#32: Queer Buns in Queer Ovens (Fertility & Family Building for LBQ+ Women, Part 1)
COMMUNITY VOICE: Tiffany Cook | HEALTHCARE EXPERTS: Brent Monseur MD, ScM; Patrina Sexton Topper PhD, MS, RN | COMMUNITY REVIEWER: Olivia Hall
SHOW NOTES
Whose episode is it, anyway?
Our main focus will be lesbian, bisexual, and queer (LBQ+) women thinking about family building – whether you’re planning now or just starting to explore
But a lot of what we cover - the logistics of egg freezing, choosing sperm - are things we think other groups will find useful
For example:
Trans and gender diverse people assigned female at birth who are also considering fertility/family building (lots will overlap - we just won’t be talking about things like managing testosterone while undergoing IVF. On our list for a future episode!)
Partners and support people who want to understand the process of family building
Healthcare providers (yes, we know you listen too!) seeking to provide informed, affirming fertility and preconception care
Why this matters
For queer women, family building involves more than biology. There are extra layers of decision-making — not just who will carry or where to get sperm, but also:
How gender expression and identity shape comfort with pregnancy
How to balance desire for a biological connection with emotional or relational readiness
When and where to enter a healthcare system that isn’t always affirming
How finances, insurance coverage, and legal parenthood intersect with fertility care
Getting clear information early and surrounding yourself with supportive, queer-affirming care can make these complex decisions feel possible — and even empowering.
Thinking ahead makes all the difference.
Establish care early with a queer-affirming OB/GYN or reproductive endocrinologist. Once you’re pregnant, clinic availability can fill up fast, so building that relationship early helps.
Get a fertility assessment
Understanding your current fertility and potential barriers (like irregular cycles, prior infections, or age-related changes) gives you options down the line
Some things that can impact fertility: untreated gonorrhea/chlamydia, endometriosis, and age (though it’s not as much a hard and fast rule!)
Ask about genetic carrier screening.
Any partner contributing genetic material can be screened for inheritable conditions
These results can help narrow down the pool of sperm donors
Get the paperwork in order. Many sperm banks require clinician sign-off before you can make a purchase — something Tiffany calls the “sperm permission slip.”
Check insurance and legal details
Policies differ widely on covering fertility treatment for queer couples
For some, bringing in a lawyer early on is the right choice!
Talk with your partner proactively.
Hormonal treatments for fertility use very high doses and can shift how you feel physically and emotionally, all while you and your family are making big decisions
Planning ahead and communicating with your partner early on in the process can be really helpful
Sperm: where to get it from
Choosing a sperm source can feel surprisingly intimate — and logistical.
Known donor: a friend, acquaintance, or relative. This option may offer emotional connection but can require complex legal and relational agreements.
Sperm bank donor: anonymous or open-ID donors screened for hundreds of genetic conditions. Banks often require clinician approval and sometimes counseling.
Counseling and disclosure: Some clinics require meeting with a counselor before insemination, especially when using donor gametes. While it can feel gatekeeping-like, experts note it’s also a chance to discuss disclosure to children, family dynamics, and future parenting conversations.
If you’re going the sperm bank route, stay tuned for Part 2 of this episode — where we’ll dive deeper into how sperm banks work, what to expect in the process, and how to navigate the emotional and logistical side of donor selection.
TRANSCRIPT
Tiffany: And so I think that's a hard process. It's not an easy process. I think we were also lucky to have the money available to us to do so. And I know that that's not always the case.
[QHP THEME MUSIC STARTS]
Gaby: Welcome to Queer Health Pod, a podcast by queer people for queer people about queer health.
Sam: My name is Sam. I use he/him pronouns, and I am a queer primary care doctor in New York City.
Gaby: My name is Gaby I use she/her pronouns and I have the same job title.
Richard: I'm Richard. I use he him pronouns, and I have the same job too. I've just been doing it a lot longer.
