Accessing Fertility Treatment: Challenges and Solutions for LGBTQ+ Communities

At the latest PET event, researchers, policymakers, and advocates came together to discuss the ongoing challenges LGBTQ+ communities face in accessing fertility treatment, while focusing on practical solutions for change.

Sarah Norcross, director of PET and chair of the event, opened with a stark reflection. Sixteen months have passed since the last PET event focusing on LGBTQ+ fertility (see BioNews 1277, 1278 and 1295) and yet little progress appears to have been made. The PET NHS Fertility Funding Tracker shows that access to fertility treatment continues to worsen overall. Meanwhile, the updated NICE fertility guideline offers no improvements to recommended treatment pathways for female same-sex couples, and provides no guidance for single men or male same-sex couples (see BioNews 1334, 1335 and 1343).

The event began with a pre-recorded message from Kate Osborne, chair of the All-Party Parliamentary Group for Fertility (see BioNews 1343). She reaffirmed her commitment to fertility justice, highlighting her ongoing efforts to challenge ministers and publicly criticise the shortcomings of the updated NICE Guideline.

Osborne stressed that current eligibility criteria are not designed with LGBTQ+ people in mind, often forcing people to self-fund many aspects of their fertility journey. She argued that policy must better reflect diverse family structures and embed inclusivity in both policy and everyday practice.

Dr Carolyn Wilson-Nash from the University of Sterling and Dr Jennifer Takhar from Côte d'Azur University's SKEMA Business School presented results from a recent study, which they have also discussed in an article for BioNews (see BioNews 1344). They conducted 36 in-depth interviews with fertility patients and providers across the UK, to understand how LGBTQ+ people navigate fertility treatment differently from heterosexual patients.

Dr Wilson-Nash, Dr Takhar and their colleagues found that the 'reproductive labour' that many experience during fertility treatment is often heightened for LGBTQ+ people. This includes identity-related labour, such as having one's identity erased or ignored; emotional labour, including feeling pressure to appear 'parent-worthy'; decisional labour around complex choices involving donors, clinics and treatment pathways; and the need to become an expert in navigating the system. They concluded their talk by calling for equal NHS funding, improved cultural-competency training, clearer guidance and dedicated LGBTQ+ patient liaisons.

The next speaker was Michael Johnson-Ellis, co-founder of My Surrogacy Journey and Ethica Fertility. He discussed various pathways available to men seeking to start a family including surrogacy, adoption, fostering, fostering-to-adopt, and co-parenting. He highlighted the extensive resources now available to support prospective parents.

Surrogacy remains the most common route for single and same-sex male couples men wishing to have a genetically-related child. However, UK waiting times can extend from two to five years or longer, and there is currently no NHS fertility funding for male same-sex couples to create embryos using donor eggs. The surrogate is also initially recognised as the legal parent, requiring a parental order to transfer legal parenthood. While significant barriers remain, Johnson-Ellis emphasised that increasing information and support are helping intended parents better prepare for the journey.

Dr Susie Bower-Brown, lecturer in social psychology at University College London (UCL) and principal investigator at the Family Beyond the Binary Research Project, presented her research on three-parent LGBTQ+ families. Despite growing public interest in 'multi-parenthood', such research remains limited to date.

Drawing on interviews with 12 LGBTQ+ parents across four families, Dr Bower-Brown quoted some participants who described their multi-parent family journey as 'uncharted territory' – it can be satisfying and rewarding, but also comes with frustration and anxiety. There is little guidance for multi-parent families, and participants described how even when three parents taking on equal parenting roles, only two can be legally recognised as parents in the UK. Participants described navigating these challenges through flexibility, informal agreements and contracts.

Dr Chloe He, honorary senior research fellow at UCL, presented findings from a nationwide audit of LGBTQ+ inclusion among UK fertility care providers and focused on the specific issues faced by trans people. Medical transition through hormone replacement therapy (HRT) or surgery can significantly impact fertility, making fertility preservation an important consideration for many trans people. Dr He explained that prior studies had found that around 32 percent of trans and nonbinary people desire children, yet uptake of fertility preservation is closer to five percent. Furthermore, between 33-57 percent of trans people later regret not preserving their fertility, and 19 percent stated that they wanted fertility treatment but couldn't get it – due to cost, not wanting to delay HRT, or having no local services.

The audit found that 41 percent of clinics lacked pathways for trans and nonbinary patients, while 74 percent of staff had received no basic training in transgender fertility care. These findings mirror wider reports of transphobia, limited understanding among GPs and delays in accessing care. Dr He noted that more than half of trans people avoid the doctor when they are unwell, remaining 'a minority of a minority' within fertility research and leading to ongoing evidence gaps.

She ended by offering encouraging messages. Trans people's fertility goals are as valid as anyone else's, clinicians should educate themselves and provide compassionate care, researchers should focus on solutions and include trans people as partners, and policymakers should work towards a more equitable system.

Lastly, we heard from Natalie Gamble, director of NGA law and founder of Brilliant Beginnings. She presented on the legal issues surrounding transgender parenthood, outlining how the Gender Recognition Act 2004 permits someone to change their legal gender while the Human Fertilisation and Embryology Act 2008 is written in gendered language, which can create significant barriers.

Gamble presented two cases that highlighted these inconsistencies. The first case, a trans man who gave birth, could only be recognised legally as the child's mother despite being legally male (see BioNews 1017 and 1073). In the second case, a trans man could not be recognised as a legal parent at all because the legislation did not account for his circumstances (see BioNews 1017 and 1328). Gamble cautioned that trans people should think carefully about changing their legal gender, and – if pursuing that route – should consider the legal workaround of step-parent adoption. She argued that the ultimate solution would be law reform to adequately recognise both transgender identities and parenthood.

The event concluded with a Q&A session, including a topical question on artificial intelligence (AI) and fertility care. Dr Wilson-Nash noted that AI systems can be biased if trained on incomplete or unrepresentative data. While AI could reduce some aspects of reproductive labour, its effectiveness depends on trust. Dr He added that there is an interest in using AI to optimise embryo or gamete selection, but transgender people are typically not included in these datasets. These issues will be further explored at the PET Annual Conference, which this year is entitled 'AI and Automation in Fertility and Genomics: Pipeline? Or Pipe Dream?', and is taking place in London on 9 December.

The 'Accessing Fertility Treatment: Challenges and Solutions for LGBTQ+ Communities' event made clear that despite persistent barriers, there is no shortage of evidence-based solutions for improving LGBTQ+ access to fertility treatment. By bringing together researchers, practitioners, advocates and policymakers, the discussion highlighted both the scale of the challenges and the opportunities for change. The task now is to translate these insights into policy and practice so that fertility care becomes more inclusive, equitable and accessible for all.

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PET is grateful to Born Donor Bank, Care Fertility, CooperSurgical, IBSA and the Senior Infertility Nurse Group for supporting this event.

Registration is now open for this year's PET Annual Conference – AI and Automation in Fertility and Genomics: Pipeline? Or Pipe Dream? – which is supported by supported by ESHRE, and is taking place in central London on Wednesday 9 December 2026.

Find out more and register here.