This Pride Month, Rewire News Group recognizes that celebrating during the pandemic will look very different for many of us, which is why we’re putting together tools of resistance and hope to help us all survive (and even thrive) Pride 2020.

As pro-choice activists, we spend much of our energy railing against the legal restrictions on our bodies and fighting for bodily autonomy. This fight is an important one, and I’ve dedicated a majority of my adult life to it. But within the pro-choice movement, we often end up focusing on abortion and contraception, and we sometimes leave out those facing a different sort of barrier: infertility—and, specifically, how it affects queer people.

As a career-minded queer woman, I regularly talk to my partner about starting a family. They, a transmasculine nonbinary person, are excited about the prospect but have no interest in carrying children. I, a Black woman already carrying the weight of the statistics on Black maternal health, have polycystic ovary syndrome (PCOS), meaning my fertility isn’t guaranteed.

According to the World Health Organization, a person is diagnosed with infertility after 12 consecutive months of attempting to conceive with no success. The problem with this definition is that it makes assumptions about both access and sexuality. When “trying to conceive” is defined as having regular, unprotected sexual intercourse, it becomes something that only cisgender heterosexual couples can easily and freely achieve. This has real-life consequences for people like me. Using assisted reproduction to get pregnant is incredibly expensive, and you often need a diagnosis of infertility to get those costs covered by insurers.

This means infertility treatment costs many thousands of dollars for queer couples trying to conceive—effectively making it impossible for many. Just as abortion restrictions have always been about controlling reproductive choices, the uneven costs of fertility treatment, which block queer people from choosing to grow their families, aren’t an accident.

The high cost of fertility

Despite my partner and I being gainfully employed, living in Virginia means that insurance companies do not cover the cost of fertility treatment, and sadly my state isn’t alone in that.

Only 14 states require insurers to cover fertility treatment, and another two states require insurance companies to only offer coverage. Not all of these states include in vitro fertilization (IVF) in that coverage, and many require the patient to meet restrictive definitions of infertility to be eligible. In Texas, in order to qualify for IVF coverage offered by an employer, “the patient and the patient’s spouse” must have a history of unexplained infertility for at least five continuous years, or have one of a few specified medical conditions. To even more clearly exclude most queer couples, the law only applies if the patient’s egg is being fertilized with their spouse’s sperm.

Queer people and couples in the remaining states are forced to rely on savings, loans, and the kindness of friends when planning for a family. A colleague disclosed to me that her and her wife’s first round of conception was successful on the first try, but cost them around $15,000.

That steep price is not unusual for IVF, in which a doctor combines an egg with sperm and then implants the embryo back into the parent or surrogate. According to the Advanced Fertility Center of Chicago, the average cost of IVF in the United States is about $12,000. If donor eggs or a surrogate is required, the process costs far more.

A somewhat less expensive option is intrauterine insemination (IUI), a process in which the sperm is inserted directly into the uterus by a specialist, and even that can range from $300 to $1000 per cycle. Injectable medications to stimulate fertility, often used alongside IUI, are around $2,500 to $3,500 per month.

And before receiving treatment, prospective parents often have to undergo expensive diagnostic tests, like a hysterosalpingogram (HSG) to eliminate blocked fallopian tubes as a potential cause of infertility. This requires the specialist to insert dye directly into the uterus to see if it moves through the fallopian tubes and into the abdominal cavity.

Add to that the potential costs of additional testing and co-pays for office visits if you are insured. With the median U.S. household income at around $63,000, these treatments are not affordable or accessible by any stretch of the imagination. Collectively, my partner and I make more than this median income, but the “low end” cost of $15,000 per round makes these treatments feel impossible for us. It’s almost as if the financial barriers are in place to reserve family planning for affluent straight couples.

When we talk about advocating for bodily autonomy, we have to realize that control doesn’t end with abortion access. Until we all have equal access to contraception, abortion care, and fertility treatments, LGBTQ+ people’s fight for their reproductive rights is far from over.