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Starting a family is an expensive proposition for anyone—diapers and day care aren't cheap, after all. But for LGBTQ+ couples who can't have a child without assistance, the costs can really skyrocket.
That's because most forms of assisted reproduction, surrogacy and adoption come with a steep price tag. With often spotty insurance and workplace coverage, it's common for LGBTQ+ people to spend tens of thousands of dollars to have or adopt a child.
LGBTQ+ couples can make the process of having children easier by researching, planning and preparing their finances well in advance. Plus, new health insurance laws in some states can help make having kids financially feasible.
How Much LGBTQ+ Family Planning Costs
The LGBTQ+ community already faces financial disparities and challenges including discrimination across many facets of life, differing needs and additional costs to ensure legal protections are in place. The math gets even more lopsided for LGBTQ+ couples who want to have children since they can't do it on their own.
Because having a child isn't considered a medical necessity, many health insurance companies and employers don't offer any coverage. A growing number of states require health insurers to offer at least some coverage for fertility treatments, but many rely on an infertility diagnosis. This was previously a huge barrier for many LGBTQ+ couples, who weren't considered medically infertile; they just weren't in a heterosexual relationship, or they're transgender and can't biologically have a child or contribute a sperm or egg due to hormone treatment and/or surgery.
Fortunately, the American Society for Reproductive Medicine in October 2023 released a new definition of infertility to include LGBTQ+ people who can't get pregnant without outside assistance. This could make it easier for LGBTQ+ couples trying to access benefits if their state or employer has fertility coverage.
Unfortunately, the fertility process includes a litany of expenses, such as medication, genetic screening and storage. Even with insurance, there can still be major gaps in coverage. Plus, legal documentation is crucial for same-sex couples to protect their families. Here's how much family planning can cost for LGBTQ+ couples.
Intrauterine Insemination (IUI)
IUI is a medical procedure where sperm is inserted in the uterus around ovulation. Patients typically take fertility medication leading up to the procedure and, depending on their situation, they may need donor sperm. Since IUI is low-tech, it's less expensive than IVF. But depending on how much medication, monitoring and blood work is needed, the cost can range anywhere from $500 to $4,000 for one cycle (or attempt) without insurance coverage.
In-Vitro Fertilization (IVF)
A more intensive (and expensive) form of assisted reproduction is IVF. Doctors combine eggs and sperm in a lab, then put fertilized embryos into the uterus in a brief medical procedure. This can improve chances of becoming pregnant. If the carrying parent uses their own egg, there's a separate process beforehand that involves taking medication and retrieving eggs. While IVF is more effective than IUI, one cycle without insurance coverage can cost over $20,000 when accounting for medication and screenings, and many people require multiple cycles.
A bonus option for same-sex female cisgender couples is reciprocal IVF. One partner contributes the egg, while the other carries the pregnancy. The carrying partner isn't genetically related to the child, but the process can help both parents to feel biologically connected to the process.
Adoption
Adoption is ideal if neither partner can or wants to carry a child. Plus, adoption gives a child in need a safe home. Costs vary significantly by option, ranging from nearly free to exceeding an annual salary. If you adopt a child from a state-run child welfare system, it's nearly free, and it's possible they will qualify for financial and medical assistance from the state and/or federal government.
If you adopt a baby domestically through a private adoption agency, expect to pay between $25,000 and $40,000. Adopting from abroad can cost more or less than domestic adoptions depending on travel, the country's requirements and fees. It might be between $15,000 and $50,000, though it can go as high as $70,000.
Gestational Surrogacy
Another option is to hire a gestational surrogate to carry and deliver your baby. She doesn't contribute an egg, so she isn't genetically related to the baby. Instead, the egg and the sperm can come from you and/or your partner, or donors. Doctors create an embryo and use IVF to impregnate the surrogate.
Surrogacy is extremely expensive. If you need a surrogate and an egg donor, it can cost as high as $200,000 or $250,000 including all costs, such as legal and agency fees, and paying for the surrogate's health care. Not needing an egg donor can reduce the bill by $50,000.
How LGBTQ+ Couples Can Financially Prepare to Have Kids
If you know being a parent is in your future, here are ways to start preparing your finances now.
Explore Options and Maintain a Budget
You may know how you want to start a family. But if you're unsure, take the time to do research and have discussions with your partner. Closely review your budget and savings to see what you can afford, which may narrow down options, and consider if you'll have time to save and pay in cash or if you'll utilize financing or other means of external funding or assistance.
If you need more information, online fertility resource FertilityIQ has online courses on understanding fertility options for different identities within the LGBTQ+ community. Consider asking peers about their experiences and costs as well. If you or your partner plan to carry, you may also want to have consults with medical providers to see what's possible and the costs. Once you've made a plan, you can begin to adjust your budget for a baby.
