Scenes From a Fertility Clinic

Scenes From a Fertility Clinic

These educational videos and accompanying materials are intended to be used by people working in fertility services who are interested in improving the quality of their service to LGBTQ people, and by LGBTQ people who are considering using the services of sperm banks and/or fertility clinics.

Author: LGBTQ Parenting Network Source: Website: Journal: Journal Details: Origin Country: Canada Publish Date: 2015 Publication City: Toronto Languages: .Type: , , .Topics: , .Targets: , , , , , , . Last Modified: 2015-10-19

Description

These videos and accompanying materials are based on a research project which explored LGBTQ people’s experiences with fertility clinics in Ontario, Canada.

Creating Our Families was a community-based collaborative research project between the LGBTQ Parenting Network, Sherbourne Health Centre and Re:searching for LGBTQ Health, University of Toronto. We conducted 40 interviews with 66 LGBTQ people across Ontario about their experiences with fertility clinics, including donor insemination, IVF, gamete freezing and surrogacy. We then used participants’ stories to develop a piece of interactive forum theatre which allowed LGBTQ people and fertility clinic staff to get on stage and practice what might make things better. Now we have transformed the theatre piece into this series of free, online videos, with the goals of educating reproductive health care professionals to provide better care to LGBTQ prospective parents and to assist LGBTQ people to navigate the fertility process.

Each video segment consists of a scene or monologue, compiled from experiences we were told about in interviews. Following each scene are some short clips from LGBTQ people, commenting on how the scene relates to their own experience. You can watch each one individually, or you can choose to watch all five together. Each video is accompanied by questions to encourage reflection and by links to related materials.

Please Note

These video scenes were originally developed as live forum theatre – a technique developed by Brazilian theatre director Augusto Boal.

Forum theatre intentionally presents worst case scenarios in order to provide opportunities to explore options for change.

The scenes in the videos are a compilation of real life stories, but do not represent what happens in every clinic, nor do they represent the many positive stories that we heard.

Please use these videos to explore how fertility clinics, and other medical services, can provide welcoming, skilled and responsive services to LGBTQ people.

Scene 1: Changing Gears: Our Needs are Different

  • In this scene we meet Angie, a bisexual, Métis, single woman. She is at a fertility clinic seeking donor insemination because she does not have access to sperm. She is trying to find out basic information about the process, including how much time it might take and expected costs.

    When Angie asks questions, she is unable to get satisfactory answers, including about the various tests and treatments being recommended and why they are necessary. The doctor misdiagnoses Angie with Polycystic Ovarian Syndrome, based on her appearance. Angie is left frustrated by the lack of information, by the medical tests which are not fully explained but presented as required, and by the providers’ behaviours and assumptions about her and her body.

    This scene raises questions related to:

    • Financial and geographic accessibility of fertility services
    • Assumptions of infertility (as it is bio-medically defined)
    • Lack of understanding of a bisexual client
    • Medical authority and informed choice

    For Reproductive Health Care Providers:

    • How can you celebrate with your LGBTQ clients as they take their first steps towards bringing children into their lives?
    • How can you avoid making assumptions about your clients?
    • When and how do you recommend fertility tests and/or drug treatments, particularly for clients with no known infertility?
    • How do you make sure your clients have the information necessary to make informed decisions about tests and treatments?
    • How comfortable are you answering clients’ questions around costs? Do you list your prices on your website? Does your clinic offer financial discounts or other ways to increase access to care?
    • What are the barriers to donor availability, particularly with respect to donors of diverse ethno-cultural or racial backgrounds and identity release donors? Are there steps you can take to advocate for change in this regard?