Gaby: And you are listening to Queer Health Pod Season 3, Episode 13: Family Building for Lesbian, Bisexual, and Queer Women: Part 1.
[QHP THEME MUSIC ENDS]
Sam: So you might have clicked onto this episode because it says "fertility and queer women," but there is a lot that's there for the whole queer community, a through line that's for many queer people, regardless of whether you know how to read tarot or not.
Richard: Well, I'm learning how to read tarot, but I'm curious as to who exactly we're talking about today and who's it for?
Gaby: Thank you so much for this question that I totally didn't plant in the script. This episode comes from a big gap that I've seen in my own community of queer women. I have friends who wanna start families now or in the future, and they just don't know where to start. How do you do it? What's the process like? What kind of a doctor do you see and when should you see them? And even if you're not ready for kids yet, but you think you might want them in the future, I, is there anything that you actually should be planning earlier on? So the goal is to give people a clear sense of how and when to get medical care around fertility and family building.
Sam: And let's be clear: today we're chiefly talking about biomedical technologies that facilitate pregnancy. That includes artificial insemination, IVF- terms that you may have wondered about and we'll define them later.
Gaby: And then the other part to be clear about is who we're actually talking about. This episode is gonna center the experiences of cisgender queer women who are interested in fertility and family building. That said, I do think that there are people with uteruses or uteri, whatever your preference is, who are gonna find this episode useful. Because the mechanics of egg freezing and IVF, they actually don't change much across different populations. But the difference is that on this episode, we're not gonna explicitly cover things like say, managing testosterone while undergoing fertility treatment.
Richard: And other people who can't themselves get pregnant, like cisgender, gay, bisexual, and queer men may also find this episode useful since they might be supporting people who are going through fertility IVF and egg freezing, whether that's a partner or a gestational carrier. But we will be doing this episode from the perspective of lesbian, bisexual, and queer women.
Sam: In future QHP episodes, we hope to discuss other queer family building paths like adoption and fostering, as well as working with gestational carriers who are also known as surrogate.
Gaby: in this episode and the next we're gonna lay out a roadmap of decisions that prospective parents may be making while considering fertility and family building. We're gonna frame this roadmap as key questions that you might ask yourself at each step of your fertility journey. And for the more medical parts- that includes sperm donation, fertility testing, different methods of conception like IVF, and then all of these other related procedures like IUI- we're gonna offer you a window into what that looks like from the healthcare consumer side. So basically we're trying to give you what me and my friends didn't have.
Sam: Which was not a good tarot reading. They certainly had that.
Gaby: Yes, They did. Thank you very much.
[MUSIC]
Sam: We are about to walk you through the roadmap and all the practical questions of fertility and family building, but before we even get to that, there's a deeply personal stage that we're not gonna tackle here: deciding not only if you want to be a parent, but who you wanna build a family with. Tiffany, our community voice for this episode shares her story today and is a great example of how those two decisions can shape everything that follows.
Tiffany: Hi, I am Tiffany Cook. I use the pronouns, she, her and hers. I am a queer mom and I am really excited to be on the Queer Health podcast. When I first met Morgan,
Gaby: That's her husband, who is a trans man, and also reviewed this episode for those who are wondering at home.
Tiffany: When I first met Morgan, I had actually just ended a relationship with somebody who really didn't want kids but was willing to have kids with me, and I didn't feel like that was really fair to my future children. I really wanted to have somebody who was enthusiastic and excited about the possibility of parenting alongside me. On that first date, we actually both explicitly talked about wanting to have kids and that it was really important to us to date somebody who wanted to have kids. And so that was our first conversation together.
Gaby: Tiffany just described how she and Morgan were on the same page about wanting kids. Once that was clear, the next question on their roadmap was, who's gonna get pregnant? And for Tiffany, that was actually a pretty easy answer.
