Information Hub / LGBTQ+

Sharing a glass of wine or enjoying a night out with friends is a normal part of life for many people, but when you’re trying to conceive, it’s natural to wonder how alcohol might affect your fertility journey. The research is clear: alcohol can affect both male and female fertility, and even small amounts may make it harder to conceive. 

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Key Facts About Alcohol and Fertility 

• Any amount of alcohol may reduce fertility - there is no “safe” level when trying to conceive. 

• Alcohol affects both men and women - it can impair egg and sperm quality, making conception more difficult. 
• Drinking before conception can affect pregnancy outcomes - heavy or sustained alcohol use is linked to an increased risk of miscarriage and congenital conditions. 

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How does alcohol affect female fertility?

Studies show that alcohol can: 

Surrogacy is an agreement where a woman will carry a baby for a couple or individual who cannot conceive.

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With traditional surrogacy, sperm is inserted into the surrogate and with host surrogacy, an embryo is implanted. Host surrogacy has become more common. The surrogate will carry the baby, give birth and then, if she is still in agreement, hand the baby over to the intended parent(s).

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Who might choose to have a surrogate and why?

Surrogacy is a way that people who cannot conceive themselves, can still be the biological parent or parents of a child. Surrogacy could be an option for a single person, a gay couple or a heterosexual couple who cannot conceive naturally or through IUI or IVF. It’s also a possible option when pregnancy has resulted in many miscarriages because the intended mother has been unable to carry a baby to term, or when there is another medical or physical reason.

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Who might choose to become a surrogate mother?

A woman may choose to become a surrogate mother when she has completed her own family or has no wish to bring up more children at that point in time. In many cases, it’s a feeling of wanting to give other people the chance to become parents that is the driving force to become a surrogate.

In the UK, it is illegal to pay a surrogate, so it is not a means of earning an income. Expenses are provided to the surrogate, such as loss of earnings, maternity clothes and childcare for her own children, so that she is not out of pocket.

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What are the legal implications of surrogacy? 

Although surrogacy is legal in the UK, a surrogacy agreement cannot be enforced by the law. Therefore, the surrogate is the legal parent until she signs the baby over by parental order or adoption to the intended parent(s). If she is married or has a legal partner, they are classed as the other parent, until the baby is signed over to the intended parents. This is the case, even if the intended couple has used their own eggs and sperm.

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How can people find a surrogate in the UK or overseas?

Surrogates are not allowed to advertise in the UK, so individuals or couples in the UK can either contact a non-profit agency for help or look overseas. It is important for the surrogate and intended parents to share a good relationship.

As a surrogate agreement is not enforceable in the UK and there are not enough surrogates available to fill the demand, around half of the people looking for a surrogate, choose to look overseas. In countries where commercial surrogacy is permitted and the intended parents can be named on the birth certificate, it gives more peace of mind and security to the intended parents. However, it is important to seek advice from immigration specialists in both countries, so that the intended parents don’t get stuck overseas.

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What is National

Your chance of having a biological child as a transgender individual very much depends on whether you are a trans man or a trans woman, how far along you are in your transitioning journey and any steps you may have already taken to preserve your fertility.

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What steps do I need to take to preserve my fertility for the future, before undergoing hormone treatment and surgery to become a trans woman?

If you want to have a child that is genetically linked to you, then before undergoing hormone treatment and surgery, you will need to have your sperm frozen. This will enable you to have IVF, IUI or ICSI treatment, with either your female partner (if you have one) or a surrogate, carrying your baby.

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What steps do I need to take to preserve my fertility for the future, before undergoing hormone treatment and surgery to become a trans man?

We are Laura-Rose & Stacey, a married couple, who have been together for fifteen years. 

When we first started out on our path to parenthood, there were no support systems or organisations around for same sex couples wanting to start a family together. Everything was set up to cater for the needs of heterosexual couples and there was a massive lack of information available to us. We had to ‘muddle’ through and at times it was disheartening & frustrating. We felt unsupported and isolated without the benefit of others around us to learn from, who had been through similar feelings and experiences.

At the time when we started our journey, we had so many questions.

