LGBTQ+ people across the UK face discrimination, funding inequalities and gaps in fertility care, research has found.

Eligibility for NHS-funded treatment varies across the country, while many services are still structured around heterosexual couples.

People with diverse sexual orientations and gender identities can be left navigating complex systems, paying more for treatment and explaining their needs to healthcare professionals.

Co-author Dr Chloe He, of the UCL Institute of Epidemiology and Health Care, said: “Legal access is not the same as equitable access. LGBTQ+ patients are forced to navigate a Kafkaesque fertility care system alone – researching, self-advocating, and often educating the doctors and nurses treating them.

“In our study, we saw clinicians with no formal LGBTQ+ training, gay men pressured into being relentlessly cheerful to prove parent-worthiness to surrogacy services, and patients travelling hundreds of miles for care after experiencing transphobia at local clinics.”

The University of Stirling-led research involved 54 participants and 36 in-depth interviews with people who had used fertility services and professionals working in or alongside fertility care across the UK.

Researchers from Stirling, SKEMA Business School and University College London examined the extra work undertaken by LGBTIQA+ people seeking to have children.

They called this “reproductive labour”, which includes researching treatment, advocating for themselves, covering additional costs and educating clinicians.

The researchers said this work was used to manage “reproductive bioprecarity”, a term describing the uncertainty and vulnerability people can face while seeking reproductive healthcare.

The study, funded by a Santander Universities Research Grant, primarily reflected the experiences of cisgender lesbian participants.

One participant, Amanda, said she and her partner, Amy, spent a long time trying to find a GP willing to discuss fertility with them.

The couple eventually underwent fertility tests through the NHS, but their private clinic rejected the results because they had not been referred by a GP.

They had to repeat the tests and pay for them privately.

The researchers said lesbian couples are often required to self-fund multiple rounds of intrauterine insemination before becoming eligible for NHS support.

Intrauterine insemination, or IUI, involves placing sperm directly into the womb.

Gay men usually have to pursue surrogacy, which is not funded or supported by the NHS, while transgender people can face long waits to save eggs and sperm to allow them to have children.

Lead author Dr Carolyn Wilson-Nash, senior lecturer at the University of Stirling Business School, began investigating the issue after she and her wife made multiple attempts to conceive and faced challenges throughout the process.

The couple funded almost the entire process themselves and consulted a GP who had no experience of supporting same-sex couples seeking fertility care.

The researchers called for clearer treatment pathways, more inclusive services and better training for healthcare staff.

Dr Wilson-Nash, who is now the mother of a three-year-old boy, said: “The way the current system for fertility services is set up in the UK can lead to unequal pathways for the LGBTIQA+ population.

“For example, heterosexual couples can access NHS-funded in vitro fertilisation (IVF), whereas lesbian couples are often required to self-fund multiple rounds of intrauterine insemination (IUI) before becoming eligible for NHS support.

“Gay men usually have to pursue surrogacy, which is not funded by or supported by the NHS.

“And transgender individuals often face long waiting times to save eggs and sperm to allow them to have children. So legal access does not necessarily translate into equitable or inclusive care.

“Building a family should be neither exclusive nor this difficult. Fertility services should be available to all, regardless of their sexual orientation or gender identity.”

Laura-Rose Thorogood, founder of LGBT Mummies and part of the UK’s Fertility Justice Campaign, said: “Right now, intended LGBTQIA+ parents are being discriminated against because of who they are, and who they love.

“This is ultimately forcing them down alternative pathways which in turn put them at long-term risk physically, psychologically and socially.

“By providing access to treatment, our community can thrive and create the families they dream of by their chosen route.”

A sold-out summit at the London Institute for Healthcare Engineering will bring together clinicians, researchers, regulators, investors and founders to discuss how artificial intelligence is being applied to women’s health, and what responsible development of these tools should look like.

AI × Women’s Health: Innovation, Challenges and Opportunities takes place on 25 June.

It’s organised by MEGI Health, a femtech company building a digital cardiovascular platform aimed at supporting women’s heart health through pregnancy, postpartum and beyond.

All 140 places have gone, and there’s now a waiting list.

Nina Sesto, CEO of MEGI Health, said: “We are seeing a wave of innovation in women’s health, and AI has the potential to accelerate it.