Tiffany: So I've definitely known that I've wanted to be a mom for a really long time. I recall very explicitly having a conversation with one of my best friends when I was 16 years old. We had Starbucks in hand, talking about how we both really wanted to be moms. So I definitely really wanted to be a mom. I've always really been interested in sexual and reproductive health. And so because of that I think I was just always fascinated with the reproductive system and how it functions and like the process of birth. And for me, I really just wanted to experience it. It was like a big part about me, kind of my own identity as a woman, but also wanting to experience all of pregnancy, all of the joys, all of the challenges.
Sam: For Morgan, the answer on his side was also pretty straightforward: he knew early on that he did not wanna carry a pregnancy himself.
Tiffany: From what I recall from those kind of early conversations, Morgan was like very uninterested in having to go through the treatments it would take to utilize his eggs.
Gaby: I do wanna point out that this question of who's going to get pregnant and carry the pregnancy isn't as straightforward for everyone as it was for Morgan and Tiffany.
Richard: As our first expert voice, Dr. Patrina Sexton Topper, who researchers the experience of queer couples navigating fertility technologies,
Dr. Sexton Topper: My name's Patrina Sexton Topper. I use she I identify as queer and I'm an Assistant Professor at Villanova University in the College of Nursing, where I teach social justice and health equity, and I teach some of our doctoral level courses.
Richard: She explains how there are a lot of personal, social and structural factors that shape these decisions.
Dr. Sexton Topper: I think it has a lot to do with reproductive rights and justice and those three legs of the stool: the right to have child, the right not to and choose not to in a body that is capable of doing that, to choose not to do that, and then the right to parent free from threats of harm. And I think all of those things come into play when you're making decisions. And they don't have to be explicit, but they are present.
Richard: For some people like Tiffany, the question of who's gonna carry the pregnancy is obvious and feels intuitive, but for so many queer people with uteruses the question can feel more complicated. It can bring up tension or even guilt: you want kids and your body could carry a pregnancy, but you feel ambivalent about being pregnant.
Sam: So I don't have a uterus and I'm not someone who's gone my whole life thinking about whether I want to carry pregnancy or not, whether I should carry pregnancy or not, and having other people expect that of me. So Gaby, can you unpack a little more of these complicated questions that someone has to answer on their own?
Gaby: So I have a uterus. It's- spoiler alert, big reveal on main, the short hair didn't hide it. So anyway, so I, I have never wanted to be pregnant and I've always wanted to be a parent and... and this has been true actually since before I was even out as queer, or I think even conceptualized of my queerness. It was there when I was little. You can ask my mom. But, I think as I have grown into my queerness and grown into that being a possibility for me, meaning that I can be a parent and not carry because I'm with a partner who was open to carrying and then queerness also just made it evident to me that there were these other options where I didn't have to carry in order to be a parent. As all of this has sort of become evident to me, I've developed a lot of guilt around what that means and just the sort of weirdness of, I have all the equipment to be able to carry a pregnancy, and so why don't I wanna do this, and what does it mean for me that I'm making somebody else do that experience "for me". And to be clear, my wife is like consenting and very excited about the process, but I, I think I sit with that weirdness and it makes me wonder like what does it mean that I want a parent so badly but don't wanna have the experience that would make me a parent canonically? I think that is the sort of tension that I'm describing and that I've really struggled with and I think that a lot of conversations with other queer people have normalized the experience for me. But for a while it felt like I got this like cheat code and that I was lucky and had sort of made it out scot free.
Sam: As long as you get to be anything canonically.
Gaby (laughing): I know.
Sam (laughing): Richard, what were you gonna say?
Richard: It's interesting because you're framing that as a queer experience, but as Tiffany points out, this isn't just a queer experience that cisgender straight women can face a similar question also about their own desire to be pregnant and to also be parents, right? You might not want one and want the other.
Tiffany: I would say this is true for like cis straight women too, like that there's a lot of people who are kind of indifferent to like the actually caring and birthing process, but like overall wanna have a family, right? There's a much bigger conversation there that's harder to have, right? Around like, what does it mean to wanna build a family, but not wanting to like actively put your body on the line to do that.
