Ariel Cohen and Ben Bowman hold their newborn twins.

Let’s be honest. No one ever really knows what to expect when they’re expecting. Every person’s family-building experience is unique. For LGBTQ people the roadmap to childbearing is especially unclear. According to a Gallup poll, the number of U.S. citizens who don’t identify as heterosexual has doubled in the past ten years. But for queer people looking to begin their family planning journey, there are still a lot of questions in the air.

Luckily for Illinoians, our state is one of the most progressive in terms of reproductive healthcare access for queer people. In July 2021, there was an amendment to the state’s existing infertility insurance law to include LGBTQ+ families and single parents.

“I think probably the best part about this law is that it separates sex from reproduction,” said Dr. Eve Feinberg (she/her), a Reproductive Endocrinology and Infertility specialist. “It basically says that reproduction is a medical issue, and what people do in the bedroom is really outside of this scope. If you want to have a baby and you need medical assistance, you’re entitled to full coverage for that.”

And yet, even with this law, confusion around medical insurance and total costs are inevitable. Part of this is due to a lack of clarity and choice in insurance options. In states like Illinois, the state often dictates what policies exist for people who do not have coverage through a large employer. And for those who do get coverage through their employer, insurance benefits and maximums are determined by their company’s benefits team. Financial, mental, and medical hurdles remain too high for queer individuals, and the process often is frustrating and takes much longer than anticipated. Couples sometimes spend large amounts of time and money trying to conceive without success

Still, queer people may be surprised about the options available to them. Those options depend on what sex organs a person has, their gender identity, and how that identity matches up with a partner’s. Baby-making is no longer such a straightforward process according to state law, and straight couples are not the only template when it comes to family planning. The permutations of what a couple brings to the table have increased, and with that comes confusion around process, timelines, and costs.

Navigating Costs

Kayla Koch (she/her), a mom to a 3-month-old son, was surprised by the lack of financial clarity when she and her wife Madeline (she/her) began planning to conceive. “Something that’s really frustrating about family planning is you don’t know what the costs are,” she said. “You go to the fertility clinic and you say, ‘This is what I want to do, how much is it going to cost?’ And they say, ‘we don’t know.’”

Kayla and Madeline used Progyny Insurance and overall were happy with the company. The couple decided on reciprocal IVF, an estimated $15,000 procedure, and around 75% was covered via their insurance. Reciprocal IVF is a fertility treatment option for cisgender lesbian couples and trans men that allows both partners to have an intimate role in the pregnancy. Partner A harvests and freezes their eggs, which are then transferred to Partner B’s uterus to carry the pregnancy to term. This is a more expensive option than intrauterine insemination (IUI), where concentrated sperm are placed directly in one’s uterus (roughly $5 thousand per cycle).

For Kayla and Madeline, reciprocal IVF was not as straightforward as it sounded. First, the couple had to find sperm–around a $5,000 process that, unlike the IVF procedure itself, was not covered by insurance. Then, the first attempt to retrieve Madeline’s eggs was unsuccessful. The second was a success, and Madeline’s egg was successfully planted in Kayla’s uterus. The process involved hormone injections for both women, as well as planning financial and medical decisions around their cycles. The couple’s first appointment with a fertility specialist was around November 2020; their son was born in November 2022.

Kayla and Madeline Koch prep for the birth of their baby conceived through reciprocal IVF.

Overall, the Kochs’ family planning journey cost around $20,000 with insurance. Without insurance, Kayla estimates the amount would have been triple. Some of the costs were surprising, like $2,000 per year in “storage fees” in case they want to have another child in the future. “We’re paying three storage fees a year. We’re paying for Maddie’s embryos, mine, and the remaining donor sperm that we have, because it’s per patient rather than per family.”

Setting Expectations Without A Uterus

For anyone without a uterus, the family planning process becomes more complicated. Jake Anderson, (he/they) Co-Founder of FertilityIQ, believes that the number of cisgender men pursuing surrogacy in any given year is in the low thousands.

Ari Cohen (he/him) and his husband Ben Bowman (he/him) knew that it was going to be an uphill journey when they decided to try and have a biological child. Unlike the Kochs, who had friends they could talk with, Cohen and Bowman didn’t have anyone in their life who had gone through a similar family planning experience.

“We went to the Men Having Babies Conference here in Chicago, in February 2019,” Cohen said. Men Having Babies is an organization that provides workshops and information for gay prospective parents. Going to the conference helped the couple understand their options as well as set expectations.

“No one was really mincing words when the issue of finances came up, or the extreme amount of time that this process tends to take,” he said. “Each step is significantly longer and more expensive than I think we would have thought.” And yet, even with in depth research, the couple feels that they couldn’t have prepared for the process. They had to go through it.
Cohen and Bowman decided to use a gestational carrier and to implant two embryos instead of one. This meant going through an agency to find a gestational carrier who would be willing to carry twins, as well as finding an anonymous egg donor. The decision was financial as well as practical. Although implanting twins is a riskier process, Cohen and Bowman wanted more than one child and to go through this journey only one time. What’s more, it would allow Cohen and Bowman to each be a biological parent to one of the twins.

