My pregnancy began with my feet dangling haphazardly over the top of my bathtub. I’d duct-taped a hand mirror to the side of the tub so that if I squinted, I could see my own open cervix just well enough to guide a catheter through it into my uterus. It was my own version of intrauterine insemination (IUI), which is typically performed in medical facilities. However, I am queer, single, disabled, and most of all low-income, and thus unable to afford sperm banks or clinic-based IUI. When you don’t have access to institutions, you make do, so I read about the process and watched patient education videos until I felt brave enough to try it on myself.
This left me with my trusty headlamp, my speculum, and sperm donated by an old friend from growing up — a gay man who also planned to love my baby. In what was becoming our own weird tradition, I cooked him dinner and then left to walk my dog while he ejaculated into a red plastic solo cup. After my friend let himself out of my apartment, I began “washing” the sample he left on my bathroom counter, a procedure that separates the sperm from the semen surrounding it, using a $60 centrifuge I purchased from a science supply store.
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I tried to inseminate at least twice per menstrual cycle, and it became so routine that my friend once accidentally blurted out that he needed to go jerk off at my place when a coworker asked why he wasn’t staying late for a team dinner. It was pure queer magic. I became pregnant after nearly a year of this.
My pregnancy, sadly, ended in stillbirth, for reasons totally unrelated to how I became pregnant (I contracted cytomegalovirus, a common virus that causes mild cold-like symptoms in adults but can be lethal for a fetus). Like many relationships that are tested by stillbirth and grief, my friend and I are no longer close. Certainly not close enough to resume trading a home-cooked meal for a party cup of semen.
Adoption was actually my first choice for parenting, but it is not friendly to low-income people. It often costs $20,00 to $40,000 or more for private domestic adoptions, and fostering or adopting through the deeply flawed child welfare system involves an extensive assessment process that costs around $900 to $3,000. Though grants and other forms of financial assistance are often available for the assessment itself, it’s likely that evaluators would count my poverty, my small apartment, my queerness, my disability, my background and beliefs as a radical activist, and even my sweet old pit bull as strikes against me. So for me to be a parent — for me to get to experience the sweetness of morning cuddles, the endless questions and challenges, the beautiful and mundane care work of guiding new life across a dying world — pregnancy is my best option.
However, without the ready access to fresh sperm that my friend provided, getting pregnant again will be expensive as hell. In addition to purchasing the sperm itself, which often retails for more than $850 a vial, there are storage fees ($350 per year), shipping fees ($180), and fees for viewing donor profiles ($50 for three months). All for a single attempt at insemination.
And it usually doesn’t stop at just one vial: Even for people in their 20s and early 30s, when it is generally easier to conceive, IUI has a success rate of less than 20 percent per attempt, and typically needs to be tried multiple times. In fact, in one study, only 24 percent of people had a live birth after 3 cycles of IUI, even when they attempted two IUIs per menstrual cycle. And while the birth rate rises with more IUI attempts, so does the cost.
In other words, even assuming the bare minimum cost for each IUI attempt, three attempts at IUI could cost $3,490, for a one-in-four chance of becoming pregnant.
And that’s just the sperm. Conception-related health care is also expensive, with costs for IUI in a clinic ranging from $250 to $4000 per attempt. Fertility specialists recommend moving to in vitro fertilization (IVF), which begins at $12,000 to $15,000, after three unsuccessful IUI cycles. Insurance companies, however, often demand that prospective LGBTQ parents “prove” their infertility by paying out of pocket for six or more in-clinic IUIs before providing insurance coverage for IVF (self-insemination doesn’t count towards this total). This means that, even with insurance, queer people might have to spend over $30,000 ($6,580 on sperm and another $24,000 on clinic fees) before their insurance begins to cover fertility care. (Straight, cisgender couples, in contrast, typically receive coverage if they report having unprotected sex for 6 months to a year.) For people who rely on surrogacy, the costs often start at six figures in the U.S.
These costs are obviously not an option for low-income people. So, we either don’t have kids or we get creative. Hence the duct tape.
Studies show that queer people want children at the same rate as straight people, but our access to parenthood is limited by our statistically lower incomes and, for those of us who don’t produce it, the price of sperm. The high cost of fertility treatments like IUI is often significantly, disproportionally burdensome for queer people, who are more likely than our cishet counterparts to live in poverty, especially if we are people of color, trans, gender nonconforming, or women.
Queer people like me are also more likely to have or acquire disabilities — in my case a brain injury from police brutality. Disabled people are almost twice as likely to experience poverty, with even higher poverty rates among disabled women, gender minorities, LGBTQ folks, and people of color. People who receive certain disability benefits can lose them if they ever amass assets worth more than $2000, which prevents disabled people from saving up for sperm, pregnancy, or parenting.
Sperm banking is a big business, with profits reported at almost 4.8 billion globally. Sperm banks are just one facet of the rapidly growing — and incredibly profitable — fertility industry, valued at 8 billion dollars in the U.S. alone. This industry is prone to predatory behavior, and increasingly controlled by venture capitalists.
Regulation might help with this, especially if it was designed to explicitly protect queer families and other oppressed groups. In addition, there is no reason to require people to undergo psychological evaluations (another expense) nor get a physician’s permission to purchase and receive sperm, though many sperm banks and clinics do.
Currently, just one state (New York) extends fertility coverage to people on Medicaid, the largest insurer of people living in poverty; fertility coverage for people on Medicaid must be extended nation-wide. Further, only 19 states mandate that private insurance companies cover any kind of fertility-related services. As described above, insurance industry policies often result in queer people having to pay dramatically more for care than straight couples.
A recent lawsuit against Aetna Health claimed this disparity constitutes a violation of Section 1557 of the Affordable Care Act, which bans insurance companies and health care entities from discriminating on the basis of sex. Though Aetna updated their policy within days of the lawsuit, Section 1557 should continue to be applied to ensure equitable treatment of LGBTQ health care consumers, including when it comes to building our families. I also want more legislation, such as the law recently enacted in Illinois, designed to prevent queer parents from having to pay more than our cishet counterparts to access fertility treatment.
Until we have equitable policies that protect us, queer people will care for each other, including helping each other build families. I started teaching friends and neighbors in my local queer community how to wash sperm and perform IUIs on themselves and their partners, usually in exchange for beer and pizza. Many of my friends were using known donors for the same reasons I had: cost. Even folks who were using sperm banks often wanted to do their own IUIs to save money after the outrageous amount they had spent acquiring each precious vial of semen.
I still dream of parenting, but it seems more and more out of reach as I approach 40 and my credit card debt gets worse, not better. I know I’d be a good parent, in that I would love my child hard, with the same drive that had me taping a mirror to my bathtub and processing semen in a centrifuge meant for high school chemistry classrooms. What stops me is not doubt, or even exhaustion, but the cost of being beautifully queer in a world that privileges heterosexuality.