    More Information

    Lori E. Ross, Amy Siegel, Cheryl Dobinson, Rachel Epstein & Leah S. Steele (2012): “I Don’t Want to Turn Totally Invisible”: Mental Health, Stressors, and Supports among Bisexual Women during the Perinatal Period, Journal of GLBT Family Studies, 8:2, 137-154

Scene 2: Creating Inclusive Spaces: Checking Assumptions

  • In this scene we meet Vick and Samuel, two trans men.  They are planning to conceive with Vick’s eggs and donor sperm, and with the assistance of the fertility clinic. The receptionist who answers the phone when Vick calls to inquire about his referral makes a series of incorrect assumptions, and when Vick and Samuel arrive at the clinic they are confronted again by the incorrect assumptions embedded in the clinic forms and even the location of the bathrooms. Vick has an extremely uncomfortable experience as the doctor performs a hysterosalpingogram, while using incorrect pronouns and asking inappropriate questions.

     

    This scene raises questions related to

    • Assumptions related to sexuality and gender
    • Inclusive forms, facilities and environment
    • The challenges of self-advocacy
    • What it means to be truly welcoming of LGBTQ people

     

    For Reproductive Health Care Providers

    • Are your intake forms, advertising materials, and website inclusive of LGBTQ identities and families? How can you ensure that intake and procedure forms work for all the clients who may be using your services?
    • How do you find out a client’s preferred name and pronoun?
    • How do you communicate your sensitivity to the needs of LGBTQ clients, including the specific needs of trans clients?
    • When does it make sense to make small talk with clients? Are there some topics that might create discomfort for clients?
    • How can you make a challenging procedure easier for a client?  What strategies might you use to help a client relax so that you can perform procedures as comfortably as possible?
    • How can you advocate on behalf of LGBTQ clients?

     

    More Information

    Fact sheet for clinicians: Reproductive Options for Trans People

    Brochure for trans people: Fertility & You

    Stories of trans parents: Transforming Family Film

    Our research page: Research on trans parents

    Examples of ungendered forms: Mount Sinai Centre for Fertility and Reproductive Health Referral Form

    James-Abra, S., Tarasoff, L.A., Marvel, S., Green, D., Epstein, R., Anderson, S., & Ross, L.E. Trans people’s experiences with assisted reproduction services: a qualitative study. Human Reproduction 2015; 30(6):1365-74.

Scene 3: Client-Centre Care: Learning to Listen

  • In this monologue we meet Angel, a trans woman, who wants to freeze her sperm for use at a later date. She goes to the clinic with a very close friend who is initially assumed to be her surrogate, and then is ignored by the doctor.  The doctor is not sensitive to the implications for Angel of going off the hormones she is taking as part of a medical transition and Angel is put in the position of having to educate the medical professionals she encounters. She feels that she is jumping through hoops in a process that does not understand her specific needs and concerns.

     

    This monologue raises questions related to

    • Clients being put in the position of educating professionals
    • Assumptions about family configurations
    • Lack of understanding of trans identities and reproductive needs

     

    For Reproductive Health Care Providers

    • How can you create openings in your practice for clients to tell you about themselves?
    • Can you ask open-ended questions to help you understand the identities, family configurations and fertility needs of new clients?
    • What particular challenges might trans people face in your clinic and how can you help mitigate these challenges?
    • How can fertility services be made more financially accessible?  Does your clinic offer discounts for people pursuing fertility preservation for medical reasons? If so, does that discount extend to trans people and the services they may require?
    • How can you create a service where clients receive the emotional and practical support they need in an environment rooted in openness and a lack of assumptions? How does this relate to the idea of “client-centred care?”

     

    More Information

    Fact sheet for clinicians: Reproductive Options for Trans People

    Brochure for trans people: Fertility & You

    Stories of trans parents: Transforming Family Film

    Our research page: Research on trans parents

    Examples of ungendered forms: Mount Sinai Centre for Fertility and Reproductive Health Referral Form

    James-Abra, S., Tarasoff, L.A., Marvel, S., Green, D., Epstein, R., Anderson, S., & Ross, L.E. Trans people’s experiences with assisted reproduction services: a qualitative study. Human Reproduction 2015; 30(6):1365-74.

