Gay fathers' motivations for and feelings about surrogacy as a path to parenthood

Parenthood desire, perceived parenthood stigma, and barriers to achieving parenthood in childless sexual minority men

PURPOSE

To examine the parenthood desire, perceived parenthood stigma, and barriers to achieving parenthood among sexual minority men (SMM) in Canada, and to investigate factors influencing their fertility and assisted reproductive knowledge.

METHODS

Data were collected from March to mid-June 2023 using a 78-item anonymous online survey. Childless cisgender SMM (age 18+) living in Canada were recruited from the LGBTQIA+ community outside the fertility care networks. Chi-square, t-tests, ANOVA, reliability tests, Spearman's correlation, and hierarchical regression model were used for analysis.

RESULTS

Over 160 people clicked the survey hyperlink during the study period and 112 completed surveys were analyzed. The mean age of participants was 33.2±8.5 (range: 19.7-60.0). Having a child by any means was "quite"/"very" important to 35.7% (n=40), yet 56.0% (n=61) thought it was "unlikely" to achieve parenthood. Financial readiness (n=90, 85.7%) and relationship stability (n=86, 81.9%) were the two most "important" parenthood considerations. Participants who were non-white (p=0.017), under age 30 (p=0.008), and had no siblings (p=0.024) had significantly higher means of parenthood desire compared to others. The final hierarchical regression model explained 43% of the variance in the knowledge scores (R2adj =0.353), predicted by the levels of (i) education (β=0.37, p<0.001), (ii) family acceptance of sexual orientation (β=0.39, p=0.004), and (iii) parenthood desire (β=0.27, p=0.002).

CONCLUSIONS

With an increasing number of SMM desiring children, it is pivotal to advance family-building equality through improving their fertility and assisted reproductive knowledge, removing disparities in accessing adoption and assisted reproductive services, and decreasing social stigma against SMM having children.

European gay fathers via surrogacy: Parenting, social support, anti-gay microaggressions, and child behavior problems

The present study investigated child behavior problems, parenting styles, coparenting, and couple relationship satisfaction in 67 European gay father families via surrogacy and 67 European heterosexual parent families via unassisted conception, all with children aged 1.5-10 years (M = 3.57 years, SD = 2.09). The two family groups were matched for child age and gender. In the gay father group only, the associations between family anti-gay microaggressions, family/friend support, and other main variables also were explored. Children of gay fathers had fewer externalizing and internalizing problems compared to children of heterosexual parents. Also, gay fathers reported more effective parenting styles, greater coparenting quality, and higher couple relationship satisfaction compared to heterosexual parents. Overall, child externalizing problems (i.e., aggression, rule-breaking) and internalizing problems (i.e., anxiety, depression) were more strongly associated with being raised in a heterosexual parent family, more authoritarian parenting, and lower positive coparenting. Specific to the gay father sample, anti-gay microaggressions experienced by family members were associated with more child internalizing problems, lower positive coparenting, and lower social support from family and friends. These results refute concerns about possible detrimental effects on child development of surrogacy conception or of being raised by gay fathers. The results further suggest that family therapists treating child behavior problems should focus mainly on improving the coparenting relationship, reducing authoritarian/punitive parenting styles, and (for gay father families specifically) coping with anti-gay microaggressions and lack of social support outside the nuclear family.

Motives for desiring children among individuals of different sexual-romantic orientations: a cross-sectional study

PURPOSE

Little is known about the reasoning behind the desire to have children in non-heterosexual individuals. This study compares the motives of different sexual-romantic orientations and their preferred ways of fulfilling this desire.

METHODS

This was a monocentric cross-sectional study. Subjects were recruited via social media, personal contacts and queer organisations in Switzerland. An anonymous questionnaire comprised general questions about the participant's background, a validated survey about the desire to have children and additional non-validated questions addressing the impact of sexual-romantic orientation on the desire to have children. The inclusion criteria were adults without children and a completed questionnaire.