Sam: And even beyond preference, there's the physical reality of what pregnancy demands of a body.
Tiffany: There's also just the reality that no matter who it is who's birthing, there's a significant tax on your body, even if you wanna do it. It's a hard conversation to have with anybody you're partnering with, but especially I think when there's a choice involved, I think it's something you have to kind of have.
Gaby: Tiffany's point to me highlights something that I think is really important to say out loud, which is that for cisgender straight women, carrying a pregnancy isn't a choice in the way that I've described it as one for me. It can oftentimes just happen without a lot of forethought, which means that taking on the physical and emotional tax of pregnancy is something that somebody is taking on without necessarily having to think deeply about it, or maybe with minimal planning. But for queer women, pregnancy just doesn't occur automatically in the same way or, well, it, it doesn't occur that way for many queer women. And so navigating things like timing and method and access and taking on that same exact physical pregnancy tax is something that has to be planned for and opted into from the very start.
Richard: I can imagine that gender expression and presentation adds a whole nother layer of complexity to who opts into being pregnant. Dr. Sexton Topper describes situations from her research where she's spoken to queer women who are masculine presenting and want to be the gestational carrier. What does it mean to be the person who contradicts their gender expectations of who might want to get pregnant?
Sam: Please welcome our next guest, the esteemed Margaret Atwood. Okay, I'm just kidding. Gaby, what would you like to continue saying?
Gaby: First off, if you don't get that Margaret Atwood joke, please go Google it. Secondly, I just wanna point out that that example of the masc presenting person wanting to carry is something that really shows how family building for queer women is a really open set of possibilities. There are some paths that are gonna be shaped by personal preference, of course, but overall, the takeaway for me is how people with less traditionally feminine gender expression can take on roles in family building that expand and challenge gender norms that are really historically tied to parenting.
Dr. Monseur: It is so much a choose your own adventure. There's so much possibility.
Gaby: One way that this possibility shows up is in this like mix and match element to queer women, fertility and family building. So to put it into an example, the mix and match is that one partner can donate their egg to the pregnancy through something like egg freezing, while the other partner is the one who carries that egg to delivery. So I guess what I'm kind of saying is that there are a lot more options and that means that there are also a lot more decisions to make along the way, which is something that Tiffany and Morgan navigated early on in their journey to parenthood.
Tiffany: I remember having conversations with his parents earlier on because Morgan had just started his transition right around the time that we started dating. And so that actually really also influenced our own conversations about family building, because really early we had to have pretty explicit conversations. He started T a couple months after we started dating, and so that was a conversation we had to have, like, "Hey, or is this something that will ever impact, like kind of your wants and desires around kids, right? Is this something we need to think about before you start?" So that's a hard conversation to be having so early. But it also meant that we clarified a lot of things really quickly: that it wasn't important to him to have the bio connection, that it was okay that we would use sperm donor and that I would be the one that would carry,
Sam: The impact of testosterone on potential egg fertility is a complicated and understudied area of gender affirming medicine. Egg fertility likely goes down once you start testosterone, and that could be irreversible, which is something we talk a lot about with people before starting testosterone.
Gaby: But please know that this summary just scratches the surface of this topic, and we are hoping to cover this in a future fertility episode on QHP.
Sam: Real takeaway here is that you have options. You can choose biological connection, but not carrying, you can choose neither like Morgan did, or choose both, like Tiffany. It's all about figuring out what works best for you and your partnership.
Richard: One big question that may or may not be variable depending on someone's health is: is it safe for me to carry a pregnancy?
Gaby: And that question of whether it's safe for someone to be pregnant is a really complicated and big one, and it's not one that we're going to answer on this podcast in part just because of time. We had to make this episode into two episodes, so we had to draw the line somewhere in terms of content we were including. But part of it also is that this is a really deeply personal question that really relates to some of the chronic health conditions that you might carry and how those might impact pregnancy. Or be impacted by pregnancy. And so really this is a conversation that occurs between you and your primary care doctor and your OB.