Research What Your Insurance and Employer Covers
Years ago, it was rare for health insurance companies to provide any coverage for fertility treatments. While many Americans still lack it, an increasing number of employers and insurers offer some benefits or financial assistance. Additionally, over 20 states have passed laws that require health insurance to cover some or all forms of infertility treatment for those who can't conceive on their own.
However, plans and coverage vary by state, employer size and workplace policies, so it's important to understand the costs and restrictions. For example, New York passed a law that requires health insurance to cover up to three IVF cycles, but only for insurance through workplaces with 100 or more employees.
It's possible some things will be covered but not others. Find or request a copy of your insurance plan's summary plan description to see exactly what's covered, the costs and if there are restrictions or exclusions related to infertility or reproductive services. If you're stumped, call your insurer's customer service line for help.
Know that some businesses offer family-building perks to employees beyond health insurance. For example, some offer adoption assistance, which reimburses some adoption costs and might offer paid leave. Ask your HR department if there are any family-building resources or benefits you should be aware of as you plan.
Look for Other Ways to Save
If you're going the IUI or IVF route, there are various ways to find savings. For example, some companies that make fertility medications offer savings programs for those paying out of pocket, and you can also cost-compare at different pharmacies. Some clinics also offer limited amounts of free fertility medications from past patients who donated their extras.
If one of you can carry a baby but you're having trouble getting pregnant with the sperm and egg combination you're trying, another option is a donor embryo transfer. Many people who successfully complete IVF have embryos leftover, and some donate those to people still on their family-building journey. While it can still cost between $2,500 to $4,000 to transfer a donor embryo, it's often more affordable than using donor eggs or going the IVF route.
The costs of medical fertility treatment can also vary by location, according to data by FertilityIQ. For example, they found the average cost of a complete IVF cycle is around $20,000 in Boston, while nearly $26,000 in Los Angeles. So consider comparing prices in other nearby cities or regions; just know that you'll need several in-person visits, so account for travel costs.
Financial Assistance for LGBTQ+ Couples
If the costs of starting a family exceed your savings, you'll need outside help. You can always ask your friends and family for loans or donations, but that can get messy, so here are some other ways to make parenthood possible.
Explore Grants
Since the expense of family-building can be so steep, some grants exist to help fill the gap. These grants typically have limited funds and few spots available for applicants who meet qualifications. There are often rules about how funding can be used, but the money doesn't have to be repaid. The nonprofit organization Family Equality has an ongoing list of LGBTQ+ family-building grants. Fertility Within Reach, another nonprofit, has its own list of grants that can help with adoption, surrogacy and fertility preservation.
Be aware that when applying for grants, you may need to demonstrate financial and/or medical need.
Request Employer Coverage
If your employer doesn't offer fertility benefits, either through corporate benefits or health insurance, request that they provide coverage. It can help to find other employees who also want this to make the case for demand. It's possible the company simply hasn't had employees in need of it or requesting it.
Fertility Loans
Due to the demand for fertility services and high out-of-pocket costs, many companies now offer financing programs and loans for this purpose. Many are very similar to personal loans; patient advocacy nonprofit Resolve has a list of some of the current options out there. Some clinics offer their own financing, while others partner with third-party financing companies. As you compare options, pay attention to interest rates, fees and any restrictions on how the money can be spent.
Some of these loans allow you to finance costs associated with medicine, genetic testing, attorneys and storage fees in addition to the procedures themselves. Certain programs have discounts if you require multiple rounds of treatment, or offer full or partial refunds if treatment isn't successful. Additionally, some of the options available include fertility coaching or support.
Take care to review the fine print and see if there are any potential pitfalls.
Personal Loans
If you don't want to use a fertility-specific loan, you may consider using a personal loan. There are typically few restrictions on how personal loan funds can be used. The loans aren't specialized to your situation and won't be connected to a clinic, but some may appreciate this flexibility. Make sure to compare interest rates, terms and fees to see how they stack up with fertility-specific loans.
Home Equity Loans
If you own a home and have built up significant equity, you could borrow from it to pay for having children. Home equity loans let you tap into this money; just be aware of the risks of using your home as collateral.
0% Intro APR Credit Cards
These cards have an introductory period with a 0% annual percentage rate (APR) on purchases, balance transfers or both, which can last anywhere from 12 to 21 months. After this time, the APR becomes the card's standard rate, but if you can pay off a large chunk (or all) of your balance before then, you get to borrow money without paying interest.
Get Creative to Overcome Obstacles
Starting a family is especially hard for LGBTQ+ couples, who often face discrimination and can't have kids without spending a large amount of money. Fortunately, there are many options for help, from grants and drug savings programs to personal loans and 0% intro APR credit cards. There's nothing wrong with using a combination of personal savings and various forms of responsible borrowing to help make your dreams come true. Just be sure to plan ahead, create a budget and monitor your finances as you go.