RESULTS

Of 837 participants, 642 were included in the study. Four groups of sexual-romantic orientations consisted of more than 35 participants: bisexual-biromantic (n = 38), heterosexual-heteroromantic (n = 230), homosexual-homoromantic (n = 159) and pansexual-panromantic (n = 55). Subgroups with a positive wish for a child rated all motives in the same order and with minimal numeric difference. The most important aspect seemed to be emotional involvement. Non-heterosexual-heteroromantic showed concerns about adverse reactions regarding their wish for a child. All orientations hoped for a biological child.

CONCLUSION

Our findings about bi-, hetero-, homo- and pansexual people and their motives for a desire to have children agree with the existing literature about hetero, homo and bisexual. The impact of the fear of adverse reaction and discrimination has been discussed before and is supported by our data. We suggest better support before and during the realization of the wish for a child as well as support for non-traditional aspiring parents.

Israeli Single Gay Fathers' Choice of Lone Parenthood via Surrogacy: A Qualitative Study

This article focuses on Israeli single gay fathers' reproductive choices. Thematic analysis of 13 in-depth semi-structured interviews with Israeli single gay fathers yielded two themes related to their reproductive choice. The first theme pertains to their decision to become single fathers. Three dimensions were prominent in the participants' decision to pursue lone parenthood: the choice to fulfill parenthood as gay men; the choice to separate parenthood from couplehood; and the view of single parenthood as empowerment. The second theme pertained to the fathers' decision to use surrogacy, which was influenced by three key factors: the desire to parent a biological child, the desire for exclusive fatherhood, and the perceived advantages of surrogacy for single fathers. The findings indicate that the fathers narrated their reproductive experiences in terms of choice and autonomy, while negotiating with dominant concepts of parenthood as a two-parent, heteronormative and biogenetic phenomenon. These men referred to the challenge they posed to some of these concepts and the social barriers they encountered as factors that facilitated their coping skills in lone parenthood, thereby enhancing their agency. These findings highlight the contextual, multidimensional and relational nature of the reproductive choices of men from minority groups like single gay fathers.

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning

The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.

Gay Fatherhood Experiences and Challenges Through the Lens of Minority Stress Theory

Gay-fatherhood raises questions about hegemonic gender norms and traditional family systems in different contexts and countries. This study explores gay fathers' desires, motivations, and experiences of having a child. Participants' challenges and concerns regarding having and raising children also were explored. Data were obtained through in-person interviews of 11 self-identified gay fathers. The data were then analyzed using interpretive phenomenological analysis (IPA) analysis. The analytical results identified three themes that shed light on participants' desires and experiences of parenthood. These were: (1) innate motives to parent and gender role strains, (2) enacted stigma (i.e., acts of rejection due to sexual orientation and traditional gender roles), and (3) children's social rejection due to their parents' sexuality. The findings of this study stress the influence of contextual factors (stigma) and intrapersonal factors (internalized anti-gay prejudice) in participants' health and well-being. This study potentially tries to expand cultural awareness of research in this field.

Experiences and Meanings of Surrogate Pregnancy Among Gay Israeli Men Who Become Parents Through Overseas Surrogacy

This study explores the experiences of single gay men and gay men who raise children in couples who have created their families through surrogacy procedures in different countries and cultural contexts. The analysis of 39 in-depth, semi-structured interviews with these fathers suggests that the effects of medicalized reproduction on these men are twofold. Medicalized reproduction leads these men, on one hand, to feel alienated from surrogate pregnancy and the fetus, and on the other hand, to contribute to the construction of a new form of intimacy between the surrogates and the newborns. This highlights the paradoxical character of overseas surrogacy, which resonates with other forms of reproductive procedures. The importance of these findings is examined by means of a qualitative paradigm, through which we stress the complex impacts of medicalization on gestation, childbirth, and transition to parenthood among ART (i.e.: Assisted Reproduction Technologies) participants, in particular on gay men.