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What ARE our options? Do we want to carry a child? Who carries? How? How much does it cost? Where can we do it? How do we choose a donor? Where would we find a donor? How long would it take to fall pregnant? What other routes are available for us? The list was endless. 

Throughout our journey, we were often being contacted by others who wanted to know their options too and had those same burning questions that we did. We’d be contacted through social media, work, friends of friends, even in the recovery room after having one of our children! 

It became such a frequent occurrence, that it soon became apparent that there was a need for an organisation & community for people like us. Information needed to be more readily available for LGBT couples who wanted to start their own family too. IVF is challenging for heterosexual couples, but even more complex for same sex couples and it was clear that a support network was needed to help them to deal with everything involved, the practicalities as well as the emotional implications. We knew we had to use our lived experience, knowledge & expertise of dealing with multiple organisations over the years and with that, LGBT MUMMIES (formerly The LGBT Mummies Tribe) was born.

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Over the past eleven years and as our organisation has continued to grow

We have been incredibly lucky to have had three miracle children by IUI & IVF. But our journey wasn’t always easy- over that time we have had a total of 12 cycles & spent in excess of £50k to have our children. We have navigated severe PCOS, miscarriage, multiple failed cycles, a diminished ovarian reserve, birth trauma & trying to conceive during the global pandemic! There were times that it nearly broke us and we thought we wouldn’t be able to continue. with & implications that accompany most LGBT+ journey like lack of funded access to finance children. 

For same-sex couples in England, the cost can be even greater, because even if their local NHS Trust funds IVF for same-sex couples, they have to go through at least 6 self-funded, unsuccessful IUIs first (in a private clinic) to prove their infertility.

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For heterosexual couples there is no such cost, as their infertility is proven by 6-18 months of trying to conceive through sexual intercourse and being unsuccessful.

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How can we find out if we are entitled to funded treatment?

Your GP will be able to talk to you about your plans to start a family and can advise on any tests and medical examinations, as well as having a conversation with you about your medical and family history. They can also tell you about the NICE (National Institute for Health and Care Excellence) guidelines and any extra exemptions imposed by your local NHS Trust.‍

How much do same-sex couples have to pay for IUI?

IUI is a popular method of trying to conceive for same-sex couples and single women, as it’s less invasive than IVF and cheaper. It can work for women who have no other known barriers to conception. Costs can vary considerably, from hundreds of pounds per cycle, to around £3,000 per cycle and medication may bring additional charges. Donor sperm (enough for one cycle) is around £1,000. Bearing in mind that in most areas of England, same-sex couples have to have gone through at least 6 unsuccessful attempts of IUI before qualifying for NHS funded IVF if they need it, for many this is prohibitively expensive.

How much do same-sex couples have to pay for IVF?  

Privately funded IVF is more expensive than IUI and is around £5,000. Donor sperm for one cycle is around £1,000. Costs will vary according to the clinic and what is included in the package price. 

For surrogacy using IVF, the costs would be the same, plus expenses agreed by the couple and the surrogate in advance of starting the process.  

Is it cheaper to go abroad for IVF treatment?

If you want to have a biological connection to your child, then the options open to you might be IUI, IVF, surrogacy or co-parenting. 

If, for some reason, this is not possible for you in your circumstances, you could opt to foster or adopt a child. Fostering and adoption are also first choice options for many people, who wish to provide a secure home for a child who cannot live with their biological parents.

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What is the difference between IUI and IVF and which should I choose?

IUI (intrauterine insemination, is where sperm is inserted directly into the uterus, via a thin tube, around the time of ovulation. This can be done with or without the use of fertility drugs. It is a simpler and less invasive form of ART (assisted reproductive technique) than IVF, with few side-effects. It is suitable for women who have no diagnosed barriers to conception.

IVF (invitro fertilisation) involves multiple hospital visits, fertility drugs, self-injection, egg collection and embryo transfer. If there are issues with blocked or damaged fallopian tubes, then IVF is considered to be a more viable option than IUI.

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As a single female, where can I find donor sperm?

