It had not been a good day, and it didn’t feel like it was going to be a good night, almost right up until the moment that Malkia and Nick Hutchinson-Arvizu won a free vial of sperm.
It was raining, and they were arguing, and the traffic was brutal on their drive over to the Montrose Center in Houston.
They had signed up for an informational panel at the LGBTQ center, which they’d stumbled on on Facebook, called “Using Donor Sperm to Build Your Family.” It’s something they really wanted to do together, build a family, but that night in March they just weren’t feeling at all like leaving the house.
So much so, Nick said, that “we almost didn’t go.”
But they did. It felt awkward at first. There weren’t that many people there when they walked in. Nick was pretty sure he was the only trans person in the room.
But then, two good things happened. First, they learned that they’d be getting three free months of access to donor profiles at the California Cryobank.
And then, much to their surprise, they won a voucher for a free vial of sperm in a digital coin toss (there’s an app for that now). They’d decided to play the game, because why not, what was there to lose.
“I don’t win things!” Malkia said.
But this time she did win. And they walked out of the Montrose Center feeling a lot different than when they walked in. Full of excitement and optimism and possibility.
“It started to feel real at that point,” Malkia said, the idea of having a baby together.
It was something they’d always wanted, ever since they got serious with each other, but the expense was daunting. Now, suddenly, in the space of an evening, it had gotten about $1,000 cheaper.
“It’s not a small amount of money for us, by any stretch of the imagination,” Malkia said.
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Conceiving with donor sperm and IUI
Still, though, $1,000 is just a fraction of what it can cost to conceive using donor sperm and intrauterine insemination (IUI), which is one of the more affordable paths out there for many people who want to have a biological child but aren’t able to conceive on their own. There are cheaper ways — such as using a known donor and at-home insemination — but barring that, buying sperm and doing either vaginal insemination or IUI is the next cheapest way to try to conceive.
Costs vary, since sperm banks and fertility centers all set their own prices, but a vial of donor sperm generally costs $900 to $1,000. The insemination procedure itself is often about $200 to $400, though it can be higher. A lot of people will try twice per cycle, which doubles those costs. A lot of cryobanks charge for the detailed profiles of sperm donors. There are all the required appointments and co-pays, and often monitoring and fertility drugs, which can run hundreds or thousands more per cycle.
“It’s quite variable,” said Alice Ruby, executive director of The Sperm Bank of California, the only non-profit sperm bank in the U.S. “It’s kind of hard to say, ‘this is how much it costs,’ because it really is going to depend on the age and fertility of the individuals involved, and what procedures they’re using.”
Then there are the odds: only about 10% to 20% of people conceive on the first try, using IUI.
“We do find, for people who continue to try, that about 80% of our recipients conceived in the first seven tries,” Ruby said. “But most of those folks aren’t conceiving on the first and second try. So when someone’s budgeting for this process, they definitely want to think about what it’s going to cost them to do more than one try.”
Grappling with the cost
Nick and Malkia have thought about that, though their brains go to different places. Nick is all about thinking positively, and believing that they will be among that 10% to 20% who conceive on the first try.
Malkia is a little more cautious, and a little more stressed by the numbers.
“Just in terms of practicalities of what we can spend, I don’t think I’d say more than $5,000,” she said. “I don’t think IVF is really financially an option for us. So if it doesn’t work with the first IUI, and we have to pay out of pocket for the next vial, and then go through the whole process again, I mean, I think that would be it for me. Like maybe two or three tries with IUI.”
Even that, though, is a lot.
Especially considering that not long after the high of that night at the LGBTQ center, when they won that free vial of sperm, that one almost-free try at a baby, they hit a low: Malkia lost her job.
Suddenly, instead of a household income of $98,000 a year, they were living just off Nick’s salary, $35,000 a year.
“That was a huge turning point of like, well, we’re gonna have to put this on pause because it’s just not feasible anymore,” Malkia said.
Not only did the cost of getting pregnant feel crazy to her now, so too did the prospect of job searching while pregnant.
Nick felt differently.
He was still thinking, “we have the free sperm, we still got to beat the biological clock,” he said. “I don’t want something to happen and us miss this chance.”
But for Malkia, the cost of even trying — and the fact that insurance wouldn’t cover a dime until they’d proven they had been trying for at least six months — just felt insurmountable, at least for the time being.