United States Normative Attitudes for Pursuing Parenthood as a Function of Gender, Sexual Orientation, and Age

Decisions about whether or not to become a parent are significant parts of normative human development. Many studies have shown that married different-sex couples are expected to become parents, and that many social pressures enforce this norm. For same-sex couples, however, much less is known about social norms surrounding parenthood within marriage. This study examined injunctive norms and descriptive norms for the pursuit of parenthood as a function of age, gender, and sexual orientation. Participants in an internet survey included 1020 (522 heterosexual, 498 lesbian/gay) cisgender people from across the United States Findings showed that norms, especially descriptive norms, for the pursuit of parenthood for heterosexual people were much stronger than those for lesbian women and gay men, and that norms for lesbian women were stronger than those for gay men. These differences were more pronounced for older, heterosexual, and male participants. However, lesbian and gay participants, especially gay men, reported that lesbian and gay people ought to become parents to the same extent as heterosexual people. Overall, the results indicated that, regardless of sexual orientation, adults report that lesbian and gay married people ought to become parents, but that they expect only a minority of these couples will pursue parenthood. This research provided a glimpse into how Americans are envisioning family formation among same-sex couples today.

Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives

BACKGROUND

Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate.

METHODS

Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care.

RESULTS

Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV.

CONCLUSIONS

Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

Can HIV-positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that 'being undetectable' changes how HIV-positive gay men experience their sex lives. But how does it affect gay men's reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV-positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people's understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.

Comparison of perinatal outcomes between spontaneous vs. commissioned cycles in gestational carriers for single and same-sex male intended parents

PURPOSE

To determine whether gestational carrier (GC) in vitro fertilization (IVF) cycles (commissioned cycles) for same-sex or single male intended parents have an increased incidence of adverse perinatal outcomes compared with spontaneous cycles in the same GCs.

DESIGN

GC singleton pregnancies were identified from a database of 895 commissioned cycles from a large fertility center. Of these, 78 commissioned cycles met inclusion and exclusion criteria and were compared with 71 spontaneous cycles by the same GCs. The primary outcome was the composite score for adverse perinatal outcomes. Secondary outcomes included mode of delivery, birthweight, and gestational age. Chi-square test of association and Mann-Whitney U tests were used to compare categorical and continuous variables between the cohorts, respectively. Logistic and linear regressions controlling for GC age were constructed to determine the influence of GC cycle type on adverse perinatal outcomes.

RESULTS

Commissioned cycles were significantly associated with adverse perinatal outcomes (25.6% vs. 9.9%; p = 0.02) and lower average gestational age (38.7 ± 1.5 vs. 39.4 ± 0.9; p < 0.001) compared with spontaneous cycles. Commissioned cycle increased the likelihood of adverse perinatal outcomes (OR 3.3; p = 0.03) and was a significant independent predictor of a lower average gestational age (β = 0.897; p < 0.001). There were no significant differences in the incidence of vaginal deliveries or cesarean sections between commissioned and spontaneous cycles.

CONCLUSIONS

Commissioned cycles confer a greater incidence of composite perinatal complications and were independently associated with a lower average gestational age when compared with spontaneous pregnancies carried by the same GC despite a confirmed healthy uterine environment, sperm samples, and donor oocytes.

Pathways to Parenthood in Social and Family Context: Decade in Review, 2020

OBJECTIVE

This article reviews research from the past decade on patterns, trends, and differentials in the pathway to parenthood.

BACKGROUND

Whether, and under what circumstances, people become parents has implications for individual identity, family relationships, the well-being of adults and children, and population growth and age structure. Understanding the factors that influence pathways to parenthood is central to the study of families and can inform policies aimed at changing childbearing behaviors.

METHOD

This review summarizes recent trends in fertility as well as research on the predictors and correlates of childbearing, with a focus on the United States and on research most relevant to family scholars. We document fertility differentials and prevailing explanations for variation across sub-groups and discuss alternative pathways to parenthood, such as adoption. The article suggests avenues for future research, outlines emerging theoretical developments, and concludes with a discussion of fertility policy.

RESULTS

U.S. fertility has declined in recent years; whether fertility rates will increase is unclear. Elements of the broader social context such as the Great Recession and increasing economic inequality have impacted pathways to parenthood, and there is growing divergence in behaviors across social class. Scholars of childbearing have developed theories to better understand how childbearing is shaped by life course processes and social context.

CONCLUSION

Future research on the pathways to parenthood should continue to study group differentials, refine measurement and theories, and better integrate men and couples. Childbearing research is relevant for social policy, but ideological factors impact the application of research to policy.

