Same-sex and transgender patients seeking fertility treatment through England's National Health Service (NHS) face a financial and administrative burden that their heterosexual counterparts largely avoid, a phenomenon informally known as the "gay tax." In some areas, female same-sex couples must pay up to £25,000 privately for repeated rounds of artificial insemination before qualifying for NHS-funded IVF (in vitro fertilisation), while heterosexual couples can typically demonstrate two years of unsuccessful conception attempts without undergoing paid clinical procedures. Researchers who interviewed 54 LGBTQ+ patients and fertility professionals found that beyond the financial cost, these patients endure significant hidden labour — including self-educating through peer networks, managing emotional pressure to appear ideal as parents, and sometimes travelling hundreds of miles to find inclusive clinics — burdens that reflect a fertility care system still structured around heterosexual couples.