Medicine is weird, and Reproductive Medicine is even weirder! (Now THAT should get the internet buzzing!)

Why is the “practice” of medicine weird?  Health insurance, is one reason. Expectations are another. And for the LGBTQ community, one thing that may be a stumbling block is the notion that you need to seek out a special fertility practice to meet your needs.

Health Insurance

First and foremost, it shouldn’t be called health insurance. A more appropriate name is disease, trauma, catastrophe and accident insurance.  So, given the myth that folks think they need insurance companies to get good health care, why aren’t these companies covering conditions like infertility?

Only a few states cover the diagnosis and treatment of infertility. Now, don’t get me wrong, I am happy about those few, but even then they limit coverage. The AMA and WHO classify infertility as a disease, wouldn’t it make more sense if insurance companies did too?  Second, what’s the deal with limiting care for this disease?  Over 25,000,000 folks in the U.S. are infertile, against their wishes. Why is there a debate about providing care? Health insurance companies have a requirement to cover podiatry (truly, how many of us even know what podiatry treats?), so why not infertility?

Here is the insurance conundrum for LGBTQ folks: they cannot, by definition, get pregnant without help or medical assistance, i.e., they are missing either eggs, sperm, a uterus, or some combination of those factors.  Should insurance companies have an obligation to cover their care?  I think so.

Why isn’t EVERY IVF center demanding insurance coverage for fertility care? Income streams from insurance-based care is lower than cash base, could that be one reason?  Fertility clinics may think they are busy enough, due to the scarcity of clinics, perhaps that’s why there’s no impetus to push for universal coverage. Private Infertility coverage companies are also canvassing high-dollar tech companies to pay for these services without the support of health insurance companies or government agencies.

But the biggest obstacle, in my view, is that patients are simply not helping themselves!  For 3 years I had a prewritten letter in my waiting room, ready for any patient to fill in the blanks and send to their representatives to demand infertility coverage. In 3 years, only one person wrote a letter. (Yikes!)

Expectations

Many people have a notion of pregnancy and conception as a natural, easy process. What most folks don’t understand is that treatment is often necessary to mitigate factors that hamper the odds of a successful conception, such as pollution, pesticides, herbicides, poor nutrition, poor rest, excess cortisol (the stress hormone), obesity, smoking, caffeine usage, alcohol or marijuana use, prescription drug use, and population density, among others. Humans are predators, and predators actually have a very low reproductive potential. Their peak fertility occurs at under 23 years of age but cultural norms, and personal and professional choices, often delay trying to conceive, and can significantly impact future fertility.

Another factor is that the health status of parents directly impacts their children’s and grandchildren’s future fertility (look up for epigenetics online).  Diseases such as PCOS, endometriosis, poor sperm parameters, and others can be passed on.  Given that an LGBTQ patient can’t “biologically” reproduce, aren’t they (and shouldn’t they be) exceptions to the health insurance paradigms?

Unique needs of LGBTQ patients

Finally, what is so different about a lesbian couple compared to a heterosexual couple that does not have access to sperm?  None, truly. A sperm donor is needed in either case.  For a gay couple, a donor egg and uterus are need. Likewise for a heterosexual couple where the woman has had a hysterectomy, or is menopausal, but wants to add to her family.

Transgender couples are only slightly more complicated. If the transition is male to female, then sperm should be saved before transition or they can use donor sperm. For female to male transitions, eggs should be saved beforehand or donor eggs can be used.

Conclusions

So, for me, each and every patient has “unique” circumstances regarding their fertility options.  In some cases lesbian couples, for example, actually have an advantage in that sperm is relatively cheap to purchase from sperm banks, and if each female is of reproductive age, then the “best” egg and “best” uterus can be used, simple as that! Gay men can use donor eggs (which have the highest reproductive potential) and an optimized uterus (wherein the gestational carrier is usually a proven carrier) so their chances of success are phenomenal.  Don’t let marketing forces make you think you need “special” (read: “more expensive”) treatments.

Please, please, please talk to the HR department at your job and ask for documentation of infertility coverage, in writing, and send a copy to the company’s board of directors or owners.  Please, please, please ask your fertility practice for a letter (you can copy the one on our website) that you can send to your congressman and senators.  Finally, follow developments with and pledge support to Resolve, Path2Parenthood and other organizations that support legislation mandating insurance coverage for fertility care.

You see, your “unique” circumstances aren’t really that unique. When I meet with LGBTQ patients, I see loving couples who want to create a family together. Together, we can make that happen for your family too.