Richard: It also might have something to do with your age - coming from the Generation X person on this podcast.
Sam: What's that? Margaret Atwood, who's still in the studio? What are you asking yourself? Am I fertile? Ugh, you're so right. That is another big question and one that many people with uterus often have on their minds. So of course, we actually had to talk to a real person who we actually spoke to who is actually an expert to answer these questions.
Dr. Monseur: I'm Brent Monseur. My pronouns are they and he, and I'm a reproductive endocrinologist at Stanford University, and I'm also the director of the Q plus Family Building Clinic, which is the nation's first program in an academic center that's entirely dedicated to LGBTQ+ family building.
Richard: FYI, Dr. Monseur's, specialty,, Reproductive endocrinology and infertility, or REI is the formal name for what many people refer to as a "fertility doctor"
Sam: We asked Dr. Monsour if there are factors that make it harder for someone to get pregnant.
Dr. Monseur: Yeah. So for folks who have a history of sexually transmitted infections, particularly like gonorrhea or chlamydia, there's an increased risk of damage to the tubes. And if your tubes are damaged, it can actually make insemination less successful.
Sam: To be clear, this is in cases where there is prolonged untreated gonorrhea or chlamydia that impacts the whole pelvis. This is not gonna happen from a run-of-the-mill chlamydia or gonorrhea infection.
Dr. Monseur: So sometimes going into a fertility clinic and getting an assessment of your tubes can be a helpful, you know, first start., Other risk factors, not necessarily for infertility in this case, but that could potentially cause issues if you have irregular cycles and it makes it difficult to time the insemination. These ovulation predictor kits and other techniques might be harder to do without someone helping you in a clinic. And you might even need medications to make your cycle regular in order to be successful with treatment. These are kind of the kind of most kind of obvious risk factors. There are obviously other things as well.
Richard: And again, another thing people think a lot about is age.
Sam: GAYYYY
Gaby: No, but a lot of women do worry that there are these numbers that we all have somehow internalized that at like 32 or 35, the chances of fertility drop dramatically. And so I found personally that what Dr. Monse ur says is really reassuring because those numbers really aren't as cut and dry as I was led to believe that they are.
Dr. Monseur: Yeah, there's definitely not a magic age. I think the magic age that gets thrown around a lot is 35. It's also the age that we start calling people like elderly pregnancy, which is like very offensive terminology I think 35 caught on because we use it. In obstetrics as in a marker for increased risk during pregnancy. But the reality is it's a steady decline that actually starts even before you are born. So the number of eggs is gonna go down throughout your life no matter what. No matter if you are taking birth control, no matter if you are getting pregnant or not whatever you're doing, the eggs number are gonna go down. In general, for most people, there is a steeper decline that occurs in your late thirties into your early forties. But there is no magic number. Ultimately though earlier is better. And so if you have the resources and you're able to freeze eggs, but you're still making final decisions, it's often a good idea to keep those options on the table and freeze sooner versus waiting.
Sam: , So to wrap up the section, the first big question is who will carry the pregnancy? That's about personal preference, partnership dynamics, and the reality that pregnancy comes with a physical and emotional tax. Next, the question of biological connection. Do you wanna carry? Do you want a genetic link? Both or neither? Tiffany and Morgan's story shows that all of these choices are possible depending on what works for your partnership. And finally, fertility. How likely and safe is it for someone to carry a pregnancy? And that depends on factors like age, medical, history, and underlying conditions. Thinking through all of these things early on gives you more options and helps you make informed decisions as you move through the family building journey.
Richard: And none of this is. People's preferences, circumstances and bodies can all change over time. As Dr. Sexton Topper explains. The early stages of these conversations are just the beginning and what you think you want at first can evolve as you move forward.
