New York journalist, David Kaufman, a member of the MHB community, had twins via surrogacy with his husband three and a half years ago. Kaufman is featured in the recent Refinery 29 article, “The Hidden Costs of Starting a Family When Queer,” that shares personal stories of LGBTQ couples who run into multiple roadblocks with their own health insurance when starting a family. Kaufman describes how he was continuously surprised by the costs, including trips to visit their surrogate and hospital bills after their sons, Aaron and Luca, were born. Many couples need help to pay for fertility treatments and surrogacy, so they look to organizations like Men Having Babies for discounts and assistance.

Whether they need IVF, IUI, a donor egg, or donor sperm, chances are LGBTQ couples will pay every penny for the service. LGBTQ couples often face much higher financial obstacles to becoming parents than straight couples, in part because of how “infertility" is defined.

The World Health Organization defines infertility as a “disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” The Centers for Disease Control and Prevention in the U.S. similarly defines infertility as “not being able to get pregnant (conceive) after one year (or longer) of unprotected sex.” When state laws and health insurance companies utilize these definitions, LGBTQ people are often excluded from infertility coverage.

“The key is not to call it a disease or condition,” explains Ron Poole-Dayan, the founder of Men Having Babies. He prefers a definition drafted by Cathy Sakimura, the family law director of The National Center for Lesbian Rights (NCLR). Sakimura calls infertility the “inability to conceive or birth children without medical intervention,” which can be shown, in part, by “a statement that a covered individual plans to conceive a child either as an individual or with a partner with whom the covered individual cannot conceive a child through sexual intercourse.”

Resolve: The National Infertility Association has put forward legislation that has changed the definition in some states. The association is now working with NCLR and Men Having Babies to ensure the definition is inclusive across the United States.

“We want to try to remove cost as a barrier to care, and argue that reproduction is a basic human right,” says Betsy Campbell, the chief engagement officer at RESOLVE. “We have the medical care to make that possible, and we think that insurance should cover medically necessary treatments.”