Europe Needs to Make Assisted Reproduction Available to Queer Men
Fertility treatments across Europe are expanding with more than 1.1 million treatment cycles done at nearly 1,400 clinics in 2021 (1). However, fertility treatment availability across Europe varies widely by country. In this article, I will review European national policies for assisted reproductive technology (ART), including in vitro fertilization (IVF), surrogacy, gamete (egg/sperm) donation, and embryo donation.
After this review, one thing should be clear: Europe is biased towards queer men when it comes to ART, and I will share some thoughts on why this is and what can be done to change it.
A research paper was published in 2022 titled European policies on same-sex relationships, adoption and assisted reproduction (2, full article is available for free). This publication was authored by Dr. Pedro Brandao from the Department of Reproductive Medicine, IVIRMA and the Faculty of Medicine, University of Porto in Portugal. He analyzed the national policies of 31 European countries, including all those in the European Union, Iceland, Norway, Switzerland, and the United Kingdom.
Unsurprisingly, same sex relationships are recognized in the majority of these 31 countries. Ten countries recognize civil unions/registered partnerships and 16 allow same-sex marriage, with the rights afforded to couples being almost identical in both types of legal partnerships. Only 5 countries do not officially recognize any kind of queer partnerships: Bulgaria, Lithuania, Poland, Romania, and Slovakia.
While Europe is progressive and largely accepting of same sex relationships, the same cannot be said for ART. To explore the national regulations around Europe for ART, Dr. Brandao leveraged three reputable sources of information:
Official legislation available in English or translated.
If official legislation was not available, he utilized the following resources:
ILGA Europe (https://www.ilga-europe.org/): A leading database on LGBTQ+ rights and freedoms.
ESHRE (https://www.eshre.eu/): The European Society of Human Reproduction and Embryology.
While there was no data available for Luxembourg and Romania had no official legislation on any ART, Dr. Brandao summarized all the other countries in an extensive table in the paper.
However, in reviewing this, I wanted to develop my own, ART-specific version of this table as a sort of heat map. I used color coding and a legend in order to find trends among the European countries.
For the table that I developed, I have the following color coding for when a specific ART is available to a group:
Yellow: Single women.
Orange: Lesbian couples.
Light Blue: All women (single women + lesbian couples).
Purple: All women with a medical need.
Green: All women and men.
Red: No one.
Dark Blue: Pending legislative changes.
With that legend, here is the heat map that I developed:
| Country | IVF | Reciprocal IVF | Surrogacy | Sperm Donation | Oocyte Donation | Embryo Donation | Categorization |
|---|---|---|---|---|---|---|---|
| Denmark | Female preference | ||||||
| Finland | Female preference | ||||||
| France | Female preference | ||||||
| Germany | Female preference | ||||||
| Iceland | Female preference | ||||||
| Ireland | Female preference | ||||||
| Norway | Female preference | ||||||
| Portugal | Female preference | ||||||
| Spain | Female preference | ||||||
| Sweden | Female preference | ||||||
| Austria | Female preference | ||||||
| Bulgaria | Homophobic with female preference | ||||||
| Croatia | Homophobic with female preference | ||||||
| Cyprus | Homophobic with female preference | ||||||
| Estonia | Homophobic with female preference | ||||||
| Greece | Homophobic with female preference | ||||||
| Hungary | Homophobic with female preference | ||||||
| Latvia | Homophobic with female preference | ||||||
| Belgium | Near reproductive equality | ||||||
| Malta | Near reproductive equality | ||||||
| Netherlands | Near reproductive equality | ||||||
| United Kingdom | Near reproductive equality | ||||||
| Czech Republic | Overall restrictive | ||||||
| Italy | Overall restrictive | ||||||
| Lithuania | Overall restrictive | ||||||
| Poland | Overall restrictive | ||||||
| Slovakia | Overall restrictive | ||||||
| Slovenia | Overall restrictive | ||||||
| Switzerland | Overall restrictive |
In order to further categorize the trends, I developed 4 labels in the far right column titled, ‘Categorization’:
Female preference: Countries where ART is available to all women, regardless of sexual orientation (i.e. partnership status).
Homophobic female preference: Countries where ART is available to mostly ‘single’ women, as in they have a more homophobic culture that does not allow for same-sex female couples to undergo ART.
Near reproductive equality: Countries where they offer almost all ART for women and men.
Overall restrictive: Countries where there is no ART offered, regardless of gender or sexual orientation.
There are a couple aspects that I want to highlight, specifically as it relates to ART for queer men:
Only 4 countries offer ART for men: Belgium, Malta, the Netherlands, and the United Kingdom.
Only 3 countries allow surrogacy (altruistic) for men: Belgium, the Netherlands, and the United Kingdom.
Lastly, there are a few trends in general that I wanted to point out:
With the exception of the homophobic countries that will not perform reciprocal IVF for same sex female couples, women overwhelmingly have access to sperm donation and IVF across Europe.
In addition to sperm donation and IVF, women also have considerably more access to oocyte (egg donation), making it near impossible for queer men to create embryos in Europe outside of the 4 countries mentioned above.
