The State of LGBTQ+ Fertility and Family Building

lesbian couple with their young baby

We’ve come a long way in LGBTQ+ family building. With advances in reproductive technology, there are now more ways than ever to grow families. But LGBTQ+ access to fertility and family building care, especially in the workplace, still has miles to go.

We recently surveyed 1,000 LGBTQ+ individuals to help employers better understand their dreams of expanding their families, the barriers that continue to get in their way, and how much access to support they have.

We found that despite a rise in employer-sponsored coverage options, coverage for LGBTQ+ families is far from equitable.  

Here, we examine the state of LGBTQ+ family building, explore the modern options for growing LGBTQ+ families, and provide resources to help ignite a conversation about more equitable access to family building benefits.

LGBTQ+ Fertility and Family Building Survey shows significant gaps in access

Here are a few key findings from our recent LGBTQ+ Fertility and Family Benefits Survey:

  • 68% of survey respondents with a fertility benefit are “locked out” of access because a diagnosis of infertility is usually needed to access the coverage (and this diagnosis often requires heterosexual intercourse).
  • LGBTQ+ families are looking to grow as more than half of respondents indicated they’re actively trying to expand their families.
  • Growing families are worried about the cost of expanding. Many are relying on outside sources for funding. These include personal savings (61%), taking out loans (27%), borrowing from friends and family (33%), and applying for grants (11%).
  • 62% of respondents see fertility coverage at work as a priority. For respondents that are looking to expand their families, 79% would consider leaving their current job for one that offers these benefits. Furthermore, 81% said they would even take on a second job to get fertility coverage!

You can dig into the survey results in full here.

The findings highlight a real disparity between how LGBTQ+ individuals and their heterosexual counterparts can access the same coverage. But they also signal to employers that equitable coverage is desired and highlights an opportunity to recruit world-class talent with smart benefit plans that make an impact.

So, how do we start a dialogue about better care for our growing LGBTQ+ families? We help benefit leaders learn about the LGBTQ+ parenthood options their employees are exploring and the barriers they face. We mobilize our support resources. We bring awareness to the impact employers and plans can make and help them understand that can have a major effect on this community.

LGBTQ+ family building: common pathways

The right to family is universal and there are options for each path to parenthood. Your workforce is looking for support.

Reciprocal IVF

For a couple where both are female sex assigned at birth, reciprocal IVF allows both partners to play a key role in having a child.

In this process, partner A provides eggs. Those eggs are fertilized with donor sperm to develop embryos. Those embryos are frozen, then genetically tested. The highest quality embryo is then transferred into partner B. Partner B will then carry the pregnancy to term.

Common Coverage Barrier: Eligibility requires a medical necessity diagnosis due to infertility (same-sex couples need access to coverage regardless of fertility status).

Solution: Remove eligibility restrictions around fertility diagnoses.

View Progyny’s Reciprocal IVF infographic to see the process.

Check out Chrissy and Lindsey’s story on expanding their family with reciprocal IVF.


Surrogacy is an excellent option for couples where both are male sex assigned by birth or single parents by choice. This option is when a third-party carries a child for the intended parent(s). The child is typically not genetically related to the gestational carrier.

Intended parent(s) create embryos with their sperm (or donor sperm) and their egg or a donor egg. Then the highest-quality embryo is transferred to a gestational carrier who carries the pregnancy.

Common Coverage Barrier: Coverage exclusion or not enough financial flexibility within the plan design.

Solution: Include resources and services that support surrogacy, such as a financial assistance program that offsets some of the costs.

Interested in a deep dive into the surrogacy member experience? Check out Progyny’s LGBTQ+ Family Building: Surrogacy 101, then dig into LGBTQ+ Family Building: Donor 101 to learn how egg and sperm donation relates to IVF and surrogacy. 


Adoption is another meaningful path to parenthood that can help expand LGBTQ+ families. The process can be complex, but there are some factors you can explore to determine if adoption is right for you.

Common Coverage Barrier: Coverage exclusion or not enough financial flexibility within the plan design.

Solution: Include resources and services that support adoption, such as a financial assistance program that offsets some of the costs.

Check out Understanding the Adoption Process to understand this pathway to parenthood.

Fertility preservation

Tissue cryopreservation, such as egg or sperm freezing, is used in many fertility treatments and family building approaches. For transgender individuals, it can be especially beneficial to preserve fertility before gender-affirming treatments or therapies which may affect fertility, either temporarily or permanently. Therefore, cryopreservation before these therapies can help transgender people to preserve their own genetic material. This allows them to expand their family in the future if they wish, using their frozen sperm or eggs.  

Common Coverage Barrier: Coverage exclusion or medical necessity diagnosis due to infertility required.

Solution: Include in coverage and make sure there are no eligibility restrictions around requiring infertility diagnoses, including for dependents (adult children). 

Hear Dr. Mark Leondires, of Illume Fertility and Gay Parents to Be, talk about the importance of covering egg freezing as part of your strategy to support your LGBTQ+ workforce.

Educational resources to expand access to LGBTQ+ family building support 

What do we do with this information?  

Employees can get to work – at work 

One of the richest fields for change in the LGBTQ+ family building space is at the employer level. Benefits leaders and insurance companies have the power to influence fertility coverage in the workplace. This changes LGBTQ+ individuals’ access at its most basic levels.  

Resources for benefits leaders

If you work in the benefits space, you know that there’s a complex dance involved with expanding coverage. But in the war for talent, you also know how powerful a meaningful benefit can be.  

Contrary to widely held belief, adding fertility coverage for employees does not mean a significant increase in health care costs. A RESOLVE survey that included more than 450 employers revealed that 97% of employers who cover infertility did not incur a notable rise in costs, even when they cover IVF.  

Here are some key resources for exploring and advocating for better family building benefits at your organization:  

There is a clear need for better LGBTQ+ family building support. These resources can help make a compelling case for creating improved benefits.

Resources for the LGBTQ+ community and allies

LGBTQ+ individuals or couples who are considering family building have many options. There are numerous resources available to help them.

Progyny’s LGBTQ+ resource center is a great place to start. We have been working with LGBTQ+ families since 2018 (hear from some of our LGBTQ+ families). We have created articles, infographics, podcasts, and interviews with experts to help you explore the different family building options and fertility treatments. 

There are many voices advocating for LGBTQ+ family building care:

  • Family Equality is a nonprofit dedicated to the advancement of family building equality for the LGBTQ+ community. The organization offers helpful resources, support groups, and special events. The group is also active in advocacy, fighting for policy change that benefits LGBTQ+ family builders.  
  • RESOLVE, The National Infertility Association provides advocacy, educational resources, support, and awareness-building efforts. The organization also undertakes specific legislative initiatives and provides resources for LGBTQ+ families.  
  • XHood is focused on creating a community where Black queer people can feel supported and empower in their family building journey. The organization provides a variety of services. They host safe forums and support groups, facilitate financial assistance, and curate a directory of affirming care providers. Additionally, they host a wide range of events.  
  • Men Having Babies provides support for gay men who are pursuing family building through surrogacy. The group hosts conferences, webinars, workshops, and a grant program that has provided funding to hundreds of growing families.  

For LGBTQ+ family builders and allies who want to drive change from within – learn out to lend your voice here.  

Together, we can create a world with more equitable support – and where anyone who wants to pursue the dream of having a family can do so.  

Ready to discuss a better way to support your LGBTQ+ workforce? Contact Progyny