Since the moment their three-year-old daughter was born, Tianne Spence-Stokes and her partner Carina have seen their lives upended in the most magical way possible.
As a same-sex couple, they had spent years and thousands of pounds undergoing fertility treatments involving a sperm donor to get pregnant. In 2022, they welcomed their baby girl, who they describe as “the greatest joy of our lives”, and now hope to welcome a second child through in vitro fertilisation (IVF).
Yet they face a staggering bill of more than £20,000 to expand their family. Unlike heterosexual couples, they also had to fully fund fertility treatment during their first pregnancy.
While heterosexual couples are also excluded from NHS-funded fertility treatment for a second child, female same-sex couples must pay for additional intrauterine insemination (IUI) testing before they can seek IUI or IVF.
“It feels like the treatment was never meant for us, that we are added on as an afterthought,” Tianne told The Independent. “A lot of the processes for fertility treatment are very heteronormative, and have a negative impact on marginalised communities.”
For same-sex female couples, there are two main pathways to getting pregnant. IUI is a non-surgical procedure in which sperm is injected into the uterus, while IVF is the process of removing an egg from a woman’s ovaries and fertilising it with sperm in a lab.
Both procedures are costly, with the majority of Integrated Care Boards (ICBs) – which are responsible for commissioning NHS services in local areas – insisting that queer women undergo three to 12 rounds of IUIs before they can be deemed eligible for IVF.
Same-sex female couples in 38 out of 42 ICBs across England usually have to pay up to £25,000 for treatment or have up to 12 rounds of private IUI treatment, whereas heterosexual couples have to try to conceive naturally for up to two years before becoming eligible for NHS-funded treatment.
A 2023 report by the Human Fertilisation and Embryology Authority (HFEA) found that the NHS funded 39 per cent of IVF cycles for heterosexual couples, while only 14 per cent of female same-sex relationships were deemed eligible.
Tianne and Carina have known each other since they were 16 years old, spending several years as best friends before entering a romantic relationship in 2016. They married in 2018 and embarked on their fertility journey a year later, a process which Tianne described as “really confusing”.
“A lot of effort goes into explaining to heterosexual people about family planning from the age of 17,” she said. “Everything that is set up to support people through this is heteronormative, and I struggled to see how I fit into that space.”
Despite paying for their appointments, choosing a donor, securing medicine and undertaking ovulation tests ahead of insemination, their plans came to a halt at the outbreak of the Covid-19 pandemic. As an anaesthetic nurse working in a London hospital, Tianne would be required on the NHS front lines and it no longer felt like the “right time” to get pregnant.
As a result, they had to restart the process and pay twice for blood tests, appointments and new medication. While fertility clinics often offer bundles, prices can range from £380 for an appointment, £900 per vial of sperm with £300 exporting costs, and a £700 HyCoSy test, which is a process of placing dye into a woman’s fallopian tubes as a fertility test.
“The IUI is just an expensive queer test,” she said. “We shouldn’t need to prove infertility, it should be obvious given that we are in a same sex couple that we can’t naturally conceive.”
Now both aged 40, the couple have started trying for a second child but are facing several obstacles. Tianne has been warned that her fertility is declining, and given her age and the fact that they have already welcomed one child, they are no longer eligible for more affordable IVF routes like egg-sharing.
With only one ampule left of the same sperm, they need £5,000 just to begin the process, with a breakdown of costs including £3,400 for egg freezing, £3,450 for egg thaw and embryo creation, £5,559 for stimulation medication, among several other medications and appointments.
In total, they estimate they face an eye-watering bill of over £21,000, having already spent £13,500 on previous fertility treatments.
In 2021, another lesbian couple launched a landmark judicial review against their NHS Clinical Commissioning Group for its “discriminatory” fertility policy, after discovering they would have to pay up to £26,000 for 12 rounds of IUI before accessing IVF.
They later dropped their legal action after the NHS Frimley Care Board said they would be addressing the inequality. Despite their success, it remains up to each individual ICB to set the policy for their local area.
“The thing with fertility is that it’s the hope of wanting to. In my heart, I always thought I’d have two to three children, I always imagined my daughter would have a family to go through life with,” Tianne said.
Becoming emotional, she said: “If I’d have known how incredible it is to be a mum or to have children, I just would have just done it so much sooner, but we didn’t have the security of marriage.
“That’s important for queer couples in terms of birth certificates. Our daughter is incredible, I’ve always been quite career-minded for a long time and actually she makes everything disappear; she’s just such a joy.
“Becoming a mum has been the best thing I’ve ever done, she is the light of our lives.”
An NHS spokesperson said: “ICBs make decisions for their area, balancing the needs of their local patients and the resources available – and all ICBs have a responsibility to ensure services are provided fairly.”
