'If we were a straight couple...': Understanding LGBTQ+ family-building experiences in the UK

Imagine wanting to have a child and discovering, at every stage, that the system was not designed with you in mind. This is the reality for many LGBTQ+ people in the UK who seek fertility treatment each year.

Our study explores LGBTQ+ experiences of fertility services in the UK through in-depth interviews with 54 participants: 41 LGBTQ+ fertility service users and 13 clinic staff and LGBTQ+ advocates.

Although fertility treatment is legally available to LGBTQ+ people in the UK, our findings reveal a significant gap between legal access and equitable access. LGBTQ+ people are often left to overcome barriers that heterosexual couples do not face.

For example, lesbian couples are typically required to self-fund six to twelve rounds of intrauterine insemination (IUI) before becoming eligible for NHS-funded IVF. Gay men pursuing surrogacy receive no NHS support, while many transgender people struggle to access NHS-funded fertility preservation because of long waiting lists and inconsistent local funding decisions.

One participant, Megan, a young trans woman, was denied NHS fertility treatment because of her BMI. As a result, she stopped taking hormones for several months and, in her words, had to 'go back to living as a man' to access private care.

Four forms of invisible labour

Our research identifies four types of labour that LGBTQ+ people often perform simultaneously while navigating fertility services:

Intimate labour refers to the physical and emotional work involved in navigating healthcare systems that were not designed for LGBTQ+ patients.

One lesbian couple completed all their NHS fertility tests, only to be told by their private clinic that the results could not be used because they had not been referred by a GP. They were forced to repeat every test at their own expense.

For transgender patients, intimate labour often involved undergoing procedures that felt uncomfortable or incompatible with their gender identity in clinical environments that lacked awareness of their needs.

Emotional labour involves managing and performing emotions throughout the fertility journey.

Paul and Jordan, a gay couple pursuing surrogacy, described feeling pressure to be 'relentlessly delightful' throughout the process, constantly demonstrating warmth, patience, and suitability as parents despite feelings of exhaustion and anxiety.

Juliet, a lesbian woman who underwent seven rounds of IVF, challenged what she described as the fertility industry's culture of 'false positivity': 'The thing that annoyed me was the false positivity and the false hope… I need you to be realistic with me.'

Managing both personal emotions and the emotions presented to others requires significant effort, work that many heterosexual couples do not have to consider in the same way.

Decisional labour refers to the mental burden of making complex, high-stakes decisions within restrictive systems.

Which donor should be chosen? Who will carry the pregnancy? Which clinic is most suitable? LGBTQ+ patients often conduct extensive research to answer these questions, only to find their choices limited by policies they were never informed about.

Alexandra and her wife spent weeks selecting a sperm donor before discovering that their chosen clinic would not accept him because of a screening requirement they had not been told about. They had to begin the process again. Similarly, George and his partner carefully selected a local clinic but encountered transphobic treatment and ultimately travelled 230 miles to access a service that met their needs.

Auto-didactic labour describes the work of educating oneself because clinics are often unable to provide adequate guidance.

Without clear information pathways, many participants relied on social media groups, WhatsApp communities, peer networks, and extensive independent research to understand their options. Amy explained that her main source of information about reciprocal IVF came not from healthcare professionals but from 'hundreds of voice notes from other LGBTQ+ women.'

Steve, a gay man, discovered through his own research that his surrogate's treatment had been cancelled for reasons that were not medically justified. After challenging the decision, the treatment protocol was changed, and the surrogate became pregnant. His self-acquired expertise saved months of additional treatment.

The paradox

The labour performed by LGBTQ+ patients helps them navigate the fertility system, but it also obscures its shortcomings. When patients educate themselves, advocate for their own care, travel long distances, and absorb the emotional burden of treatment, the system continues to function without addressing the underlying inequities. Those with fewer financial resources, less time, or less confidence are often left at an even greater disadvantage.

What needs to change?

We argue that NHS funding policies should be reformed to remove the financial disadvantages faced by same-sex couples. Fertility clinics should provide mandatory, standardised LGBTQ+ cultural competency training, and the Human Fertilisation and Embryology Authority should develop guidance that reflects the diversity of people using fertility services.

We also recommend that clinics establish dedicated LGBTQ+ patient liaison roles to ensure that patients are not left to navigate complex systems without support.

These are not radical proposals. They are basic requirements for a healthcare system committed to treating all patients with equal dignity and respect. The title of our article comes from a comment made by Robyn, a lesbian participant reflecting on the financial and emotional cost of her fertility journey:

'If we were a straight couple, we could go out on a night out and just get knocked up... we're having to pay thousands upon thousands of pounds.'

That single observation captures the structural inequities that continue to shape LGBTQ+ experiences of family building in the UK.