By Carol Southall
This blog is a summary of our published article:
Benoit, Z., Rosen, N. O., Renaud, M., Bergeron, S., Brassard, A., & Péloquin, K. (2024). “Doctors asked if we are sisters or friends”: Experiences of 2S/LGBTQIA+ couples in the context of medically assisted reproduction. Canadian Journal of Human Sexuality, 33(3), 429–442. https://doi.org/10.3138/cjhs-2024-0028
2S/LGBTQIA+ couples and medically assisted reproduction
2S/LGBTQIA+ couples who are unable to have children biologically may seek help from fertility clinics and undergo a process of medically assisted reproduction (MAR). Fertility treatment can be difficult for all patients [1], however, queer couples face unique barriers and challenges due to the fact that fertility clinics and MAR services are based on a heteronormative, medical definition of infertility that often does not apply to 2S/LGBTQIA+ couples [2, 5].
What did we want to know?
This qualitative study aimed to explore the impact of MAR on 2S/LGBTQIA+ couples by investigating the different aspects of life that were affected from the perspective of queer couples. Given the fact that 20% of MAR patients are 2S/LGBTQIA+ couples [3], we were interested in gaining a deeper understanding of how MAR affects the lives of both partners of a couple, within the heteronormative context of fertility clinics.
What did we do?
Couples were recruited for a broader study investigating MAR that included heterosexual couples. Couples were screened for eligibility and were then each sent a questionnaire to complete. Of the 305 couples recruited, 58 identified as 2S/LGBTQIA+. The open-ended question “If you or your partner identify as 2S/LGBTQIA+, what should we know to help us better understand the impact of medically assisted reproduction on different aspects of your life (emotional, relationship, sexuality, professional life, social life, etc.)?” was included at the end of the questionnaire. The 78 individual responses to this question were analyzed to reveal common themes.
What did we find?
Participants’ responses showed that 2S/LGBTQIA+ couples experienced issues with heteronormativity and cisnormativity in fertility clinics, such as unsuitable questionnaires and inadequate terminology [4]. As well, the difference between medical infertility (experienced by heterosexual couples) and social infertility (experienced by 2S/LGBTQIA+ couples who are unable to have children due to their relational status) can go unrecognized in fertility clinics, resulting in queer couples being treated as though they are dealing with medical infertility [2, 5]. Responses also showed that there is a significant lack of tailored services towards 2S/LGBTQIA+ couples. This includes a lack of personalized treatments, quality resources, and care for the non-carrying parent. As well, medical staff may lack the training to provide knowledgeable and sensitive care to 2S/LGBTQIA+ couples.
All of these factors contributed to psychological distress reported by couples. The process of MAR induced psychological distress for many 2S/LGBTQIA+ couples. Gender identity and expression presented unique challenges to couples throughout treatment that contributed to the difficulty of the process. As well, there was a reported emotional toll of repeatedly coming out within the healthcare context and in society. Within the healthcare setting and outside it, 2S/LGBTQIA+ couples experienced stigmatization and discrimination throughout the MAR process, including microaggressions from family members, societal judgement, assumptions and a lack of support systems. Finally, the financial burden associated with the MAR process was significant and contributed to the stress that 2S/LGBTQIA+ couples experienced.
What does this mean?
The experiences of 2S/LGBTQIA+ couples in MAR are the challenges and barriers encountered throughout the process [4]. This investigation shows the need for a fundamental reform of the fertility care system to meet the needs of 2S/LGBTQIA+ couples, such as:
- More inclusive practices, language and tailored services
- Sensitivity educational programs for medical and fertility staff
- Resource development geared toward 2S/LGBTQIA+ couples, including supportive networks and specialized educational programs
- Efforts to educate families and communities about the different options and paths 2S/LGBTQIA+ couples may take to have a child
- Financial accessibility to ensure equal access to fertility treatments
References
[1] Bright, K., Dube, L., Hayden, K. A., & Gordon, J. L. (2020). Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction for individuals and/or couples undergoing fertility treatment: a systematic review and meta-analysis protocol. BMJ Open, 10(7), e036030. https://doi.org/10.1136/bmjopen-2019-036030
[2] Bell, A. V. (2016). The margins of medicalization: Diversity and context through the case of infertility. Social Science & Medicine, 156, 39–46. https://doi.org/10.1016/j.socscimed.2016.03.005
[3] Green, D., Tarasoff, L. A., & Epstein, R. (2012). Meeting the assisted human reproduction (AHR) needs of lesbian, gay, bisexual, trans and queer (LGBTQ) people in Canada: A fact sheet for AHR service providers. LGBTQ Parenting Network.
[4] Kirubarajan, A., Patel, P., Leung, S., Park, B., & Sierra, S. (2021). Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives. Fertility and Sterility, 115(5), 1294–1301. https://doi.org/10.1016/j.fertnstert.2020.12.002
[5] Lo, W., & Campo-Engelstein, L. (2018). Expanding the clinical definition of infertility to include socially infertile individuals and couples. Reproductive Ethics II, 71–83. https://doi.org/10.1007/978-3-319-89429-4_6