Children's Exploration of Their Surrogacy Origins in Gay Two-Father Families: Longitudinal Associations With Child Attachment Security and Parental Scaffolding During Discussions About Conception

Evidence is lacking about the factors that are pivotal in enhancing the exploration of surrogacy origins in children of gay fathers during middle childhood. The present study examined the separate and combined influences of child attachment security and parental scaffolding (i.e., fathers' attempts to accept, encourage, and emotionally support their children's expression of thoughts and feelings) during discussions about conception on children's exploration of their surrogacy origins in 30 Italian children born to gay fathers through gestational surrogacy. Within each family, both father-child dyads (n = 60) participated in a 5-minute videotaped conversation regarding an aspect of the child's conception when children were mean aged 8.3 years (t1). At this time, children were also administered the Security Scale Questionnaire to evaluate their attachment security. Approximately 18 months later (t2; M age = 9.9 years), children were interviewed about their surrogacy origins. Linear mixed models (LMMs) for longitudinal data indicated that, with higher levels of parental scaffolding, only children who perceived greater attachment security reported greater exploration of their surrogacy origins. The findings are the first to underscore the importance of conversations about surrogacy within the context of parent-child attachment relationships, as well as the importance of fathers sensitively supporting their children as they explore their origins during middle childhood. In doing so, it is expected that fathers will likely facilitate their children's positive integration of their surrogacy conception into a coherent sense of identity during adolescence.

Desire for Parenthood in Context of Other Life Aspirations Among Lesbian, Gay, and Heterosexual Young Adults

Research has established that sexual minority young adults generally report fewer desires and fewer expectations for parenthood than do their heterosexual peers. Little is known, however, about other desires and expectations. Is parenthood the only domain in which lesbian and gay individuals report fewer desires and expectations than their heterosexual peers? Or do lower aspirations among lesbian and gay adults about parenthood also occur in other domains, such as marriage and work? In this study, we explored a variety of desires and expectations for the future among lesbian, gay, and heterosexual young adults. Participants for this internet survey were recruited via social media, and included 368 childless cisgender young adults (211 lesbian or gay and 157 heterosexual) living in the United States. There were three main findings. First, while lesbian/gay individuals were less likely than heterosexual participants to express desire for parenthood, desires in the other future domains did not vary across sexual orientation. Lesbian/gay participants were as likely as heterosexual individuals to desire marriage, friendships, and community connections, as well as career and economic success. Results for expectations were, however, very different. Lesbian/gay participants were less likely than heterosexual individuals to expect that they would marry, become parents, feel connected to a community, achieve meaningful careers, live in their ideal housing, or that they would attain financial stability. Thus, although desires were largely unrelated to sexual orientation, many expectations were strongly linked to it. Lesbian and gay individuals were also far more likely than their heterosexual peers to desire future goals that they did not expect to achieve. Overall, for lesbian/gay young adults, low parenthood aspirations were part of a general pattern of low expectations (though not reduced desires) across a number of life domains.

Incidence of surrogacy in the USA and Israel and implications on women's health: a quantitative comparison

PURPOSE

Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades.

METHOD

The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison.

RESULTS

The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer.

CONCLUSION

GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies.

Parents' relationship with their surrogate in cross-border and domestic surrogacy arrangements: comparisons by sexual orientation and location

Objective

To study heterosexual and gay couples' relationship with their surrogate and their disclosure decisions when the surrogacy arrangement was completed domestically compared with internationally.

Design

Cross-sectional study.

Setting

Not applicable.

Patient(s)

Participants were 40 gay couples and 76 heterosexual couples who had domestic surrogacy in the United Kingdom (UK) (n = 38) or international surrogacy in the United States (n = 58) or Asia (20). Most (75%) of the children were aged <4 years.

Intervention(s)

Online surveys containing open-ended and multiple-choice questions.

Main Outcome Measure(s)

Experiences of finding a surrogate, relationship with the surrogate, and disclosure to the child were examined among UK parents who had undergone surrogacy in the UK, United States, or India/Thailand.

