Love makes a family, the saying goes, but — as LGBT parents quickly discover — love isn’t enough: money plays a central role as well. From family creation to securing legal ties and finding welcoming schools, parents and prospective parents may face additional, unique financial obstacles because they are LGBT.

It’s not all dollar signs either. Costs may also come in terms of time and other trade-offs. Lack of family support and an unfriendly political climate can add to the challenges. Balancing financial, emotional, and time-management needs can require a combination of frugality, creativity, and luck.

Getting Pregnant

Infertility can be costly for anyone, but it can hit queer families particularly hard. Most insurance companies will not pay for fertility treatments until after a certain number of failed attempts to have a child without it. For different-sex, cisgender couples, that simply means having unprotected vaginal intercourse.

For individuals or couples who only have uteruses, however, this means inseminating at a medical clinic, explained Liz Coolidge, a family and parenting services coordinator at Fenway Health in Boston. Costs vary depending on the clinic, but Fenway charges an initial fee of $300 plus $250 for each standard insemination. Unless the person or couple is using donated sperm, they must also buy a sample at an additional $400 to $1,000 per vial, plus $200 for the cryogenic shipping.

Even with an infertility diagnosis, infertility coverage is only mandated in 15 states, and the specifics of what (and who) is covered vary, according to Resolve, the National Infertility Association. In 2016, four lesbians filed a federal civil rights lawsuit against the state of New Jersey over a mandate that women demonstrate infertility through “two years of unprotected sexual intercourse” before treatments are covered. In response, Gov. Chris Christie signed a law this spring that requires infertility treatments be covered for parents of any sexual orientation.

Two New York bills are pending that would mandate infertility coverage “regardless of [the] sexual orientation, marital status, or gender identity” of the insured. Hawaii has a similar bill. Since 2013, California has required equal coverage for LGBT prospective parents; while Maryland requires insurers provide married same-sex couples the same benefits provided their heterosexual counterparts.

The costs of infertility can quickly add up. “We definitely live paycheck to paycheck,” said Nicole, a high school English teacher. She and her wife, Bethany, a child development specialist, live in San Diego with their 1-year-old son, who they had after a long battle with infertility. They own a home, but have no savings.

The couple first tried to get Nicole pregnant at a clinic through intrauterine insemination, which has a better success rate than intracervical inseminations (the “turkey baster” method typically done at home with a syringe). After multiple failed attempts at $2,000 a pop, they discovered Nicole’s fallopian tubes were blocked. They switched to in vitro fertilization, where the eggs are taken out and fertilized in the lab before being placed in the uterus. Their plan was to use Nicole’s eggs and have Bethany carry them. The cost of IVF in San Diego was over $17,000 per attempt. Their insurance only covered medication. The couple took out a loan and got creative: they rented a house in Colorado Springs, where a clinic offered the same procedure for $10,000. Bethany got pregnant on the first try.

They’d like to have another child, but, “financially, right now, we can’t afford to,” Bethany said. Nicole and Bethany have also been unable to afford the legal protections of a second-parent adoption and a termination-of-rights document from the donor, which they said would cost about $3,000. Instead they drew up their own document for the donor, based on online examples. Both of their names are on their son’s birth certificate, but — after the election — they’ve started worrying they need the added strength of a legal adoption.

“At some point we were literally broke,” said Katrina, who faced infertility issues with her wife Tiffany. The couple, who produce the video blog Two Mommies and a Blessing, live in upstate New York where Katrina works part-time as a counselor and Tiffany is a police detective.

When Tiffany and Katrina started their journey to parenthood in 2007, Katrina said, “Tiffany was barely making $900 a month, our rent was $600, and we had one car that always had issues.” Katrina was unemployed, unable to keep a job while taking off so much time to see specialists.

The couple initially chose IUI because it was what their insurance covered. They elected an open donor (one who allows contact once the child turns 18) “because it was cheaper.” Tiffany’s insurance paid for 75 percent of the procedure, but not the sperm or medications. They tried four times without success, paying about $7,000 in total.

They took a year off, then tried again with a new clinic and new donor. In the meantime, Katrina had been diagnosed with only one working fallopian tube, and their insurance now covered IVF and most of the medications. “That was a huge relief,” Katrina said. They had also managed to save the $2,300 out of pocket for sperm, medications, and co-payments.

Still, “money was always a worry,” Katrina admitted, but added, “We desperately wanted to have a child of our own, so we would have sacrificed even more if we did not get pregnant.” Luckily, they did, and their son is now 7.

New Yorkers Chelsea and Chris, who publish the video blog LBC Party of Five, bore the cost of infertility treatments while raising two special-needs children, who Chelsea had from a previous marriage. Chris works in law enforcement and Chelsea is a paralegal. Chelsea conceived her first two children easily, but tried unsuccessfully for two years to have a third, with four rounds of IUI costing about $5,500. Chelsea also went through two surgeries for endometriosis, a condition of the uterus lining that can contribute to infertility.

Chelsea and Chris went to a different clinic and were advised to try IVF, “which scared us solely because of the costs involved,” Chris said. They took out a personal loan to buy supplemental insurance, which covered two IVF cycles, but not the medicines

or sperm, which added $5,600. Still, they managed to get pregnant.

After they had their third child, Chris came out as transgender, which had financial implications for them as well. He explained, “I opted for a more expensive insurance plan to ensure that hormone replacement therapy and any related surgery would be at a minimal out-of-pocket cost.”

Sometimes, misinformation about LGBT people can also add costs. Tom*, a transgender man who works in digital publishing in New York, recalled trying to conceive with his then-partner, a cisgender woman. They tried multiple times with sperm banks and a nurse friend helping them do IUI at home.

“Late in the game” they discovered their insurance would cover pre-conception testing, even though they were queer. Through testing they learned Tom’s partner, “the one into whom most of the expensive bank sperm went,” was “100-percent infertile.” Tom ultimately got pregnant with their fourth donor. The couple is now separated and sharing custody of their 7-year-old.

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