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The Hurdles Facing the LGBTQ+ Community for Fertility Treatment

In 2022, it may seem like we have made lots of progress when it comes to supporting members of the LGBTQ+ community on their road to parenthood. In society and on social media, there are more diverse examples of family life than ever before and medical advancements have made it possible for same-sex couples to become parents and even for men to carry their babies.

However, it would be naive to think that there are still not huge disparities in how fertility support is offered – and that LGBTQ+couples are getting a rough deal. Here are just 4 examples of discriminatory barriers LGBTQ+ couples face, if and when they decide to become parents.

Harder for LGBTQ+ couples to get IVF on the NHS

We are all aware that the NHS postcode lottery is unfair. In England, the country is split into separate Clinical Commissioning Groups (CCGs) – and each CCG has its own rules on how to assign free IVF treatment. It means that some couples can have more NHS-funded support, depending on where they live – in some areas you can have three rounds whereas elsewhere it’s only one. This process affects many couples and definitely needs to change, but for LGBTQ+ couples it is even more unjust.

Most of the time, heterosexual couples qualify for NHS-funded IVF if they can’t conceive after two years of unprotected sex. However, in many CCGs, female LGBTQ+ couples and single women have to self-fund private rounds of artificial insemination before they can even be considered for free treatment. This process is not only long and stressful, but it can also be incredibly expensive – which brings us to our second point…

Home Insemination is increasingly expensive

Whilst at-home insemination might sound simple – it’s far from it – and can come with lots of risks and/or a huge bill. In 2005, rules were changed which means it’s no longer possible for sperm from sperm banks to be shipped to private homes. That means that if you want to go through artificial insemination you have two options.

One is to use sperm from a sperm bank and have the insemination done at a clinic. This comes with lots of costs involved. A vial of donor sperm costs around £1000 and that’s before you even pay for the insemination process itself.

The other option is to use a private sperm donor – and for some couples, this is the right choice and one they are happy with. You might decide to choose a donor who is a close friend or family member, so you and your child can have an ongoing relationship with them and it’s a lot more affordable than going through a clinic. However, private sperm donation can also come with risks. There can be legal complexities when using a known donor and you can’t always be sure that the sperm has been tested for STIs or that the donor hasn’t already fathered multiple children (in clinics there is a limit). There is also a growing number of men who offer sperm donation via social media. Whilst some of these guys are offering to do this with good intentions – there are some people out there using it as an opportunity to prey on vulnerable couples. You can read more about private sperm donation here.

In forcing LGBTQ+ couples to go through artificial insemination before they can get any support for IVF, we’re putting them in a tough situation – spend thousands of pounds on treatment or put yourself at risk.

Other countries banning LGBTQ+ couples completely

For heterosexual couples, when NHS funding is not available – or if they are struggling to pay for expensive private treatments – they do have another option: go for IVF abroad. IVF in other countries is often a lot cheaper than treatments in the UK – and significantly cheaper than in the States.

However, for LGBTQ+ couples, their options for cheaper IVF are limited as there are still some countries that refuse to help them. Popular countries for affordable IVF – such as Greece and Turkey – still have discriminatory legislation that means same-sex couples can’t access affordable treatment. Even if in the UK we are constantly working towards improved gay rights, for couples to have complete equality when it comes to fertility, it’s essential that other countries follow suit and at least make it possible for LGBTQ+ couples to attempt IVF.

Trans Fertility Preservation

It’s not only IVF that is controlled by CCGs. Other processes involved in fertility treatments – including fertility preservation – are also impacted by geography. This can be a big problem for members of the trans community.

In the UK, if you are having medical treatment that could affect your fertility – for example, radiotherapy for cancer – you will be offered the option to freeze sperm or eggs for free on the NHS. However, there is no blanket rule to support those transitioning, despite the fact that their fertility will definitely be affected as they go through the process.

Once again, the chances of you getting affordable support are dictated by your local CCGs, but even then the chances of receiving help are low. At present, the National Institute for Health and Care Excellence (NICE) guidelines – which provides advice to CCGs on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria.

It’s clear that for LGBTQ+ people, the road to parenthood is not always easy – and it certainly isn’t cheap. We need to keep pushing for fair fertility treatment for all, no matter who they are and who they love.

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Wearing tight pants and underwear

Studies show that men who wear looser underwear have higher sperm concentration and total sperm count compared to men who wear tighter underwear. So, lose the tight clothes and wear something loose to give your testicles some air.

CONCLUSION: learn more about how heat can affect sperm quality here.

Stress

Besides higher mortality rate and various diseases, stress is associated with low sperm quality. Stress is known to be associated with lower testosterone levels and oxidative stress with both playing an essential role in producing and maintaining healthy sperm cells.