Result(s)

Parents who had surrogacy in the UK and United States felt very involved in the pregnancy compared with those who had surrogacy in Asia. Couples whose surrogacy was completed in Asia were less likely to want contact with their surrogate after the birth and were also less likely to have any current contact with the surrogate. Parents who had surrogacy in the UK and United States described positive relationships with their surrogate. Gay couples intended to tell their child about surrogacy more than heterosexual couples.

Conclusion(s)

The specific country where couples conducted their surrogacy arrangement (i.e. United States, UK, or Thailand/India) was associated with how involved they were in the pregnancy and their contact with the surrogate over time. Limitations of the study include use of survey methodology and that the representativeness of the sample is not known.

Self-Perceived Parental Role and Mental Health Concomitants Among Israeli Gay and Heterosexual Fathers

In this study we examined the association between self-perceived parental role and adverse mental health (indicated by depressive symptoms, neuroticism, and negative affect) in a sample of 82 Israeli gay fathers (Mean age = 39.57, SD = 6.70) that were individually matched with 82 heterosexual fathers (Mean age = 39.11, SD = 7.88). Results showed that although self-perceived parental role was associated with adverse mental health, this association was moderated by sexual orientation, such that a significant negative association between self-perceived parental role and adverse mental health was evident only among gay fathers. The findings are understood by features of gay fatherhood, which is intentional and purposeful, and usually achieved after contending with particular difficulties in the journey to fatherhood. These features presumably shape the perceived parental role, and thus may link more strongly with lower levels of adverse mental health among gay fathers, compared to heterosexual fathers.

Can Children Have Ordinary Expectable Caregiving Environments in Unconventional Contexts? Quality of Care Organization in Three Mexican Same-Sex Planned Families

The aim of this research was to explore the elements that configure the quality of care among three Mexican same-sex planned families: two female-parented families (through donor insemination) and a male-parented one (through adoption). The first family consisted of two mothers and a 3-year-old daughter; the second one had two mothers and a 1.5-year-old set of boy twins and the third family consisted of two fathers and a 2-year-old girl. It was assumed that Ainsworth’s notions of quality of care organization are useful in order to understand caregiver–child attachment relationships, regardless of the parents’ sexual orientation. A collective case study was selected due to the fact that these families shared their “unconventionality” (i.e., parents were not heterosexual) and the fact that they were planned, but each one constituted a particular case with a unique configuration. Four trained independent observers used the q-sort methodology (Maternal Behavior Q-Sort and Attachment Q-Sort) to describe parents’ and children’s behavior, respectively. The findings showed that parents were highly sensitive and all children used them as a secure base. To provide an in-depth examination of which elements configure the quality of care, a semi-structured interview with each parent was carried out. Through a thematic analysis, an over-arching theme named Affections and Emotions was identified, together with six subthemes: (1) Creating an affective environment; (2) Being available; (3) Acknowledging and expressing emotions; (4) Perceiving, interpreting and responding adequately to the child’s real self; (5) Taking the child’s perspective into account; and (6) Agreeing on roles and dividing the tasks. In order to showcase the particular configuration of gay parenting, the male-headed family narrative is reported in detail, because gay parents have been perceived as violating traditional gender roles as well as the hegemonic model of masculinity. The findings were consistent with the notion of quality of care as proposed by Ainsworth and her collaborators. The implications of the methodological device and research regarding same-sex planned families are discussed so as to understand the organization of the caregiving environment.

Rights-holders or refugees? Do gay men need reproductive justice?

A thriving North American industry has emerged designed to help gay men become biological parents through surrogacy and egg donation. Taking as given that gay men have the same ethical right to pursue such reproductive technologies as heterosexual couples or individuals, this article asks whether access to egg donation and surrogacy for gay men specifically could be considered a matter not just of (consumer) rights, but of justice. The idea of shifting discourse about reproduction from the language of 'rights' to that of 'justice' is most notably articulated by women of colour. Their call for reproductive justice seeks to expand discussion beyond the narrow right to an abortion (as a negative privacy right) to encompass broader, positive rights, such as the rights to bear healthy children and to raise them in safe environments. What, if anything, might we learn from reproductive justice movements about how to frame gay men's desire/demand for access to surrogacy? While I find several productive connections between the two groups, two factors lead me to argue against understanding gay access to surrogacy as a matter of justice: first, the necessary reliance on women's reproductive labour; and second, the largely non-structural causes of gay couples' inability to reproduce. Nevertheless, by considering two driving forces behind gay male assisted reproduction - social norms favouring biological family formation and the need for family security - I ultimately conclude that a basis for solidarity exists between gay men and reproductive justice movements. That basis is a concept like 'procreative liberty'.

