- Almost two-thirds, 63%, of LGBTQ+ people plan to use assisted reproductive technology, foster care, or adoption to become parents, according to a survey by Family Equality.
- Gay male couples typically face a more expensive journey, as surrogacy or adoption are their primary choices.
- While more employers are offering fertility benefits, many of these packages are limited when it comes to covering surrogacy.
Bret Shuford and Stephen Hanna knew from early on in their relationship they wanted to raise a child together. But the married couple didn't think a biological child was a possibility.
As freelancers in the creative arts, Shuford and Hanna don't always see steady income, even when working on Broadway. The Houston-based couple, known as the "Broadway Husbands," thought having a child with a donor egg and gestational carrier "seemed like it was something that was only available to people who were very wealthy," said Shuford, 44.
It's a safe assumption that having a child with a surrogate, now most often called a gestational carrier, is cost-prohibitive. While expenses vary widely due to a number of medical and legal factors, "the average cost of surrogacy in America has gone from $75,000 five years ago, to anywhere between $150,000 and $250,000 today," according to Dr. Brian Levine, a reproductive endocrinologist who founded surrogacy matching platform Nodal.
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In the U.S., there are only about 5,000 successful surrogacy journeys per year, Nodal estimates.
"That's only about 8% of met need," Levine said. "In plain English, 92% of the people that dream of starting or growing or completing a family with surrogacy will not be able to do so in America due to the sheer time and cost constraints that are there today."
Alon Rivel always wanted to be a father. "As I grew up, I realized I was gay," said Rivel, 34. "So I thought, this will never happen for me. I don't have the money, but I wanted it desperately."
"We were shocked when we started to look into [having a biological child] and realized nothing is covered by insurance unless you can prove that you're infertile," said Rivel, who lives in Arlington, Massachusetts. He and his husband believed that "this is complete discrimination on the insurance company's part because we are gay men."
"It is not a choice," Rivel added. "We were born this way and, thus, we are actually infertile."
Experts say the demand for surrogacy relationships has grown since same-sex marriage became legal in the U.S. in 2015.
Gay male couples typically face a more expensive journey, as surrogacy or adoption are their primary choices. In contrast, same-sex female couples are often able to carry pregnancies to term on their own, though they may possibly have to pay for donor sperm and fertilization.
Donor eggs are exponentially more expensive than donor sperm largely because the egg retrieval process is more invasive and complicated. While costs, again, vary wildly, donor eggs and the associated costs can range between $20,000 and $60,000, according to fertility marketplace GoStork, while donor sperm can be from as little as several hundred dollars to around $1,000.
Donor eggs, meanwhile, are only one of many expenses.
Shuford and Hanna's health insurance covered only the tests done on their sperm samples. Their remaining expenses, they estimate, ran between $150,000 and $180,000. That included around $40,000 for donor eggs, the medical costs to create, store, test and freeze embryos, medical insurance and out-of-pocket medical costs for their gestational carrier, her compensation, and other expenses.
The couple used savings, credit cards and high-interest loans to cover that tab.
Rivel and his husband's journey to parenthood ultimately cost $220,000.
"We're taking money away from our child's college fund," he said. "We're taking money away from our mortgage."
"Compared to [many of] our friends, our baseline is $200,000 below where they started," Rivel added.
More employers are starting to offer fertility benefits, often through a specialized fertility benefits manager such as Kindbody, Carrot, Progyny or Maven. In 2022, 40% of U.S. employers offered some type of fertility coverage, up from 30% in 2020, according to the International Foundation of Employee Benefit Plans.
Fertility IQ, which keeps a workplace index of employer fertility benefits, found the average amount of fertility coverage in 2021 was $36,000 per lifetime, flat from the year before.
But while more companies are offering fertility benefits, many of these packages are limited when it comes to covering what's needed to build families using non-traditional methods.
Almost two-thirds, 63%, of LGBTQ+ people plan to use assisted reproductive technology, foster care or adoption to become parents, according to a survey by Family Equality.
Yet fewer than half of employers offering fertility benefits provided any benefits for adoption, and only about 10% provided benefits related to surrogacy, according to a 2021 survey from Resolve: The National Infertility Association and health-care consultancy Mercer. And state laws requiring employers of a certain size to offer fertility benefits often leave out coverage for third-party reproduction such as a gestational carrier or the purchase of donor eggs or donor sperm.
