IUI for Lesbian Couples
IUI to IVF: Family Planning as a Lesbian Couple
Any couple knows that family planning is one of the most exciting, yet daunting, experiences you can go through – and that’s when there are zero complications. If there are any fertility issues, you have to involve more than just your OB/GYN and it starts to get incredibly expensive. Add to that, the amount of red tape you have to get through is so overwhelming many give up or are simply not able to comply. And if you have never had legislation passed or denied about your body or what you do with it, consider yourself privileged. The journey of multiplying your household can be a nightmare for some and a beautiful story for others, and knowing what to expect is the best foundation. IVF or IUI for lesbian couples is a specific journey that needs more attention, better wording, and less paperwork. Let’s get into it.
What is IUI?
IUI or intrauterine insemination is the process of using a catheter to inject “washed” semen directly into the uterus, bypassing the cervix. Bypassing the cervix allows the swimmers to avoid the mucus which, by design, kills a lot of the sperm before it gets to the uterus. The sperm needs to have been washed to keep the receiver’s body from rejecting it.
What is IVF?
IVF or in vitro fertilization is the process of fertilizing an egg outside of the womb. After the sperm is injected into the egg, there is a 2-6 day wait to make sure the fertilization “takes”, at which point, the embryo is placed into the womb.
How is it different for Lesbian couples?
How is IVF or IUI for lesbian couples and single women different from the cishet couple experience? For starters, there’s no sperm built into the process. There’s not a producer of sperm who can regularly contribute to the fertilization process. This means that there needs to be a donor. This donor can be a trusted friend or from a sperm bank. The donor’s sperm has to be tested for STIs and washed which can get quite expensive. Additionally, many people going through the treatment of IVF or IUI for lesbian couples want more than one child. This means freezing sperm which adds to the cost. Sperm donors average around $1000 per load. These costs add up and guess what? Insurance companies aren’t interested in covering the cost. And this is where we start to run into the real difference in experience for IUI for lesbian couples.
For most insurance companies, fertility treatment isn’t covered unless the patient is declared infertile. However, the wording of how that declaration is accepted by insurance companies is aggressively exclusive of single women and WLW couples. Since this includes trans* folks, this is just as difficult a process for them, if not more so because of stronger biases. Paraphrased, the wording includes mentions of infertility only being declared if the person isn't impregnated after having practiced unprotected sex for a specified period of time, is unable to impregnate after a specified period of time, or is unable to carry a child to live birth. This means people who don’t have sperm and don’t have sex with people who produce sperm are left out of the conversation – and insurance coverage – entirely.
The REAL Cost
This becomes a socioeconomic issue when we consider the costs of paying out of pocket. Without including all the tests that need to be run to ensure that you are, in fact, medically fertile, you have to consider the following:
$1000-2000 for monitoring of ovulation and any blood work-ups
$1000-2000 for the drugs that ensure the development and ovulation of the eggs
$1000 for each injection of donor sperm (it takes an average of 3-4 cycles for success)
After full-term pregnancy, the birth itself has to be considered. With no complications, the live birth of a single baby can cost up to $24,000 depending on location, method of birth, and insurance coverage.
While this is financially restrictive for many that are planning a family, it’s still the go-to solution even though it doesn’t produce the best results. Why? It’s significantly cheaper than IVF which has a better success rate.
While IUI offers a success rate of around 88% after three rounds and 95.5% after 4 rounds, it's less likely to be effective at all after that. For more successful results, the other option for lesbian couples is the IVF route. IVF can cost upwards of $30,000 per cycle with 2-3 cycles being the average for successful implantation. The draw for the WLW community? IVF allows both mothers to physically participate in the process via reciprocal IVF where the egg from Mom 1 is fertilized in vitro and implanted into the uterus of Mom 2 to carry. Between mutual participation and a stronger success rate, IVF is the option most desired by lesbian couples.
Insurance coverage for IVF
There are some serious barriers to insurance coverage for IVF. For one, only 9 states mandate that it be covered. Alternatively, you can look for a company that includes IVF specifically in its coverage. Even then, there are still stipulations that make IVF incredibly difficult to get coverage for. These stipulations vary from state to state and range from age restrictions and the requirement of medical infertility (there’s a range of what constitutes infertility) to mandating that the sperm must come from the spouse and a limited number of cycles. There are even stipulations that you have to have already proven that you can’t get pregnant through less expensive means. And in most cases, these stipulations overlap, so as soon as you solve one problem, there can be quite a few more just ahead.
Considering the fact that the politics around pregnancy are rapidly changing, while the legislation for IUI and IVF are definitely not, understanding your state's laws and the policies outlined in your insurance coverage are the best places to start. Preparing your mind and body for carrying a child is just a part of this uphill battle. Finding alliances with organizations and support groups that share valuable information is going to be the key towards more successful family planning, as is strategizing as early out as possible.