Dr. Sexton Topper: Across the board in many of the couples I've spoken to, there's just been so many variations on that theme, what people wanna do, what people thought they wanted to do initially in, in the early stages of a conversation. And then they start to go down the path of action and behavior and motivations start to shift, intentions can shift right over time, and I think having room for those conversations for it to be really iterative and for people to live in their bodies. We live in our bodies, right? Even though like our society is highly disembodied and it's like incentivized to be disembodied, we still live in bodies and we're still capable of reproduction through our bodies. And to know, like it's iterative what our intentions and our desires may be over time and that might change in the context of a relationship.
Richard: [ MUSIC]
Gaby: Okay, so we've talked a little bit about fertility assessments. We've talked about who will carry the pregnancy, and so the next question in our roadmap is, where's the sperm coming from?
Richard: I have news for you, Gaby.
Sam: classic
Gaby: lesbian
Sam: A classic lesbian question, where is the sperm coming from? But don't worry, listeners, this specific lesbian knows exactly where the sperm is coming from, and who I'm referencing when I say this lesbian, we shall not disclose.
Richard: Speaking broadly, the options could be a known donor, like a friend, family member, or acquaintance, or going through a sperm bank.
Gaby: We asked Dr. Monseur about how people usually approach choosing a donor source.
Dr. Monseur: A lot of times, people think about this for many years, like, "Oh, we're gonna be using a donor." But until you actually start to have that conversation, either with kind of friends or family or your partner, whoever is kind of involved, it can be a pretty, intense decision.
Sam: Here's Tiffany talking about her family building decision process that ultimately led to a decision to go with a sperm bank.
Tiffany: I think in the end it just made more sense for us to utilize sperm donors from a bank. We did talk about friends, and known donors. Really, we didn't even consider the potential of family donors until it was brought up by his parents. And then that was a conversation that we had with them and then with each other, and then with his siblings, and ultimately wound up not choosing to go that route. so we did wind up talking to both of his brothers and their wives about the possibility. And ultimately after we talked about it, it felt funny. You know, none of it felt right. Nobody really felt super solid about it. Like the idea of having like, you know, a potential like biological dad being your uncle, and like, not knowing like exactly how to kind of be in that relationship I think was complicated, right? Ultimately, it kind of came down to like, if we were gonna do that, we would wanna figure out what that looked like explicitly with people who we loved so much that it was almost like, why do we wanna go through this process with them where we have to like figure out a legal, like document and contract with people who we just really wanna have close relationships with forever.
Sam: At this point, if you've made a choice about a sperm source, whether a known donor or a sperm bank, you might be thinking, "Great, let's get started." But before you dive in, not necessarily into the sperm,
Gaby: Ew.
Sam: There are a few things. It helps to get just to make sure everything after the sperm donation goes more smoothly.
Dr. Monseur: Just as you're putting together a plan, I think first and foremost, something that some people often skip, but I think is a good idea, is doing genetic carrier screening. So sperm donors are routinely tested for a panel of. 400 to 500 of these conditions. And so if you both get tested with that panel, you can start eliminating choices by making sure you don't kind of carry the same thing. So common examples of this are like sickle cell disease or cystic fibrosis. So that's one thing that I say as a starting point. it's not necessarily trickier, but if you're doing this as a. A couple, for example, or a larger multiplex parenting situation, then each of you would need to get that testing and then you need to make sure that there's not a match between any of you and the donor.
Richard: Where might someone get these tests? Well, if you're already in care with a fertility doctor, that's your go-to. But Dr. Monseur did point out that that's not strictly necessary. An O-B-G-Y-N can readily do the testing, as can some PCPs, though that's usually a less common experience speaking from my personal clinic.
Sam: Genetic testing may be the thing that brings someone to a queer friendly OB early, but Tiffany recommended trying to get established regardless.
Tiffany: It's important to get in with a queer friendly OB, GYN before you get pregnant. Because once you are pregnant, it's harder to get somebody because they're all full. and so if you're already a part of the practice, then you're gonna be seen for a pregnancy. I think what happens is like people start to like trust and get excited about their REI folks, right? Then they go in for their first ultrasound because "yay, we're pregnant." They go in and they're doing that with their REI folks and then they get turfed off to an OBGYN and they may or may not have thought about that point. And so then suddenly they're with a new person who they may not have built trust with, may not be queer friendly.
