Have you seen the price of sperm? It's time to democratise fertility treatment | Arwa Mahdawi

One big advantage of homosexuality? Built-in birth control. One big disadvantage of homosexuality? Built-in birth control. You can’t just casually start trying for a child when you’re in a same-sex couple, you’ve got to meticulously plan parenthood. Instead of getting off the pill, you start taking them.

You also start buying sperm. (Look up the price of sperm if you want a shock: it’s more bonkers than bitcoin.) And you start booking doctors’ visits. And getting blood tests. And ultrasounds. And trigger shots. And you go to the hospital and magic medicalised baby-making happens. And then you wait two weeks. And then you get your period and you have to do it all again.

My partner and I spent much of 2020 engaged in variants of the above. Finally, after four IUI (intrauterine insemination) procedures and about $20,000 in bills, she got pregnant. (Hurrah!) I won’t get into the technicalities of IUI but it’s less invasive and expensive than IVF (in vitro fertilisation); the flipside is that it’s not as effective. We may have shelled out a small fortune but, in the end, we were lucky: getting pregnant could have taken a lot longer and cost a lot more. Our health insurance didn’t cover IVF: if we’d had to go that route then I’m not sure how long we would have been able to keep trying. Meanwhile, some of our straight friends going through IVF had insurance that covered everything. Which, while great for them, felt somewhat arbitrary and unfair.

To be clear: I don’t think having kids is a human right. I don’t think every lesbian couple should be issued one free baby courtesy of the state. But I also don’t think fertility treatments should be something only the lucky or the loaded have access to. Which, in England and the US at least, is how the system currently works. In England, getting fertility treatments on the NHS is a postcode lottery. (Scotland offers the “gold standard” of three NHS-funded cycles of IVF; Wales offers two cycles. In England it varies between three and none at all.) In the US, fertility coverage depends on your health insurance. Which, in turn, depends on the size of your employer and the laws around infertility insurance coverage in your state. Not to mention your sexuality: you have to jump through a lot more hoops to get covered when you’re a same-sex couple.

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But perhaps things are slowly changing: I was thrilled to see that England’s first not-for-profit IVF clinic is opening in London this year. It will address the inequalities in IVF provision by offering at-cost treatment; it also won’t offer all the expensive (and often ineffective) add-ons that private clinics do. I mean, did you know that EmbryoGlue is a thing? Or that you can pay extra for “assisted hatching”? The industry is so ridiculous I’m surprised you can’t order satellite TV to relax your embryo as it awaits implantation.

Also ridiculous is the amount of judgment that can still be attached to fertility. “Why did you wait so long to start trying?” “Perhaps you should have focused on finding a partner instead of your career.” “Why don’t you ‘just’ adopt?” (There is nothing simple about adopting.) “Are you sure you should be having kids when you’re not married to a man?” Seriously, if I had a penny for every unsolicited opinion I’ve heard about my ovaries, I could buy the world a round of IVF. We need to widen access to fertility treatments, but we also desperately need to widen the conversation around fertility.


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