“The opportunity is enormous, but it only pays off if these tools are built on representative data and designed around the realities of women’s health.

“That is exactly the conversation we wanted to convene, across clinicians, researchers, industry and regulators.”

AI is increasingly being applied across women’s healthcare, with proponents pointing to earlier diagnosis, better risk prediction and more personalised care.

The summit will look at tools in development across fetal and gynaecological ultrasound, maternal cardiovascular monitoring and clinical decision support, alongside the question of whether women risk being left behind as the technology develops.

The timing reflects wider momentum in the sector: women’s health has been drawing more investment and policy attention, and the World Economic Forum and McKinsey Health Institute have estimated that closing the women’s health gap could add at least $1 trillion a year to the global economy by 2040.

A recurring theme for the day is data.

Women have historically been under-represented in medical research, and organisers argue that AI tools trained on incomplete or unrepresentative datasets risk repeating those gaps rather than closing them.

Sessions on data, ethics, privacy and equity will run alongside the more technical and commercial discussions.

Dr Fran Conti-Ramsden is a clinician at Guy’s and St Thomas’ NHS Foundation Trust, academic at King’s College London and Chief Medical Officer of MEGI Health.

Conti-Ramsden said: “Working at the intersection of clinical practice, academia and industry, I see both the tremendous challenges we face in delivering clinical care for women and the need for innovation, alongside the rapid development of AI and digital health technologies.

“But bringing innovation into clinical practice is fraught with challenges.

“I hope this day brings together people from across the landscape to discuss and define those challenges as well as celebrate progress in the field, sparking dialogue on how we should innovate responsibly, and to make sure women’s health is not left behind.”

The half-day programme is split into four sessions, chaired respectively by Professor Eugene Oteng-Ntim, Professor Richard Dobson, an interactive breakout segment, and Professor Asma Khalil. Other speakers include MiRa Jacobs (MHRA), Professor Jane Hirst (The George Institute), Tulsi Patel (Hertility) and Dr Kimberley Peven (Scarlet), among others.

Organisers say they hope the event will help build a longer-term UK community around clinical AI in women’s health.

Menopausal women using hormone therapy reported healthier diet, exercise and sleep habits than non-users in a study of more than 10,000 women.

The menopause transition is associated with a higher risk of chronic health conditions and symptoms including hot flushes and problems affecting the urinary and genital systems.

Hormone therapy is often used to manage these symptoms, but it remains unclear whether it affects health outcomes directly or indirectly through changes in health behaviours.

Previous research has produced mixed results, with some studies suggesting that postmenopausal women pay greater attention to maintaining a healthy lifestyle.

The cross-sectional analysis examined whether menopause status and hormone therapy use were linked to diet, physical activity and sleep duration.

A cross-sectional study assesses participants at one point in time. It can identify associations but cannot establish whether one factor directly caused another.

Diet, exercise and sleep are described as modifiable health behaviours because people may be able to change them to improve their health.

The researchers found that postmenopausal women who had never used hormone therapy reported eating less fruit and vegetables.

Women who had never used the treatment were also 19 per cent less likely to meet guidelines for muscle-strengthening activity.

Sleep duration was shorter among postmenopausal women who had never used hormone therapy.

Compared with premenopausal and perimenopausal women, the likelihood of meeting sleep guidelines was 14 per cent lower among never-users, 26 per cent lower among current users and 24 per cent lower among past users.

Perimenopause is the transitional period before menopause, when hormone levels and menstrual periods can change.

Researchers said these findings may be linked to higher levels of follicle-stimulating hormone among postmenopausal women who do not use hormone therapy.

They may also relate to lower levels of oestradiol, a form of oestrogen, which have previously been associated with poorer sleep.

Hot flushes and urogenital symptoms can also disrupt sleep, although hormone therapy may ease these symptoms.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “This large observational study underscores that women who use hormone therapy tend to adopt overall healthier lifestyles.

“Although this association may partly reflect better symptom control enabling healthier behaviours, healthy-user bias is likely a significant contributor.

“Women who choose to use hormone therapy are often more proactive in their healthcare and may systematically differ from nonusers in socioeconomic resources, access to care, and health literacy.

“This largely explains why early observational studies of hormone therapy suggested cardiovascular benefits that were not confirmed in subsequent randomised, controlled trials.”