Unlike the Kochs, whose insurance covered most of their procedures, Cohen and Bowman had many frustrations. Bowman is an Emergency Medicine Resident at the University of Chicago Medical Center, and the couple figured they would be well covered on his insurance, Blue Cross Blue Shield and Caremark.

Calling On (And Out) Your Insurance

Cohen and Bowman ran into multiple unexpected snags with a health and insurance system that wasn’t built around families like theirs.

Because Cohen’s full name is Ariel, they mistakenly put him in their system as a female. “Initially, it seemed like they were going to be covering a lot of this process. However, once I called them and informed them that I was not female, it became a lot harder.”

One doctor initially refused to implant twins, claiming that the procedure was unsafe. However, according to Cohen and Bowman, the same doctor was unable to cite substantial research that backed his viewpoint.

“Is this because we’re a same sex couple?” Cohen wondered. “Or is there some scientific calculus here that I am not aware of that he actually doesn’t have any sources for?”

Bowman is unsure that the couple would have moved forward without his professional skill set. “I don’t know how someone would navigate this process without knowing the intricacies of insurance or you know, reproductive endocrinology,” he said.

At one point, the couple’s insurance would only cover medication for their gestational carrier if they gave their insurance the biological mother’s name. Unfortunately, because they had used an anonymous egg donor, they didn’t have access to that information. Whenever insurance wouldn’t approve a procedure in a timely fashion, Cohen and Bowman had to pay out of pocket.

“Honestly, it wasn’t a surprise,” said Bowman. “On a daily basis, I see the struggle that my patients go through.” However, just because it wasn’t surprising doesn’t mean the couple didn’t push back.

“I’ll be honest, I spent about five months on the phone with [our insurance],” Cohen said. “And then, when June rolled around, I saw that both Caremark and Blue Cross Blue Shield had very obviously changed their LinkedIn profile stuff to rainbows.”

Cohen typed a post on LinkedIn about his frustrations and tagged both companies. This was in 2021, just before the fertility law went into effect.

“I think some 23,000 people saw the post,” he said. “And then [Caremark and BCBS] called me and gave me, I think somewhere around $5,000 to $10,000 extra that they should have covered.”

Bowman and Cohen celebrate the twins’ first Hanukkah.

Perhaps most surprisingly, after the twins were born, a boy and a girl, Cohen and Bowman still had to legally adopt each other’s biological child. Cohen was caught off guard when his surrogacy agency informed him that they needed to go to court. “We did have to meet with the judge at 8:30 in the morning, and it was a very quick appointment. But it still happened.”

All in all, Cohen and Bowman’s journey was a success. Their twins were born August 22, 2022. They have a good relationship with their gestational carrier, whom they found through an agency. Still, the process took more time and more money than they were expecting. In total, Cohen said their family planning journey cost around $170,000 dollars, with insurance paying for $25,000. The process took around 3 years.

Family Planning and Mental Health

Both the Cohen-Bowman and the Koch families noted that having a therapist was an integral and important part of this process, and something that both of their insurance companies were willing to help cover.

“I’ve been seeing a therapist through this process, and she has been super helpful,” said Kayla. “A lot of people don’t understand the process, and so if you’re the first person they’ve met that’s going through it, they want to know everything. And you may or may not want to have those conversations and you might not have the vocabulary to do that… A therapist is super helpful in navigating what is really murky waters.”

These are just two stories, and every person will have a different journey with different obstacles and successes. Demystifying these processes is the first step to normalizing them.

Dr. Feinberg wants prospective parents to understand the options that are available to them. Prices for queer family planning are certainly high, but one can seek help to cover the costs. Many organizations give grants to couples unable to shoulder the financial burden. The Cohens received $20,000 from The Coalition for Family Building, and Ari currently serves on their board.

Bowman advises queer couples seeking information on family planning that finding a trusted source for answers like The Coalition for Family Building or The Men Having Babies Conference are extremely helpful and much better than trying to google the answer.

“If you start on the Internet, it’s a disaster,” said Bowman. “It’s sort of like if you have a headache and you go to Google, you’re not gonna get an answer. You’re gonna get scared and you’re going to be confused.”

Both couples wished that their process was easier, but the end result is hard to beat.

“Our girl came out first by two minutes,” said Cohen. “She is hilarious. She loves to laugh, and it’s the most charming thing that I have ever experienced in my life… Her brother is younger by two minutes. He now has a full head of hair while his sister is totally bald. He is the chattiest of Cathy’s, and is so so smiley, so it’s impossible to be the least bit frustrated with him when he wakes up three or four times in the night.”

“Both my wife and I are really grateful that we live in a time where science is available for us to create a family together,” said Koch. “Even though I wrote in my journal after my first egg retrieval that I would not do it again, because it was so unpleasant… I would absolutely do it again.”