Gaby: You might actually need to establish care with an OB GYN before you can get sperm.
Tiffany: Another reason to go in for the family planning visit is not only to establish care, but also so they can sign your form to purchase sperm. You have to have a signed form. You cannot purchase sperm without a sign off from a clinician, which is annoying.
Sam: The reason why is that sperm banks want to know you've talked to a doctor about how to use sperm to conceive. It's kind of like the fertility equivalent of a work form, but as Tiffany points out, it can have some consequences on folks going through the process .
Tiffany: It's a big gatekeeping thing. It is a real thing. So you do have to have that signed off. It gives you access for a year. So then you have to get a new signature every year if you're continuing to try.
Gaby: Speaking of gatekeeping, when you go in to get your sperm "permission slip" you may also be asked to speak to a mental health professional.
Richard: And if not, then many fertility places require this. At a later point during the fertility journey, we asked Dr. Monseur about why this happens.
Dr. Monseur: Yeah, so this is a complicated topic in the field, and I have to just be honest that I kind of disagree with what has been determined to be the standard of care. The recommendations to speak with a counselor really came out of, again, the cishet folks. And a lot of times, right, when this population is using donor sperm, it's an option of last resort. So they have found out they have this diagnosis of infertility. They may have been trying for years, they've been unsuccessful, and it's a huge pivot. Infertility diagnoses can sometimes, for some patients be worse they would say, than a cancer diagnosis, for example. So this idea of counseling came out of that kind of concerns and those fears. Over the years, though this counseling has evolved to think more about the impact on donor-conceived children. What is the role of disclosure? What are some things that maybe you haven't thought about? If you're using a known donor, have you really considered the role that they're gonna play in children's lives? So I think counseling has gotten more nuanced. Um, and so there is still something to be gained for it, but I don't know that I agree that everyone has to do it, but it is actually the party line. So the American Society for Reproductive Medicine can't legally require it, but they use the language strongly recommend, that's kind of medical speak for, it should be mandatory. Like a clinic should make a policy that it really should be done. And so it can be a pain point, but I think one thing that I do that is really helped kind of get some buy-in for patients that might be resistant, is really stressing the fact that this in no way is an assessment of you being fit to be a parent. And it's also not specific to LGBTQ+ individuals. It is for anyone using donor egg, anyone using donor sperm, and anyone using a surrogate or a gestational carrier. Doesn't necessarily change the fact that you have to do it, but I think it is important that folks know that it's not discriminatory in that way.
Sam: So at face value, no, it's not discriminatory 'cause everyone's being asked to do it, but we as the host feel that there is an equity issue here because cis het folks are coming to this very differently than LGBTQ+ folks. And this sort of blanket statement is gonna hit differently depending on how folks experiences are even within the queer community. So being told that you need to engage with a mental health provider for many people may feel stigmatizing or make it feel like your experience is one of pathology or sickness, and in such a heightened and sensitive process, we feel that that may not always go right. So we love folks having mental healthcare access, but we wanna make sure that it doesn't make them feel worse off going through that process.
Richard: And we wanted to bring up these issues here so that you'll be aware in case this is something you do have to engage with. So you know, even if it's not handled well by your provider, that this is a standard thing for everyone and not just LGBTQ+ people.
Sam: Ma – Mar – Margaret Atwood. You're on, you're on mute. Mar – Ms. Atwood.
Gaby: Anyway, I –I do get a little up in arms about this myself, but I actually really like how Dr. Sexton Topper reframes What can happen during these conversations.