Donor sperm can be obtained from a sperm bank or from someone you know. The sperm will be frozen and screened first, to test for infection or any genetic disorders. It is important to look into what your rights are when using donor sperm.

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As a single male, where can I find a surrogate?

It is illegal to pay a surrogate or to advertise as a surrogate in the UK, so you would have to go through an agency. In addition to this, in the UK, surrogate agreements are not legally enforceable, so the surrogate mother has full parental rights until she signs over those rights after the birth. There is a risk, therefore, that she may decide to keep the baby. 

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What does co-parenting involve?

Co-parenting involves two people who are not a couple, choosing to have a baby together and share parental rights. As with the use of donor sperm or surrogacy, it is really important to have a clear, legal agreement in place and to be aware of your legal rights.

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Would I be eligible for NHS funded IUI or IVF?

In England, single people and same sex couples are often expected to self-fund several cycles of IUI, to prove their infertility, before they will qualify for NHS funded treatment. Each local area also has different restrictions around funded treatment, so it is wise to talk to your GP first to find out if you would qualify for funding.

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Who is eligible to foster and what is involved?

In a world where the focus is on creating equality of opportunity and rights for all individuals, in some areas, it is still lacking. 

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So, what might be the cause of the perceived inequality when it comes to fertility? Is it down to a lack of funding, research, understanding, knowledge or care? Is it because of the attitudes and beliefs of staff, or the perception of the patients to how they are being treated? It’s likely to be a combination of factors, but it’s something that needs addressing. Society has more recently become increasingly aware of the need for a change of language in order to improve equality, acceptance and integration, but there is further to go. 

How are the needs of trans and gender diverse individuals different from others needing fertility treatment? 

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Anyone undergoing fertility treatment will have experienced an inability to conceive naturally, whether that is through a medical barrier, undiagnosed infertility, lack of a sexual partner or gender diversity.

For most people going through infertility, it is emotionally, physically and financially challenging. For people undergoing surgery, they may also need to consider preserving their fertility for later down the line, when they are ready to start a family. In the case of trans and gender diverse individuals, they may experience all of this, along with the possible judgement stemming from antiquated thinking and prejudice.

It's important that every patient’s psychological and emotional needs as well as their physical and medical ones are taken care of when they are going through surgery or treatment, regardless of their gender or sexual orientation.

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Why is there a funding difference for heterosexual couples and other couples?

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Although trans gender and gender diverse couples do qualify for some treatments in some areas of the UK, in other areas they don’t. This is due to individual NHS trusts, which can add additional conditions and requirements to those imposed by NICE (National Institute for Health and Care Excellence).

As heterosexual couples could establish their infertility by trying unsuccessfully to get pregnant through sexual intercourse over a given time period (age dependant) so in many cases, single, same sex, gender diverse and trans individuals have been expected to self-fund their cycles of IUI, before being deemed infertile and accessing NHS treatment.

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The Royal College of Obstetricians and Gynaecologists, recently created a draft guideline relating to the care of transgender and gender diverse people. The following paragraphs have been taken from the draft guideline document.

For a large proportion of the population, regardless of their gender or relationship status, having a baby and starting a family is something that they see as an integral part of their future. 

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For heterosexual couples, in most cases this can be achieved through intercourse with their partner, although many heterosexual couples still have to go through ART (Assisted Reproductive Techniques) like IUI, IVF or ICSI, to deal with issues of infertility.

For the LGBTQ community, however, it’s not as simple as that. Having a baby can involve a great deal more planning, organisation and expense, even if there are no obvious fertility issues involved.

What options are available to help lesbian, gay, bisexual, trans or queer individuals or couples to become parents?

Where conception through unprotected sexual intercourse with your partner cannot or does not lead to conception, there are a variety of other options available.