Scene 4: Outdated Rules: Negotiating Barriers

  • In this scene we meet Carole, Jeanne, and Jorge.  Carole and Jeanne are a lesbian couple and Jorge is their gay friend and sperm donor.  Carole is planning to get pregnant.

    Many fertility clinics are not open to working with known sperm donors.

    The Canadian Semen Regulations require semen from a known sperm donor (who is not a sexual partner) to be frozen and quarantined for six months. The donor must be tested for various STIs prior to the donation and the tests must be repeated six months later, before the sperm is released from quarantine. This process adds delay and cost, and can impact success rates, sometimes forcing people to go through (and pay for) more invasive treatments than they would otherwise require. The quarantine can also discourage people from seeking treatment in fertility clinics. Many people turn to home insemination when they are unable to access appropriate care at a clinic.

    People who are “sexual partners” are not subject to the quarantine.

    Carole, Jeanne, and Jorge have chosen to present at the fertility clinic as “sexual partners” to avoid the delay, risks, and cost of freezing and quarantining Jorge’s sperm. This means Jeanne is relegated to the role of a close friend. She is sidelined in the process, creating discomfort all around. Jorge is distressed by having to conceal his sexual orientation.

This scene raises questions related to:

  • The impact of the Canadian Semen Regulations  and the need for regulations based on updated science
  • The assumption that clients of fertility clinics are heterosexual, monogamous couples
  • Lack of recognition of LGBTQ family and kinship configurations
  • The impact of not disclosing one’s sexual orientation and/or family configuration in a medical setting

For Reproductive Health Care Providers

  • How do you create a welcoming space where clients can tell you about their identities, practices, and family configurations, if they so choose?
  • Are you comfortable working with clients who have a known sperm donor?
  • What options are available for you to work with clients to respect your client’s choice to use a known donor, while remaining in compliance with the Semen Regulations?’
  • How can you respectfully communicate to clients the limitations of the law?
  • What can you do to challenge outdated legislation?

More Information

Epstein, R. (2014). The Relationship That Has No Name: Known Sperm Donors, the Canadian Semen Regulations, and LGBTQ People. In M.F. Gibson (Ed.), Queering Motherhood: Narrative and Theoretical Perspectives. Toronto: Demeter Press.

The publisher has graciously granted permission for this chapter to be downloaded free of charge. Please visit Demeter Press to purchase the book.

Queer Parenting Info Brochures for LGBTQ people:
Insemination Procedures

Choosing a sperm donor: Known or Unknown?

Negotiating the Semen Regulations in Canada

The 1996 Processing and Distribution of Semen for Assisted Conception Regulations (Semen Regulations) set out stringent health and safety requirements for processing and distributing third-party donor semen for use in assisted conception. These requirements defined procedures for donor screening (including testing), labeling, quarantine and record-keeping prior to third-party donor semen.

The Semen Regulations incorporate the Technical Requirements for Therapeutic Donor Insemination, known as the directive. The directive excludes donors over 40 years of age, or who have had sex with a man, even once, since 1977.  If a recipient wishes to be inseminated with sperm from a known donor who is included in these groups, their physician must apply for permission from Health Canada through the Donor Semen Special Access Program.

Someone seeking insemination with the semen of a sexual partner is excluded from the testing requirements. People can also opt for a home insemination using the fresh sperm of a known donor.

Relevant Links

These regulations control how intended parents can access donor sperm in clinical settings. The Semen Regulations do not apply to home insemination.

