Fertility pathways for same-sex couples in the UK: options, law and funding

There is no single pathway for same-sex couples. The HFEA, the UK regulator of fertility treatment, explains that people who want a family with a biological connection to them or their partner may need fertility treatment, and that the treatments used depend mainly on whether the couple is two women or two men, and on whether either partner has a fertility problem.

Fertility treatment is also not the only way to build a family, and this page deals only with treatment. Adoption and fostering are separate routes and are not covered by the sources used here. What follows sets out the clinical options in plain terms so that you can have a more informed conversation with a clinic, your GP or a support organisation.

The HFEA describes intrauterine insemination (IUI) as commonly used by people using donated sperm, including single women and female couples. It can be done with or without fertility drugs, and the whole procedure is described as relatively quick and painless. IVF may be appropriate for people in female same-sex relationships who have fertility problems.

Reciprocal IVF is an option that allows both partners to take part in the pregnancy. Eggs are collected from one partner and fertilised with donor sperm, and the resulting embryo is transferred into the other partner, who carries the baby and gives birth. The NHS describes the general IVF process as a series of steps: medicines to stop the ovaries producing eggs naturally, medicine to increase the egg supply, egg collection under sedation, fertilisation in the laboratory, and transfer of an embryo into the womb, with a full cycle taking around 3 to 6 weeks.

For male same-sex couples the HFEA says surrogacy is the main treatment. It describes the process as finding a surrogate who is prepared to carry and give birth to a child for you, and says one partner's sperm can be mixed with the surrogate's eggs or with donated eggs. IVF can also be used in surrogacy.

Surrogacy involves legal, practical and emotional decisions beyond the clinical steps, and the HFEA has dedicated pages on it. The page used for this guide does not set out the detail, so anyone considering surrogacy should read the regulator's surrogacy guidance and take legal advice on parental responsibility before treatment starts.

The HFEA says you may need to find a sperm or egg donor, or both, and that there are many options for finding one. The decisions it highlights include whether to ask someone you know or to find a donor through a clinic, whose eggs or sperm you will use, and whether you are considering treatment abroad and are aware of all the issues.

The HFEA is particularly clear about private sperm donation, which it defines as using donated sperm outside a licensed clinic. It says this is unregulated, that you should be very careful, and that there is a risk the donor could be considered the father of the baby with all the rights and responsibilities that go with that. By contrast, donors who donate through a clinic go through health tests, receive counselling and have the legal issues taken care of.

The HFEA says that if you are not married or in a civil partnership and you want the non-biological partner to be legally recognised as a parent, it is essential that you both complete the correct forms. If you do not, the donor or surrogate could be considered the legal parent, and sorting that out is described as extremely time-consuming and expensive. The clinic will talk you through what is needed.

This is one of the most practical reasons to use a licensed clinic. The details differ according to your relationship status and the route you use, so rely on the clinic and the HFEA guidance rather than on informal advice, and keep copies of all signed forms.

The HFEA says fertility treatment can be expensive. In its words, a male same-sex couple having surrogacy will have to pay for treatment privately, and female same-sex couples need to pay for six cycles of IUI before they qualify for NHS funding, and even then it depends on what is available in the area. The NHS IVF page adds that local integrated care boards decide who can have IVF in their area and that some only offer it if you are under a certain age, a healthy weight, do not smoke or have no existing children.

If you are not eligible for NHS treatment or decide to pay, private clinics usually restrict IVF to people within a certain age or BMI range, and each sets its own prices. The NHS also warns that clinics abroad may not be regulated in the same way as those in the UK, so safety and legal parenthood need particular thought before choosing treatment overseas.

The HFEA acknowledges that even without fertility problems, treatment can be emotionally draining, and notes that one in three pregnancies ends in miscarriage and that treatment may not work. It suggests talking to family and friends, getting support from outside your existing network and considering counselling together or individually. The NHS says counselling is recommended for anyone having IVF and that your fertility clinic should offer the opportunity before, during and after treatment.

If you have severe tummy pain, feel faint, are being sick or have other new symptoms during IVF, the NHS says to contact your fertility clinic or NHS 111 as soon as possible, and to call 999 for difficulty breathing, chest or upper back pain, swelling or pain at the tip of the shoulder, as these can be signs of ovarian hyperstimulation or an ectopic pregnancy.