Running the gauntlet to get pregnant when you're LGBTQ+

In 5 seconds A new study sheds light on the obstacles faced by LGBTQ+ couples navigating medically assisted reproduction.

For LGBTQ+ couples, getting pregnant can be an arduous process.

There are countless forms to fill out and medical tests to take – many of which they feel are unnecessary – and a lot of invasive questions they have to field from friends and family who know precious little about the process.

Indeed, when they decide to have a child through medically assisted reproduction (MAR), LGBTQ+ couples face a number of barriers that heterosexual couples do not.

“It’s as if these people have to come out of the closet again and again," said Zoé Benoit, a Ph.D. student in clinical psychology at Université de Montréal and first author of a new study on the question.

"Some participants in our study reported being asked if they were sisters," Benoit said. "It’s not easy.”

The first part of her study was published last November in the Canadian Journal of Human Sexuality.

A journey within a journey

Zoé Benoît, Katherine Péloquin and Mathilde Renaud

Benoit’s work is part of the Journey Project, a large-scale study of couples and infertility led by UdeM psychology professor Katherine Péloquin, director of the Couples and Relationships Research Lab.

The project is documenting the experiences of 345 couples from Canada and the U.S. over a two-year period. In each, both partners complete an online questionnaire every six months, starting at the beginning of their MAR process.

While there have been qualitative or more narrowly focused studies, “to our knowledge, ours is the first quantitative, longitudinal study of LGBTQ+ couples undergoing MAR,” said Péloquin. “Until now, we didn’t have an overview of their experience with fertility clinics.”

Among other things, the project is examining psychological, relationship and sexual difficulties, and exploring the differences and similarities between the experiences of heterosexual cisgender couples who turn to MAR because of medical infertility and LGBTQ+ couples undergoing MAR.

Benoit was assigned the LGBTQ+ couples part of the study. She began with a qualitative analysis of open-ended questions in the questionnaire. As the measures for quality of life during MAR were developed with heterosexual cisgender couples in mind, the research team added open-ended questions to better capture the realities of LGBTQ+ couples.

These questions shed light on how the MAR process affected various areas of the lives of the 58 Canadian couples in the sample. Some previously overlooked themes emerged from the analysis conducted by Benoit and her colleague, UdeM master’s student Mathilde Renaud. “It was quite surprising,” said Benoit.

Common emotions, different paths

Assisted reproduction is a challenging process, regardless of sexual orientation. Medical infertility and social infertility—the inability to have children for social reasons—give rise to the same emotions: feelings of powerlessness, stress, anxiety. “There’s no difference in the feelings, but the reasons for them may not be the same,” said Péloquin. “That’s what our qualitative component reveals.”

For instance, LGBTQ+ couples reported preconceptions on the part of medical staff as well as friends and family. “People assume that the women are seeking assistance because of medical infertility, and they prescribe tests that aren’t always necessary,” said Péloquin. In fact, LGBTQ+ couples are usually there because of social infertility. For them, MAR is the primary route to having children.

But even though 20 to 30 per cent of the clients of MAR clinics are LGBTQ+ couples, the expectations remain heteronormative. For example, the forms they have to fill out typically ask for the father’s name.

The researchers also noted that medical and social infertility are not mutually exclusive. If one member of a lesbian couple is unable to conceive for medical reasons, medical staff sometimes wrongly assume the other partner will automatically carry the child. “Sometimes they act as if the two uteruses were interchangeable; there can be a lack of tact and sensitivity,” said Péloquin.

Participants in the study also reported preconceived ideas and intrusive questions from friends and family: “They’ll ask who the donor is, or refer to him as ‘the father’,” said Benoit.

Listening to LGBTQ+ people

Often, MAR materials and information are not tailored to LGBTQ+ people. One goal of this study is to amplify their voices. “The treatment pathway isn’t clear,” Benoit said. She hopes this research will help normalize the journey, both socially and clinically.

Péloquin would also like to develop information materials designed for LGBTQ+ couples as well as training materials to help clinics guide and support them. The last 10 years have seen positive changes, but medical staff still lack training in the specific realities of LGBTQ+ clients, she said.

“Doctors tell us things have improved. But nevertheless, the lived experience remains awkward and inequalities persist. There’s still work to be done.”

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