"I honestly believe that employers don't realize there is a gap in their benefits. And they often don't know this until an employee points that out," said Betsy Campbell, chief engagement officer for Resolve.
She said many employers she speaks to have "the best intentions" but don't understand how gestational surrogacy works or how family building benefits fall short.
Will Porteous, 39, became a father through gestational surrogacy before joining Maven as its chief growth officer. He and his husband tabulated their parenthood path cost at close to $175,000. "No employer in the entire country that I'm aware of offers anything greater than $75,000 a year, and so that only covers a portion."
But Porteous, who lives in Wynnewood, Pennsylvania, said full coverage isn't necessarily what LGBTQ+ couples want to see. "The expectation is to have equitable support to your other co-workers and seeing that your employer cares about that journey," he said.
That employer support, Porteous said, "really means a lot and it shows that you as an employer care about your employee, regardless of how they're going to build their family."
While fertility benefits manager Progyny's first clients were largely West Coast "Silicon Valley-type" businesses, according to CEO Pete Anevski, it now works with employers in 40 industries.
"There's a flywheel effect happening," he said, with more companies realizing benefits need to include family-building coverage "to be competitive, to attract and retain talent in what is still a tight labor market, an inflationary economy, even with concerns around a looming recession."
Fertility benefits manager Carrot said it has around 800 corporate clients and 80% of those offer their employees a benefit for surrogacy. "We have seen an increase in surrogacy claims year over year at about 250%," said CEO Tammy Sun.
Offering these types of benefits can be key factors for a company when job candidates are making decisions about employment, said Taryn Branca, chief revenue officer at Kindbody.
"I can't tell you how many of our clients will call us, we will get on the phone with potential candidates that they're recruiting, or we will provide information to support that recruit coming there because they are asking for very specific information before they'll accept the offer: if they have surrogacy benefits, if they have donor benefits," she said.
More than half of respondents in a new Progyny survey of LGBTQ+ community members said they are actively looking to build their families. Of that population, 79% would consider leaving their current job for one that offers better fertility and family-building benefits, and 80% would consider taking a second job to receive those benefits.
"This is not a 'nice to have,' this is a 'need to have' benefit," Anevski said.
Rivel's husband is an early employee at Massachusetts-based Beam Therapeutics. At Rivel's insistence, he asked his human resources department to look into including surrogacy benefits. Eventually, the company added a surrogacy reimbursement benefit, which at the time Rivel and his husband used it was worth $10,000.
While $10,000 was a small dent in the couple's $220,000 surrogacy journey, Rivel said it's better than nothing. "It's really admirable that they have it," he said. "I think it's a really smart benefit for recruiting more people."
Adoption is certainly another family-building option. "It's not for everyone ... it's not without its costs, and the laws vary by state," Resolve's Campbell said. "Sadly, we do see in some states that there are laws that discriminate against the LGBTQ+ community, so that's definitely a consideration."
The average nonfoster-system adoption costs between $25,000 and $60,000, according to the Child Welfare Information Gateway. As with surrogacy relationships, the adopting parents cover related expenses for all parties, from medical to legal, plus living expenses if a match is made in advance of a birth. And, of course, there are no guarantees.
Shuford and Hanna decided adoption wasn't a path for them. "There's a lot of risks involved that we weren't willing to take," Hanna said. "We had heard of stories involving birth mothers changing their minds, and children having birth defects that without [genetic embryo testing] weren't known."
Like many gestational carrier stories, Shuford and Hanna's was far from easy or straightforward.
Their first carrier dropped out of the process shortly before the embryo transfer was scheduled to take place but well after contracts had been signed and medical assessments and travel had occurred. The Covid-19 pandemic delayed the process with their second gestational carrier; then, after the first embryo transfer, the pregnancy ended in a devastating miscarriage. The second embryo transfer worked, and their surrogate gave birth to their son, Maverick, in 2022.
"So many times, we felt very excluded," Shuford said. "We want to be able to have a family and raise our child and have that child be biologically related to us, and we have a right to do that, and we have a right to feel seen and validated in that process."
But for Shuford, "in the end, it was totally worth it."
"I mean, Maverick is amazing," he added. "And we're so lucky to have a healthy baby and also having someone like Crystal, our surrogate who carried our child."
"I don't know that I've ever experienced that kind of love in my life," Shuford said. "So it's really a powerful experience."