Lesbian Couples Seeking Pregnancy With Donor Insemination

Therapeutic donor insemination for LGBTQ+ families: a systematic review

IMPORTANCE

Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) families deserve evidence-based care within environments designed for their unique needs; however, care provided in fertility clinics has been reported to fall short, most notably for assigned female at birth recipients of therapeutic donor insemination (TDI).

OBJECTIVE

To identify the aspects of routine infertility care that are clinically appropriate for this unique patient population, specifically those seeking pregnancy with donor sperm. The research question was posed, "What screening and treatment protocols are supported by the evidence regarding TDI care for LGBTQ+ families?"

EVIDENCE REVIEW

High quality, prospective studies specific to and/or inclusive of this patient population in assisted reproductive care contexts is limited, however evidence regarding age-informed prognosis, screening guidelines, treatment outcomes, insemination timing, number of inseminations per cycle, when to refer, and safety of the procedure were found.

FINDINGS

Findings indicate that compared with routine infertility care protocols, a low-tech, low-intervention model of care for ovulatory LGBTQ+ individuals renders equal or higher success rates without increasing risk.

CONCLUSION

Given the current evidence, TDI for LGBTQ+ families can, with support and training, be provided appropriately in a variety of contexts, including community-based and primary care settings as well as in fertility clinics.

RELEVANCE

This review establishes the current state of the evidence supporting TDI for LGBTQ+ families, expanding access to care for recipients as well as their care providers and outlining areas for further study.

Provision of fertility services to women in same-sex relationships at Catholic and non-Catholic clinics in the United States

INTRODUCTION

This study addressed deficient information on the provision of infertility care in obstetrics and gynecology clinics. We additionally evaluated the availability of these services based on clinic affiliations or stated sexual orientation.

METHODOLOGY

We performed a national cross-sectional "mystery caller" survey of 293 general obstetrics and gynecology clinics in 2017-2018. We matched clinics identified by web-based search engine in a 1:1 ratio by Catholic hospital affiliation, after determining number of clinics based on state-population densities. A standard call script included questions regarding provision of infertility services, ovulation induction methods, and information about the caller's sexual orientation. We performed descriptive frequencies and compared responses based on hospital affiliations.

RESULTS

Of the 293 clinics included, 49% were affiliated with Catholic and 17% with academic hospitals. The majority offered infertility care (85%, 248/293), and of these 97% (240/248) offered ovulation induction. Only 3% (6/240) reported they would not provide to women in same-sex relationships. Most clinics not offering infertility evaluations (43/45, 96%) cited it was outside of their scope of care and of these 33% (15/45) did not provide information for self-referral. Clinics affiliated with academic (aOR 0.23) or Catholic (aOR 0.34) hospitals were less likely to provide evaluations. Those with academic affiliation were more likely to provide information for self-referral (aOR 19.2).

DISCUSSION

Most general obstetrics and gynecology practices offered appointments for infertility evaluation and ovulation induction. Clinics rarely denied services to women reporting a same-sex partnership, regardless of hospital affiliation. These findings provide reassurance to same-sex couples seeking fertility care.

Putting reproductive rights into practice. The profile of the demand in a publicly sponsored ART program for single or female partner women in Catalonia

PURPOSE

To evaluate the size and characteristics of the demand for a newly established, publicly sponsored, program of assisted reproduction for single women (SW) and women with a female partner (FP) in a European country.

MATERIALS AND METHODS

We analysed the application forms received during the first two years and structured interviews with 300 successive non selected applicants.

RESULTS

The mean sustained size of the demand was of 52.6 applications per month (sd 14) and corresponded to 0.06 % of the target population. Data from 237 applicants was evaluable. 119 (50.2 %) were SW and 118 (49.8 %) were FP. The median age was 36 years, 36.5 years for SW and 34 years for FP (p < 0.001, Mann-Whitney). Clinically 18.6 % of women presented irregular cycles, and 17.8 % of women had undergone hysterosalpingography (HSG), with a 14.3% prevalence of tubal dysfunction.

CONCLUSIONS

A publicly sponsored program for Assisted Reproduction for SWFP should establish clear inclusion criteria, especially as regards to age, ovarian reserve, techniques offered, and the number of cycles to obtain the maximal efficiency. Further research specific for this group is required to ensure that they receive adequate care and ultimately to fulfil their reproductive rights.

Perceived importance of childbearing and attitudes toward assisted reproductive technology among Chinese lesbians in Hong Kong: implications for psychological well-being

OBJECTIVE

To assess the perceived importance of childbearing and attitudes toward assisted reproductive technology (ART) among Chinese lesbians and the impact on their psychological well-being.

DESIGN

Survey-based study using a 39-item questionnaire.

SETTING

Not applicable.

PATIENT(S)

A total of 438 Chinese lesbians between the ages of 18 and 35 years.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Perceived importance of childbearing; attitudes toward ART; and levels of anxiety and depression.