“It stinks,” she said. “it’s highlighted a lot of for me injustices I never even thought about before. Queer people shouldn’t have to jump through hoops to grow their families. Insurance shouldn’t make you do so much more than a heterosexual couple to cover your expenses related to fertility treatments. So it’s just been really frustrating.”
Unique challenges for LGBTQ couples
Figuring out what insurance will or won’t cover is something everyone trying to get pregnant through IUI or IVF has to navigate, queer or straight, single or coupled. It’s complicated and it varies dramatically, state to state, insurance plan to insurance plan.
Often, though, it’s more difficult for queer couples to get insurance to cover fertility treatments.
“Insurance doesn’t cover baby making for fertile individuals in the same way that it covers it for infertile individuals,” said Amanda Winn, of Family Equality Council. “Oftentimes there’s a six to 12 month period of unsuccessful pregnancy attempts before insurance will cover something like IVF.”
Which, if you’re doing it as cheaply as possible, using donor sperm, will cost a minimum of about $6,000 for 6 attempts, likely more.
“If you’re in a heterosexual couple, you can say, ‘well, we’ve been trying at home for six months,’” said Ruby, of The Sperm Bank of California. It’s a different story for LGBTQ couples.
This issue is coming up more and more, Winn said, as more LGBTQ couples are trying to have children. “We’re seeing policies starting to drop that or at least wave it for same-sex couples. It felt ubiquitous, I would say even two or three years ago,” she said. “We’re seeing that slowly start to shift.”
According to the Family Equality Council’s 2019 LGBTQ Family Building Survey, 63% of LGBT millennials are thinking about having kids, and the gap between queer and straight couples who are actively planning to expand their families has narrowed significantly. The majority of LGBTQ couples today who want to become parents are planning to do so though fostering, adoption, or assisted reproductive technologies, like IUI and IVF, all of which come with a price tag. Which, for some, is insurmountable.
“We know that, as a community, LGBTQ millennials face poverty at higher rates,” Winn said. “We know that there is a higher percentage of people of color in the LGBTQ community than in the non-LGBTQ community, and we know that communities of color are affected by poverty at higher rates. And so this really becomes, in my mind, a reproductive justice issue for our families.”
Deciding to go for it
Malkia, who has always cared a lot about reproductive justice, feels that, too, though it’s a particular aspect of reproductive justice she hadn’t thought about much before she met Nick. She had her first daughter, in a previous relationship, “the good old-fashioned way.”
So when she and Nick got together, and started thinking about expanding their family, it surprised her to learn all the steps — and costs — it would take for her to get pregnant this time.
“It shouldn’t have had to happen to me before I realized, ‘okay, this is an issue and a problem and something that … we need to be talking about more,” she said. “But it definitely did.”
Despite it all, though, all the steps and the cost and the stress, they both know for sure that it’s something they want.
It was never a question of if, Malkia said, but how. “Now, we would go with the lowest-cost investment to get a baby,” she said, that they always knew, too. Which is how they landed on sperm donation and IUI. “But it wasn’t something that we’re like, ‘oh, well, it’s gonna be way too much money. So we can’t do it.’”
Until she lost her job. Then it all started to feel like maybe it was too much money.
A few months later, though, they had their wedding, and after that, Malkia said, something shifted for her.
“I don’t know if it was just the high of coming off of the wedding or what,” she said. “I had a good job lead a few weeks ago, too, which I also think contributed to it. But we decided that we would at least start the process of looking for a donor.”
She’s still nervous about the money. Nick is nervous, too, though mostly about Malkia’s stress levels. But they’ve decided they’re going to go for it, or at least start the process. Malkia’s getting older, she’ll be 37 in December. They’re married, they’re in a good place emotionally, she’s feeling a little more optimistic about her job prospects. And even though she still has reservations about their financial situation, “it feels like something that we need to do to have our family be complete,” she said.
“I had never been in love before, period. And so meeting Nick, falling in love with him, getting married, and realizing that I just don’t feel like I’m done having children. And I want to be able to grow a human and raise a human with somebody that I love who is an awesome human being. It just feels like our family is incomplete in a lot of ways. It just feels like we’re meant to go on this journey together.”
Additional reporting by Reema Khrais and Hayley Hershman.
Did you, or will you, need to spend money to build your family? Whether through egg or sperm donation, IUI, IVF, surrogacy, fostering, adoption or other means? Is cost standing in your way of trying to have a child? We want to hear your story.