clinic (e.g. through informal arrangements), the donor could be considered the legal father or parent, which could affect both your rights as parents and the donor's obligations. To avoid legal complications, it's recommended to use a licensed fertility clinic and, if necessary, create a formal donor agreement with the help of a solicitor. This agreement should clarify the donor’s role and ensure everyone’s rights and responsibilities are clearly defined. Whilst this only shows intent and is not currently legally binding, it is supporting evidence that can be used should legal proceedings be sought later down the line.

Onto the fun stuff; Insurance and Financial Planning

Fertility treatments can be costly, but understanding your financial options in the UK can help you plan effectively.

• Coverage for Treatments. In the UK, fertility treatment availability on the NHS varies depending on where you live (a "postcode lottery depending on your local ICB policy"). As we mentioned earlier, some ICBs provide funding for female same-sex couples, but the criteria can be strict. Generally, you may be required to show evidence of infertility, which for same-sex couples might involve paying for anything between 6 to 12 rounds of private insemination before qualifying for NHS-funded treatment. Check with your local ICB to understand what is covered in your area. If you’re not eligible for NHS funding, you’ll need to consider private treatment, where costs can vary significantly. Some employers also offer fertility treatment benefits, so it’s worth checking if your workplace provides any support.
• Budgeting. The costs associated with fertility treatments in the UK can add up quickly, especially if you’re paying privately. Artificial Insemination (IUI) typically costs between £700 to £1,600 per cycle in a private clinic, while IVF can range from around £3,000 to £8,000 per cycle, excluding medication. It's important to budget for multiple cycles, as success is not guaranteed on the first attempt. Additionally, consider the costs of initial consultations, legal fees if using a known donor, and any supplementary treatments or tests that may be recommended. Setting up a savings plan or exploring financing options through your clinic can help you manage these costs more effectively.

Additional Legal and Financial Considerations

Oh yes, there’s more. A few other UK-specific legal and financial considerations to keep in mind:

• Parental Rights Documentation. Even if you are both recognised as legal parents from birth, it’s advisable to have a Parental Responsibility Agreement or court order to ensure your rights are fully protected, especially if you travel or relocate to a different country.
• Wills and Estate Planning. Consider making or updating your wills to ensure that your child’s guardianship and your assets are clearly outlined. This is particularly important in the UK to avoid any legal disputes or challenges in the event of an untimely death.
• Tax Implications. In the UK, some fertility treatment costs may be considered tax-deductible if they are directly related to a medical condition diagnosed by a doctor. However, general fertility treatments for LGBTQIA+ people are not typically tax-deductible. Consult with a financial advisor to understand what, if any, tax benefits or implications apply to your situation.

By understanding the specific legal and financial landscape in the UK, you can better protect your rights and manage the costs associated with starting your family. Consulting with UK-based professionals, such as a LGBQTIA+ family law solicitor or financial planner, can provide tailored advice to help you navigate this journey with confidence.

Key Takeaways on TTC when you're LGBTQIA+

• Fertility Disparities: ART access is increasing but remains less funded for same-sex couples and other LGBTQIA+ people compared to heterosexual couples.
• Initial Steps: Both partners should get fertility tests.
• Choosing a Sperm Donor: Opt for sperm bank donor, anonymous donor or a known donor, considering the legal and medical factors.
• Donor Information: Details include ethnicity, health history, physical traits, and personal notes. Donors are capped at 10 families.
• Conception Methods:
• IUI: Less invasive and cheaper.
• IVF: More complex, higher success rates.
• Nutrition: Mediterranean diet supports fertility; OVUM helps with essential nutrients.
• Legal and Financial:
• Legal Rights: Automatic parentage for married/civil partners; others need additional steps.
• Funding: NHS coverage varies; private treatment can be expensive. Check for local and employer benefits.
• Additional: Secure parental rights, update wills, and consider tax implications.

Throughout our content, we use additive language to support all the identities in the LGBTQIA+ community. We may refer to women and people, those whose sex was recorded female or male at birth, and same sex couples or other LGBTQIA+ people. We do this to ensure that everyone is represented and included in the language, and to appreciate that there is a myriad of different sexual orientations, gender identities, family creation pathways and families within the LGBTQIA+ community. Where we refer to 'same sex female couples' this is referring to UK Governments current proposal within the Women's health Strategy, which does not currently support or recognise others in the LGBTQIA+ community who wish to start a family via funded fertility treatment. However we always use additive language to include everyone in the community.
If you have suggestions for other terms that would better represent your identity, please feel free to email us. We value your input and want to make sure everyone feels acknowledged.