Methods include:

• Fostering or adoption, where there is usually no biological link between the foster parent/adoptive parent(s) and the child.
• Donor insemination
• IVF with donor sperm 
• Reciprocal IVF/shared motherhood
• Co-parenting
• Surrogacy

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The UK is not united when it comes to funded fertility treatments 

In Scotland and Wales, the NHS offers fertility treatment with fewer exemption categories than in England.  In England, the NICE (National Institute for Health and Care Excellence) guidelines are set and must be met, however, the individual clinical commissioning groups across the country (NHS Trusts), are at liberty to add in additional exemption categories. This makes it harder for people living in some areas of the country to receive this treatment than for others living elsewhere – it’s a postcode lottery. What’s more, some trusts do not fund IVF treatment for same-sex couples or single women, unless they have privately funded at least 6 unsuccessful IUI treatments first. The reason given, is that they have to prove that they are infertile before they are eligible for NHS funding, which heterosexual couples can do without expense through sexual intercourse, over the given period of 6-24 months, depending on the age of the female. 

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Cost implications and parental rights for the LGBTQ community

Unless you qualify for funded NHS treatment, most of the options available for those unable to conceive through sexual intercourse, come with a huge financial cost. Some of these options may also mean that you have no automatic legal parental rights to your child. Getting donor sperm incurs a cost, as do options like IUI in a clinic and IVF, though going through a clinic in the UK ensures that the sperm are rigorously screened for infection and the best sperm are selected and it can also offer the benefit of parental rights in some cases. 

It’s become increasingly more common for members of the LGBTQ+ community to become parents.

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How can a same sex couple have a baby?

Adoption and fostering are options, but where individuals or couples want to have a baby that’s biologically connected to them or to their partner, they may need to have fertility treatment. There are a variety of different ways to do this, depending on the sex, age, fertility issues and circumstances of each person.

Donor insemination, IVF with donor sperm, reciprocal IVF/shared motherhood, co-parenting and surrogacy, are some of the options available to LGBTQ+ couples or individuals.

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What is donor insemination?

Donor insemination involves sperm from a donor, being placed into the woman who is going to carry the baby. This is referred to as IUI in the clinics, where the sperm can be screened to check for genetic disorders and infections and the woman is monitored, so that the sperm is inserted as near to ovulation as possible.

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What is IVF with donor sperm?

Fertility drugs are given to the female partner to stimulate the ovaries to produce more eggs. The eggs are removed and sperm from the donor is put with the eggs in the lab to fertilise them. After a few days, one, or maybe two viable embryos, can be placed directly into the female partner’s uterus.

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What is involved with reciprocal IVF/shared motherhood?

With reciprocal IVF (also known as shared motherhood) the eggs from one of the female partners (in a same sex couple) can be extracted and fertilised in the lab by donor sperm. Then one or two viable embryos can be inserted into the uterus of the other female partner. This allows both female partners to be more involved in the pregnancy.

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What is co-parenting?

Co-parenting is when 2 people (who are not part of the same couple) team up to have a baby together.

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What is IVF surrogacy?

IVF surrogacy involves finding a woman to act as a surrogate, who will carry the embryo and pregnancy to full term. In the UK, it is illegal to pay a surrogate, but they can claim expenses and it’s important to incorporate a clause around expenses when formulating a surrogacy agreement. There are agencies that can help with finding a surrogate. It’s also possible to choose to have an egg from an anonymous donor.

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What are the legal implications around some of the LGBTQ+ options for becoming parents?

• With donor insemination done at a clinic, lesbian couples who are civil partners when the baby is conceived, will both be treated as their child’s legal parents, so will lesbian couples who are not civil partners. However, if the insemination is done at home, if there is no civil partnership at the time of conception, the non-birth mother will have no legal rights and would have to adopt the child to be a legal parent.
• With co-parenting, neither person has sole custody, so agreements have to be in place,

It’s important for anyone going through infertility issues, regardless of their gender or sexuality, to find a fertility clinic that is suited to their fertility needs and their personal preference.  

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For some people, a large clinic with a greater feeling of anonymity, might suit them best, whereas for others, a small clinic, where the same staff will deal with them on each visit, can help them to feel more relaxed.

For many LGBT+ people, trying for a baby is just one of many challenging life experiences brought about by their sexuality and other people’s responses. 

While most clinics should be able to cater for a wide variety of needs, finding one where you feel comfortable and you know the clinic are used to catering for people on a similar fertility journey to you, will help you to feel more relaxed and confident about your treatment.