Dr. Sexton Topper: Once you get into IVF or even just like medicated ovulation, you're talking about changing like hormones around which changes relational dynamics. And so being aware of the fact that relational dynamics might change, you know, and, and there are all kinds of possibilities that could deepen intimacy, right? And it could be disruptive, and it could do both. And so being prepared for some of that relational stuff, there are so many things to consider as a couple and thinking about your bandwidth at the time of trying to conceive. How much pressure is there professionally? How much pressure is there outside of professional domains? Are you a caregiver for someone in your family? Because it can take a lot of time and energy and it's physically can be depleting.
Gaby: So I think it's really important to be clear here. I get very up in arms about people making comments like, "Oh, people who are hormonal on their periods are crazy and need to be medicated or can't be trusted." Like there's a lot of dangerous rhetoric around this, and we can certainly talk about how that's dangerous for thinking about gender affirming hormones too. That is not what we are talking about here. What we're talking about is that the hormones that are being given for the purposes of these fertility procedures are very, very high doses that are above what the normal doses are in sort of unassisted or quote unquote natural menstruation processes. Right? So that's why knowing that your emotions and your emotional landscape is gonna be a bit different- it could be more intense, it could be very different from how it normally is- knowing that is super important. And so acknowledging that that's gonna be the case and saying "Let's have some of these conversations when I'm more in the space that I normally live in emotionally." I think that makes a lot of sense and is a really useful piece of intel from Dr. Sexton Topper.
Sam: And for his part, Dr. Monseur finds that these counseling moments can be a really good time to talk about disclosure.
Dr. Monseur: Because a lot of times people see a therapist individually, but they don't necessarily see a therapist with their partner. And so it can be an opportunity to really dive deep in some of these issues.
Sam: And disclosure isn't the only thing worth talking through. There's also thinking about how the larger family might respond to a pregnancy.
Tiffany: Probably the biggest thing was is Morgan and I were talking a lot about, you know, just kind of how his family would potentially treat our kids, because ours would be the first kids that a queer couple had, and that they wouldn't necessarily be like, bio related to his side, the family. And so as much as I now I feel like I have such a great relationship, very early on, you know, I didn't know Morgan's parents super well, and so I was just kind of feeling them out and trying to understand like, what is this relationship gonna look like for our kids?
Richard: It's not about letting family dictate your plans, but talking it through and having a sense of how they might respond can actually be really helpful. It can decrease a lot of stress and can strengthen your relationship as a couple.
Gaby: Oh, Margaret, can you summarize?
Sam: It turns out Margaret Atwood's my cat. . In this section, we explored how to choose a donor source and make sure that the practical steps are lined up, like completing genetic screening and finding a queer friendly OB. We also highlighted counseling is a chance to talk about disclosure and family dynamics, and getting these pieces in a place early can make the process feel more manageable and give you confidence as you move forward.
Richard: Next up on our roadmap, the sperm bank and how to pick one and what the process even looks like.
Gaby: But we'll be saving that and our conversations about the specifics of egg freezing and insemination procedures like IUI and IVF for part two of this episode. So for now, thanks for tuning in. I'm Gaby, that's Sam and that's Richard. And you've been listening to Queer Health Pod.
[QHP THEME MUSIC STARTS]
Richard: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Gaby: Thank you to our community voice, Tiffany Cook, and to our healthcare Dr. Brent Monse ur and Dr. Patrina Sexton Topper. We would also like to warmly thank our community reviewer, Olivia Hall.
Richard: For more information on this episode's topic, please check out our website at www.queerhealthpod.com
Sam: Help others find this information by leaving a review and subscribing on Spotify or Apple Podcasts.
Richard: We are also on social media. Our handle is at Queer Health Pod. Reach out and let us know what you think.
Sam: Thank you to Lonnie Ginsburg, who composed our awesome theme music into the Josiah Macy Jr Foundation who supported some of the tech we use to produce these episodes.
[QHP THEME MUSIC ENDS]
Richard: Opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions. And even though we're doctors, don't use this podcast as medical advice and instead, consult with your own healthcare provider and check out our merch store coming soon.
Sam: Byeee Margaret. Thanks for stopping by.