Yes, it takes extra effort. And on top of that, defloration, it's not easy to add blood, so I had the idea that if they didn't add it to their game, they were just incompetent, so I used to give those games a lower rating, but it turned out otherwise later on.
It turns out that some pregnancy-focused developers have problems with Patreon because Patreon considers the presence of children in a porn game to be a violation of their policies. So big bellies are the most you're going to see as a result of this policy, and that's not satisfactory.
I believe (not sure) that defloration also suffers from Patreon's policy, and there's also the cultural aspect in the West, because they see blood from the loss of virginity as if it's a horror film even if its innate, so most Western games that are classified as having virgins are lying and you won't find blood in them, unlike Japanese content, which is dominated by this because of the culture and standards.
In general, this content is rare but desirable, so if a developer wants to stand out with something as simple as this, it's to their credit. If they want their game to be just another ordinary easily forgotten game, they are free to do so.