Here at the IVF Network, although we cannot recommend individual clinics, we can tell you what to look for, to help make your selection easier. Through our dedicated channel of experts and through our website and blog posts, we provide information to help you to make informed choices on your fertility journey. 

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Do I qualify for NHS-funded IVF?

NICE (National Institute for Health and Care Excellence) guidelines in England stipulate the minimum requirements for NHS-funded fertility treatment, however, local NHS Trusts can impose additional exemptions. 

In many cases, same-sex couples and single women, for example, have to have undergone at least 6 privately-funded, unsuccessful IUI treatments in a registered clinic, before they are allowed IVF through the NHS. It’s important to check with your GP or clinic, what the regulations are in the area where you live, so that you are fully informed. Scotland and Wales have less exemptions than England. 

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What will I need to look for in a fertility clinic?

For anyone looking for a fertility clinic, there are certain key things to look out for:

• Are the staff qualified and experienced in treating patients with a similar diagnosis or need to yours?
• Do the staff take time to listen to you and answer your questions fully?
• Is there a transparent pricing scheme, so you know immediately what is (and importantly what isn’t) included in their packages?
• How are embryos, eggs and sperm stored, are there measures in place to protect them, in the event of power failure?
• How well-organised does the clinic seem? 
• Is there a team that will offer emotional support as well as medical treatment?
• Are sperm rigorously checked for genetic abnormalities or infections?  
• If the clinic is in the UK, how well does it meet the HFEA standards?

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Are overseas fertility clinics cheaper?

Many people do choose to go abroad for fertility treatment, due to the costs in the UK.

It’s important when considering overseas treatment, that you factor in extra costs, like travel, insurance, accommodation and convenience. 

Difficulty conceiving comes as a shock to many people. It’s likely that for a large chunk of your life, you have been using contraception to avoid pregnancy, so the idea that you can’t, now that you want to, may feel even more frustrating.

The best option for preserving fertility is to freeze eggs or sperm, before starting any hormone treatment or undergoing surgery. This opens up a wide range of options for assisted reproduction in the future, including IUI, IVF, IVF with ICSI, reciprocal IVF/shared motherhood or the use of a surrogate.

If you or your partner (if you have one) are unable to have your own biological child, then fostering or adoption may be another route to parenthood for you to consider.  

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What are my options as a trans man for having a biologically linked child?

If you have not fully transitioned and have retained your ovaries and uterus, then you may be able to conceive naturally with a male partner, or through IUI, IVF or ICSI, using donor sperm or a partner’s sperm. If you have already had hormone treatment, however, this may affect your ability to conceive.

If you have frozen your eggs before fully transitioning, you may wish to choose reciprocal IVF/shared motherhood with your female partner (if you have one) or use a surrogate to carry your biological child.

What are my options as a trans woman for having a biologically linked child?

Research is still ongoing, however, as it currently stands, it is not medically possible for a trans woman to have a uterus transplant.

If you have frozen your sperm before undergoing hormone treatment or surgery, then your sperm can be used for IUI, IVF or ICSI with your female partner (if you have one) or with a surrogate.  

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What costs are involved with fertility treatment?

You may have to pay for your eggs or sperm to be frozen and stored.

You may qualify for some NHS funding, depending on where you live.

Currently, trans individuals, same sex couples and single heterosexual people in England, have to self-fund at least six unsuccessful cycles of IUI, before receiving funded treatment.

Although surrogates in England are not allowed to be paid, you will have to pay for any expenses she will incur, as a result of any fertility treatment, for example, time off for appointments and time off during pregnancy and after the birth.

If I have a baby through surrogacy, will the surrogate mother have parental rights?

Surrogacy agreements are legally binding in some countries, but not in the UK.

This comes with an element of risk, as even if you use your own sperm or eggs, the surrogate has full legal parental rights until the baby is born. It is then still her decision as to whether she signs parental rights over to you and if she decides to keep the baby herself, she is legally entitled to do so.

It is recommended that everyone going through fertility treatment has counselling, however, if you are considering surrogacy, it is also wise to seek legal advice.

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