A limited market: the recruitment of gay men as surrogacy clients by the infertility industry in the USA

Gestational surrogacy via egg donation is an expensive - and sometimes ambivalently undertaken - but increasingly popular route to planned fatherhood for some gay men. The surrogacy market in the USA plays an important role for gay men with the financial resources to access these services, as it is currently the only stable, commercial market in which there are legal protections for openly gay men. While a small, ethnographic and qualitative literature on the experiences of gay fathers via surrogacy exists, less is known about the state of the surrogacy industry towards gay men as clients. Here I investigate the surrogacy industry in the USA to ask how welcome gay men are in this market. I do so via a content analysis of patient/client recruitment on infertility clinic and surrogacy agency websites. Content analysis of 547 websites indicates that the majority of infertility clinics (62%) and 42% of surrogacy agencies do not directly advertise or appear to be welcoming to gay men. A minority of gay-friendly clinics and agencies, which cluster geographically, actively recruit gay men, creating a limited but niche market. The unequal recruitment of gay men as infertility clients reflects how normative ideas about gender, sexuality and social class are reproduced in the infertility industry. This, in turn, may impact gay men's procreative consciousness and decision-making about parenting, and exacerbate inequalities around their access to intentional genetic parenthood.

Risks in Surrogacy Considering the Embryo: From the Preimplantation to the Gestational and Neonatal Period

Surrogacy is an assisted reproduction-based approach in which the intended parents assign the gestation and birth to another woman called the surrogate mother. The drivers of surrogacy refer largely to infertility, medical conditions, same-sex couples' parenting, and cases of diversity regarding sexual identity and orientation. Surrogacy consists of a valid option for a variety of conditions or circumstances ranging from medical to social reasons. However, surrogacy may be associated with risks during the preimplantation, prenatal, and neonatal period. It became obvious during the exhaustive literature research that data on surrogacy and its association with factors specific to the IVF practice and the options available were not fully represented. Could it be that surrogacy management adds another level of complexity to the process from the ovarian stimulation, the subsequent IVF cycle, and the techniques employed within the IVF and the Genetic Laboratory to the fetal, perinatal, and neonatal period? This work emphasizes the risks associated with surrogacy with respect to the preimplantation embryo, the fetus, and the infant. Moreover, it further calls for larger studies reporting on surrogacy and comparing the surrogate management to that of the routine IVF patient in order to avoid suboptimal management of a surrogate cycle. This is of particular importance in light of the fact that the surrogate cycle may include not only the surrogate but also the egg donor, sperm donor, and the commissioning couple or single person.

Assessing Prejudice Toward Two-Father Parenting and Two-Mother Parenting: The Beliefs on Same-Sex Parenting Scale

This article describes two interrelated studies that investigated beliefs and stereotypes on two-father parenting and two-mother parenting through the development and validation of the Beliefs on Same-Sex Parenting (BOSSP) scale. The BOSSP captures two beliefs: (1) prejudices toward same-sex couples' inherent inability to parent and (2) concerns about same-sex parenting that are not necessarily related to homonegativity. In Study 1 (301 heterosexual participants), exploratory factor analysis (EFA) suggested an 11-item scale for attitudes toward both two-father families and two-mother families, with two factors: parenting skills, which evaluates beliefs on same-sex couples' ability to take care of their children; and parental adjustment, which assesses beliefs on the impact of challenges related to same-sex parenting on children's well-being. Support for convergent validity between BOSSP factor scores and those of theoretically related measures were provided. In Study 2 (346 heterosexual participants surveyed in two time points), CFA indicated that the two-factor model provided the best fit. Test-retest reliability and longitudinal invariance were documented. Finally, results revealed that more negative attitudes toward same-sex parenting were held by men than by women and were associated with negative opinions on reproductive techniques. The innovative characteristics of the BOSSP and implications for future practice are discussed.