Besides surrogacy, Europe is most restrictive of embryo donation for all groups.
This last point is a good segway to the discussion on why Europe has such restrictive (especially for men) regulations on ART.
While the expense for national healthcare systems to cover ART is definitely a consideration, the trend is that fertility treatments are increasing in Europe. However, they are increasing largely for single and same sex coupled women, as evidenced by the recent statistics from the United Kingdom:
The number of single women having treatment, including in-vitro fertilisation (IVF), has increased from 1,400 in 2012 to 4,800 in 2022, while the number of female couples treated has doubled to 3,300 over the same period.’ (3)
Given the restrictions, the majority of queer men have to pursue ART abroad, with the most popular destinations being the United States, Colombia, and Mexico (4).
The European Commission is also trying to support and protect parental rights, regardless of the parents’ gender or sexual orientation (5). How can Europe have a policy that supports rainbow families but at the same time not provide any support for queer men to become parents through ART?
Another question: How can Europe be so progressive when it comes to queer male relationships but not parenthood?
I believe that Europe is still incredibly traditional when it comes to gender roles, especially parental roles.
Even in Nordic countries like Iceland, Finland, Norway, and Sweden, which all rank in the top 5 for gender equality in the workplace, these countries refuse to acknowledge that queer men should be able to be parents through ART the way that queer women can be (6). In essence, these countries are saying that women are better and more equipped to be parents than men.
Because surrogacy is so severely restricted in Europe, perhaps these national healthcare systems don’t see the point in offering ART to queer men. However, I don’t think this is fair. Why not offer egg donation, IVF, and embryo donation to queer men, and then they can ship those embryos abroad for surrogacy?
Some countries, such as Denmark (https://www.babymoonfamily.com/original-articles/denmark-surrogacy-laws) and Ireland (https://www.babymoonfamily.com/original-articles/ireland-international-surrogacy) are trying to streamline parental rights for same sex male parents who are returning home from surrogacy journeys abroad. With these types of laws, why not also allow these citizens to benefit from the same domestic ART that is offered to all women?
In the case of the United States, my husband and I have had to pay about $75,000 dollars for our egg retrieval, IVF, and genetic testing of our embryos. This would have been a considerable savings if it had been covered by the Swedish healthcare system.
I believe that Europe has to evolve and accept that more and more queer men are going to have children through ART. If the countries do not want to allow surrogacy - even altruistic surrogacy - then they have to make it more equitable to get other ART.
While this is a long, uphill battle, there are steps that all queer men (and hopefully women allies) in Europe can do to help change these policies.
Fertility Europe (https://fertilityeurope.eu/) is an advocacy organization for fertility rights across the continent that has an inclusive and far-reaching 5 point mission:
Recognise the right to try to have a child as a universal right across the EU.
Ensure equal, fair and safe access to fertility treatments.
Provide public funding for all lines of fertility treatments.
Engage the public sector in providing better information about fertility and infertility.
Implement communication campaigns to remove the stigma associated with infertility.
While Fertility Europe does not explicitly focus on LGBTQ+ intended parents, they do advocate that all fertility treatments - including surrogacy - should be available and publicly funded in Europe.
In order to help support Fertility Europe with this equitable approach to family building, you can:
Read and endorse the white paper (https://fertilityeurope.eu/cta2023/).
Donate (https://fertilityeurope.eu/partners/).
Follow them on Facebook (https://www.facebook.com/FertilityEurope.eu/?fref=ts)
Join and support ‘European Fertility Week’ every November. (https://fertilityeurope.eu/european-fertility-week/).
Another organization that advocates for LGBTQ+ people across Europe is ILGA Europe (https://www.ilga-europe.org/). ILGA Europe collaborates with over 700 LGBTQ+ organizations across Europe and Central Asia in order to drive political, legal and social change.
ILGA Europe collects and shares data on all LGBTQ+ metrics in European countries, and displays them on their Rainbow Map. ‘Family’ is one such category on their Rainbow Map (https://rainbowmap.ilga-europe.org/categories/family/). While their data and map show that Belgium, Malta and Sweden sit on top of the ranking on family. They claim that these three countries 'fulfill all our criteria.’
Given the publication and table discussed above, these countries do not fulfill all criteria when it comes to queer men and ART, so ILGA Europe needs more accurate and better criteria. If that change can be made, then countries in Europe will have a higher and more inclusive bar to reach in order to offer ART for all LGBTQ+ people.
As an American living in Europe, it’s often challenging for me to navigate the complex collection of countries, cultures, and regulations, and this is no different when it comes to ART.
However, Europe is becoming increasingly cohesive, and policy at the EU level takes precedent over that at the national level. While some countries, like Italy, can try and work to erase and prevent rainbow families through grotesque laws banning even international surrogacy, perhaps EU level regulations can be developed and advocated that can protect and support queer intended and current parents.
This is my hope, and I will continue to grow and leverage BabyMoon Family in order to make ART more equitable and accessible for queer men in Europe.
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