CONCLUSION: If you feel stressed, we recommend you get some help so you can have a balanced mental health. For a stress management guide, download the ExSeed app for free and start your personalized action plan today.

Physical activity

Scientific studies show that men who are physically active have better semen parameters than men who are inactive. Fertility specialists also state that regular physical activity has beneficial impact on sperm fertility parameters and such a lifestyle can enhance the fertility status of men.

Prioritizing exercise can help improve your overall health and result in healthy, fast swimming sperm cells that have good chances of fertilizing an egg.

CONCLUSION: Try incorporating exercise in your weekly schedule to you ensure exercising at least twice weekly. We recommend a combination of cardio training and strength exercise. Read more about exercise and male fertility on our blog.

Nutrition

Fast Food
Processed foods damage the health of sperm-producing cells and cause oxidative stress, which lead to poorer sperm quality. Heavy consumption of junk food (every week) can increase the likelihood of infertility since men who consume vast amounts of unhealthy food are at risk of having poor sperm quality. Besides harming your fertility, junk food enlarges your waistline, harms your cardiovascular system, kidneys, and more.

Vegetables
Eating more fruit and vegetables can increase your sperm concentration and motility. It’s important that you consume a healthy diet filled with antioxidants and that you eat vegetables every day. Foods such as apricots and red bell peppers are high in vitamin A, which improves male fertility by nurturing healthier sperm. Men who are deficient in this vitamin tend to have slow and sluggish sperm.

Sugary snacks/beverages: several times a week Excessive consumption of high sugar items can lead to oxidative stress, which negatively impacts testosterone levels and sperm motility. Sugary snacks and beverages are also highly associated with obesity and low fertility.
CONCLUSION: To boost sperm quality, stay away from fast food, processed food, and sugary snacks or beverages. You need to implement a healthy prudent diet filled with necessary superfoods needed for good sperm production. Check out our guide to Male Fertility Superfoods. For personalized guidance and support on how you can start improving your sperm health, check out the Bootcamp.

Heat

Direct heat can inhibit optimal sperm production and cause Sperm DNA damage. Sperm cells like environments that are a couple of degrees lower than body temperature. Avoid overheating from warm blankets, seat warmers, heat from your laptop, hot showers, and saunas.

Cigarette smoking

The exposure to tobacco smoke has significant negative effects on semen quality. The damage of cigarettes and nicotine of course depends on how many cigarettes you smoke per day and for how long, but even low usage (up to 10 cigarettes / day) can inhibit healthy sperm production.  

CONCLUSION: Stay as far away from cigarette smoking as possible if you care about your general health and your fertility. Read more here.

Cell phone

When you have your cell phone in your front pocket, your testicles are exposed to electromagnetic radiation, which studies have shown to damage the sperm cells. Put your phone in the back pocket of your pants or in your jacket pocket.

BMI

There is a clear association between obesity and reduced sperm quality. At least part of the reason for this is that obese men may have abnormal reproductive hormonal profiles, which can impair sperm production and lead to infertility. 

A BMI higher than 30 can lead to several processes in the body (overheating, increase in oxidative stress in the testes, sperm DNA damage, erectile dysfunction) that can have a negative impact on male fertility. This can result in problems when trying to conceive.  

CONCLUSION: BMI is one of the risk factors that influence semen quality and, for example, sperm motility.  

Alcohol

A beer or glass of wine now and then do not really harm sperm quality. But excess alcohol drinking (more than 20 units per week) can reduce the production of normally formed sperm needed for a successful pregnancy.

CONCLUSION: If you want to stay safe, stay under 14 units of alcohol per week. For more information on how alcohol can affect male fertility, take a look at our blog: “Alcohol and Sperm Quality”.

Age

Studies show that women younger than 35 and men younger than 40 have a better chance of getting pregnant. Men can produce sperm cells almost through their entire life, but the sperm cell DNA is more fragile and prone to damage after the age of 40.

As men age, their testes tend to get smaller and softer resulting in a decline in sperm quality and production. These changes are partly because of an age-related decrease in testosterone level, which plays a very important role in sperm

production. Higher male age (>40 years) is not only associated with a decline in sperm production but also with increased sperm DNA fragmentation and worsened morphology (shape) and motility (movement). These negative effects make the sperm cells less qualified for egg fertilization.

CONCLUSION: with an age under 40, you shouldn’t have to worry much about age as a factor in itself. However, studies have shown a slow decline after the age of 30-35 years

and if you are above 40 years of age, your sperm quality can be affected due to increased sperm DNA damage resulting in a decrease of sperm motility and concentration. Remember that you cannot evaluate the quality of a sperm sample by just looking at it – this requires a sperm analysis.