2. Materials and Methods
3.1. Insuring Infertility
“I was starting to get all these weird periods and then I was having “the infinity period” where I was bleeding all the time, so finally Jess made me go to the doctor and they did the internal ultrasound. I had a uterine polyp. I’m still paying on that, and I’ll be paying on it for two more years. It was much more expensive than having my baby was—having that polyp removed. And that was why I went to [the fertility specialist]—because I had reached my [annual insurance] deductible. It was like, “well, what else can I get done that my insurance is going to pay for now?” Some of those tests were paid for, but financially, it was going to be so difficult to try to do it. You know, neither of us makes a lot of money. We were trying to [have our baby] in a calendar year for insurance purposes—literally, I was trying to do everything as financially conservatively as possible because we were on such a tight budget that I was literally trying to get everything done. I was trying to plan my pregnancy around my insurance, the busy season at my job, and when I could afford to take off time without messing up the workflow… it was super stressful.”
3.2. Sperm Donation
“The number one reason that we chose to go with a known donor was expense. It’s just very, very expensive for the insemination—for the actual sperm. It seemed like you need several vials per cycle. Maybe the cheapest we saw was $700 a vial, so you need maybe $1400 a month. Plus, that’s just for the sperm, so then you’re also paying [the costs of the medical procedures.]"
3.3. Defining Parenthood: Legal and Adoption Systems
“A big challenge for us was the legal fees and having to jump through hoops because we are same-sex…We had to [take legal actions to] protect ourselves, to ensure that Jess has custody of her child. We were very irked by—we had to have [the Department of Social Services] come and do a home [study] so the invasion of our privacy, just the concern that they would find something that they thought was problematic. They didn’t, but they could have, so there was some angst around that, and just the paperwork that we had to get in order was probably the most stressful."
“I am actually not a fan of marriage—beginning with my childhood—so I didn’t really want to get married. However, in [our state], they only have step-parent adoption, they do not have second-parent adoption, and what that means is that you have to be married. So, we got married when I was very pregnant because we realized, like, we need to…"
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Point of Intervention||(A) Insurance||(B) Sperm Donation||(C) Legal Adoption|
|Logistical||Discussion of state- and company-specific insurance policies regarding fertility services.||Financing commercial sperm donation vs. directed donation (known donor). |
Discussion of legal implications of commercial sperm donation vs. directed donation with regard to parental rights.
|Discussion of legal documents, actions, and fees: marriage, separate medical authorization, guardianship, advance directives, other legal documentation, (wills, prenuptial agreements, etc), state-specific adoption regulations. |
Home study prepared; carried out before birth, if possible.
Select adoption mechanism of choice and ensure papers are ready for signatures at birth.
|Societal||Insurance mandated to fully cover or offer partial coverage for infertility in all fifty states, including “social infertility” . |
Mandated infertility coverage and the incorporation of “social infertility” into the purview of coverage across state lines benefits many groups.
|Incorporating language about third-party/directed donation reproduction into insurance; cost of commercial sperm donation falls under insurance coverage.ćBroader Implications: Provides coverage for heterosexual infertile couples, non-partnered, disabled, transgender individuals, and others.||Broaden, formalize, and legitimize the definition of “presumed parenthood” to include “presumed parenthood of intent” i.e., parenthood is presumed to be individuals who intentionally conceived the child together, which may or may not be genetic relations. |
Broader Implications: Supports heterosexual infertile couples vulnerable to presumed parenthood (if using third-party) and other family formations including step-parents.
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