RESULT(S)

Perceived importance of childbearing to Chinese lesbians was negatively associated with age (r = -0.23), relationship length (r = -0.18), and full-time employment (F = 4.29). Compared to heterosexual childless women, Chinese lesbians thought childbearing was significantly less important (3.30 vs. 6.00 on a 1-10 scale, t = 14.6). Most lesbian respondents (92%) supported legalizing same-sex couples' access to ART, although less than half (41%) wanted to use it themselves to have children. Among lesbians who thought childbearing was important to their parents or their partners, not wanting ART was associated with higher anxiety levels.

CONCLUSION(S)

This is the first quantitative study of childbearing attitudes of lesbians in Asia. The data suggest that Chinese lesbians in the study who perceived childbearing as important to their parents or to their partners but did not want to seek ART reported higher anxiety levels. This study helps raise health care professionals' awareness of Chinese lesbians' attitudes toward childbearing as well as calls for a better delivery system of fertility and mental health services to address the psychological burden of Chinese lesbians in relation to reproductive issues.

De novo Families: Lesbian Motherhood

The aim of this recent Australian study was to explore the experiences of lesbian women choosing motherhood. Participants included 30 self-identifying lesbian mothers. Data were collected via interviews, data collection sheets, and online journaling. The interview and journaling data were analyzed using constant comparative analysis and subsequently illuminated three main themes: becoming mothers, constructing motherhood, and legitimizing our family. These papers described the journey to motherhood and specifically explored the various methods of conception and other decisions that participants made when planning their family, the challenge of heteronormativity in health care, and legitimizing the role of the non-birth mother in de novo families. This article aims to present the participants' experiences of motherhood that was a constant topic found woven throughout all three of the identified themes. Participants identified that they had a unique opportunity to create their own mothering roles in the absence of significant "lesbian mother" role models and that they were able to adjust and to adapt their roles depending on fluctuating circumstances.

Sexual orientation of women does not affect outcome of fertility treatment with donated sperm

STUDY QUESTION

Is there a difference in fertility between heterosexual women and lesbians undergoing sperm donation?

SUMMARY ANSWER

Women undergoing treatment with donated sperm are equally fertile regardless of sexual orientation.

WHAT IS KNOWN ALREADY

Lesbians have an increased prevalence of smoking, obesity, sexually transmitted diseases and, possibly, polycystic ovary syndrome, all factors known to affect fertility. Previous studies on sperm donation inseminations (D-IUI) show conflicting results regarding pregnancy outcome.

STUDY DESIGN, SIZE, DURATION

This is a national study of 171 lesbians and 124 heterosexual women undergoing sperm donation both as D-IUI (lesbian n = 438, heterosexual n = 298) and as embryo transfers (ET) after IVF with donated sperm (lesbians n = 225, heterosexuals n = 230) during 2005-2010.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All clinics in Sweden offering sperm donation recruited patients. Differences in patients' medical history, treatment results and number of treatments to live birth were analyzed using independent samples t-test, Pearson's χ(2) test or Fisher's exact probability test.

MAIN RESULTS AND THE ROLE OF CHANCE

71.8% of heterosexuals and 69.0% of lesbians had a child after treatment. The mean number of treatments was 4.2 for heterosexual women and 3.9 for lesbians. The total live birth rate, regardless of treatment type, was 19.7% for heterosexuals and 19.5% for lesbians. For D-IUI, the live birth rate was 12.8% for heterosexuals and 16.0% for lesbians and the live birth rate for all IVF embryo transfers (fresh and thawed cycles) was 28.7% for heterosexuals and 26.2% for lesbians. There were no differences in live birth rate between the groups for each of the different types of insemination stimulations (natural cycle; clomiphene citrate; FSH; clomiphene citrate and FSH combined). Nor was there a difference in live birth rate between the groups for either fresh or thawed embryo transfer. There was no difference between the proportions of women in either group or the number of treatments needed to achieve a live birth. Heterosexuals had a higher prevalence of smokers (9.2%), uterine polyps (7.2%) or previous children (11.3%) than lesbians (smokers 2.8%, P = 0.03; polyps 1.8%, P = 0.03; child 2.5%, P = 0.003).

LIMITATIONS, REASONS FOR CAUTION

This study is limited to women living in stable relationships undergoing treatment with donated sperm in a clinical setting and may not apply to single women or those undergoing home inseminations.

WIDER IMPLICATIONS OF THE FINDINGS

These results may influence healthcare policy decisions as well as increase the quality of clinical care and medical knowledge of healthcare professionals. The data also have important implications for individuals regarding screening, infertility diagnostic procedures and treatment types offered to heterosexuals and lesbians seeking pregnancy through sperm donation.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was granted by the Stiftelsen Familjeplaneringsfonden i Uppsala; the Swedish Research Council for Health, Working Life and Welfare; and the Marianne and Marcus Wallenberg Foundation. The authors report no conflicts of interest.