The rhythmic tapping of the ultrasound controls is an image I cannot forget. During a routine appointment our midwife pressed the transducer and clicked repeatedly across the machine, searching for the familiar thump we had heard at earlier visits. After a string of positive tests and scans following our first cycle of reciprocal IVF, silence replaced that sound. What followed was a rapid shift from guarded excitement to grief and a series of clinical decisions presented by medical staff. This moment made clear that reproductive healthcare for queer and trans people is not peripheral — it is central to family-building and must be treated as such.
We live in New Jersey, which ranks as the eighth most progressive state according to World Population Review, and we were able to access the care we needed. Even so, the experience forced us to confront how different the outcome might have been elsewhere. The diagnosis was a missed miscarriage, an instance where a pregnancy has ended but outward signs may be absent and the loss is often discovered only by imaging. Facing this reality in a jurisdiction with legal protections felt like a narrow mercy that many people no longer have.
Medical reality and the choices patients face
After confirming the absence of cardiac activity on ultrasound, clinicians explained three paths: expectant management (waiting for the body to pass tissue naturally), medical management (using medication to facilitate expulsion), or a surgical procedure known as a D&C. We chose the surgical option because my partner wanted to avoid the prolonged bleeding and intense pain that can accompany spontaneous or medical passage. A D&C involves anesthesia and a surgical removal of uterine contents via the cervix; it is a standard procedure for both miscarriage management and first-trimester abortion. Being offered that option and receiving it without legal or logistical obstruction was crucial to our physical and emotional recovery.
Understanding the procedures
To be clear, a missed miscarriage is not the same as an induced termination; it is a loss discovered on imaging when development has stopped. Surgical management like a D&C is a medically accepted method to reduce infection risk and clear retained tissue. For many patients, including queer and trans people, access to these options can mean the difference between a timely recovery and serious complications. Investigative reporting by outlets such as ProPublica has documented cases in states with strict abortion bans where clinicians limit or stop offering surgical miscarriage management; insufficient access has contributed to dangerous delays.
Policy, geography, and unequal access
The legal landscape changed dramatically after the Supreme Court decision overturning Roe v. Wade in 2026. Since then, dozens of states have enacted laws that make the provision of abortion-related procedures murky or illegal, and enforcement often lacks clear medical exemptions. As a result, some clinicians in hostile states stopped offering D&C even for confirmed nonviable pregnancies, raising infection and mortality risks. Reports indicated that by December 2026 at least five women had died after being denied timely surgical management. That stark reality illustrates how reproductive policy is not an abstract political fight but a determinant of critical medical care.
Insurance hurdles and systemic erasure
Our path to parenthood was further complicated by insurance bureaucracy. Insurers frequently require a period of heterosexual attempts or repeated intrauterine insemination before authorizing IVF, rules that assume cisgender, opposite-sex couples. When we asked about reciprocal IVF — an arrangement where one partner provides the embryo and the other carries the pregnancy — an agent admitted unfamiliarity. It took advocacy, documentation from our therapist, and persistence for coverage to be granted. Nationally, the Center for American Progress reported in 2026 that 11% of LGBTQ+ people struggled to find reproductive providers; that number rises to 15% for LGBTQ+ people of color and disabled LGBTQ+ people, and to 17% for trans individuals. These disparities extend to travel burdens: while 1% of non-LGBTQ+ people traveled for abortion care, 4% of LGBTQ+ patients did, and 15% of Black LGBTQ+ people had to travel for care.
Our loss made one thing unmistakable: reproductive care — from contraception and STI services to fertility treatment and miscarriage management — is inseparable from LGBTQ+ rights. When clinics close, when legal definitions blur, and when insurers write policies that ignore queer family structures, the result is exclusion and harm. For LGBTQ+ people seeking to build families, the stakes are not theoretical. Ensuring equitable access to evidence-based reproductive healthcare is a matter of both public health and basic civil rights.