The price of starting a family: Are fertility treatments LGBTQ friendly?

Employees of all genders are requesting more support on their family planning journey, yet LGBTQ employees are the least likely to get it, due to a lack of inclusive healthcare coverage and other barriers. It's on employers to revisit their policies and ensure they're truly supportive. 

One in five adults globally identify as LGBTQ, and 63% of this population is expected to use third-party reproduction, like adoption, surrogacy or foster care, according to family-building benefits provider WINFertility. But starting a family is costing queer families significantly more than their straight counterparts — both financially and emotionally.

"Infertility is challenging to any intended parent and often brings financial and emotional stress, but for LGBTQ employees there are additional barriers," says Roger Shedlin, CEO and founder of WIN. "This includes higher costs, clinical considerations such as procuring donor sperm or egg, a surrogate if needed, the need to navigate to LGBTQ experienced providers, access to qualified surrogacy and adoption agencies and state-by- state variations in laws and regulations governing the surrogacy process." 

Read more: Justworks and Kindbody extend free fertility benefits to small employers

While advancements in infertility medicine have created new pathways and opportunities for queer couples to start a family, access and cost is challenging for this demographic, too. In many instances, fertility benefits require the clinical definition of infertility be met before accessing coverage, which renders LGBTQ patients ineligible for these services and leaves them to cover the costs themselves. 

Fertility services like intrauterine insemination can cost $500-$3,000, and IVF can range from   $12,000-$30,000 — which includes $400 - $2,000 in sperm donation or $8,000 - $40,000 in egg donations. Employees interested in adoption can anticipate fees ranging from $20,000-$40,000, while surrogacy carries a cost of $50,000-$200,000. Just one-third of U.S. employers offer financial support for these services through their benefits, according to a 2021 Mercer survey.

"There are very few companies that can support intended parents holistically," Shedlin says. "The greater clinical, emotional, regulatory and financial challenges for LGBTQ employees creates risks that family building benefits have less than optimal clinical outcomes, produce a negative patient experience and use employer benefit dollars inefficiently." 

The good news is that nearly 60% of benefits managers believe it would be a discriminatory HR policy to limit fertility coverage only to employees diagnosed with fertility issues, according to employee fertility benefit solution KindBody. But there are several steps companies have to  take to ensure that that belief is upheld. 

Read more: Fertility struggles led this CEO to tackle family building benefits at work

"Best practice is for employers to provide comprehensive support utilizing fertility trained nurse-care advocates," Shedlin says. "An inclusive benefit facilitates patients' access to LGBTQ-friendly providers and the highest quality surrogacy and adoption agencies." 

For many LGBTQ couples, the resources and benefits provided by their employers are the only way they can start a family, so making benefits easy to use and navigate is also a critical aspect of making them equitable and a seamless experience for all, Shedlin says. For example, the most comprehensive benefits will also include access to specialist surrogacy coaches and relevant multimedia tools like webinars and video libraries. 

"We've seen significant growth in our book of business of employers offering benefits well suited for their LGBTQ employees," he says. "And companies offering these inclusive benefits not only allow employers to create significant employee goodwill, but will help drive enhancements in recruitment and retention."