Processing and Distribution of Semen for Assisted Conception Regulations (Semen Regulations)
Technical Requirements for Therapeutic Donor Insemination (the Directive)

Donor Semen Special Access Program (DSSAP)

  • Scene 5: Supportive Counselling: Asking the Right Questions

    In this scene we meet Peter and David, a male couple who are planning a baby through surrogacy, with David’s sister as their egg donor.  They are attending a counselling session for those involved in third party reproduction, which is required by their clinic.  They very much want to talk about their relationship to the gestational carrier, their concerns about the law, and about the logistics of the process. The counsellor, after advising that they see a lawyer, asks them a series of personal and largely irrelevant questions about disclosure, female role models, their mental health histories, and gay bullying.  Her questions reveal a lack of understanding of gay/bisexual/queer men and surrogacy, and the complexities of sexuality and gender.  Peter and David are a multiracial family but they are not offered openings to talk about issues of race, language or culture, if they so wish.  The counsellor ignores their real concerns and Peter and David are left feeling as though they are being assessed as part of a gatekeeping process.

    This scene raises questions related to:

    • The Assisted Human Reproduction Act and legal prohibitions on paying gestational carriers
    • The role and purpose of third party reproduction counselling
    • The history of gatekeeping that LGBTQ people have experienced in relation to AHR services
    • The impact of misconceptions about LGBTQ people as parents

    For Reproductive Health Care Providers:

    • Do you begin a counselling session by explaining your role as a counsellor and letting clients know the purpose and goals of the session?
    • Do you explain why you are asking the questions that you ask?
    • Are you familiar with LGBTQ parenting history, and why some LGBTQ clients might be wary of the counselling session?
    • Can you find ways to reassure LGBTQ prospective parents that the counselling session is not an assessment of their right or abilities to parent?
    • Are you aware of helpful resources for LGBTQ parents and prospective parents?
    • Can counselling be a form of support, education, and advocacy?

    Related Links:

    Best Practices for LGBTQ Fertility Counselling – A document in progress from the Counsellors Special Interest Group – Canadian Fertility and Andrology Society.

Legal Information

While it is not your role as a reproductive health care professional to provide legal advice, many LGBTQ clients may have legal questions, and it is within your role to provide legal information.  Legal advice is when a lawyer tells a client what they should do.  Legal information can be provided by someone who has knowledge of the law, or can be provided through public legal education documents that you can provide to a client.

LGBTQ prospective parents may want information about:

  • The legalities of sperm/egg donation, with anonymous, identity release and known donors
  • The legalities of surrogacy
  • Sperm/egg donor and co-parenting agreements
  • Birth registration and parental recognition procedures for various family configurations
  • Issues related to separation, finances, custody and access

Some helpful resources for your clients:

Parental Recognition Info Sheets

These info sheets give detailed information on birth registration, second parent or stepparent adoption, and declaration of parentage. Useful to LGBTQ people using donor gametes, embryos, or conceiving through surrogacy.

Sperm, egg & embryo donation in Canada

This info sheet gives detailed information on the legalities of sperm, egg, and embryo donation in Canada. It covers both known and unknown donor.

Gestational Carriage or Surrogacy in Canadacoming soon!

Coming soon – Fall 2015 – This info sheets gives details information on the legalities of surrogacy or gestational carriage in Canada for LGBTQ prospective parents.

CLEO An Introduction to Family Law in Ontario

This document from Community Legal Education Ontario (CLEO) explains the basics of family law in Ontario in an accessible format.

EGALE LGBT Parental Recognition in Ontario – Some Key Questions and Answers

This booklet addresses some of the common legal questions that LGBT people ask when considering parenthood

All Five Scenes

Creating Our Families was a community-based collaborative research project between the LGBTQ Parenting Network, Sherbourne Health Centre and Re:searching for LGBTQ Health, University of Toronto.

For a complete list of publications and other outcomes of this project, please visit the project page.

Additional Reading

Columns from the Infertility Awareness Association of Canada’s magazine Creating Families:

Meet the LGBTQ Community

How do you fit into this picture?

LBQ Women and Infertility

Queer Spawn: The Children of LGBTQ Parents

LGBTQ Communities: The Times They are A-Changin’

LGBTQ Communities and AHR Services: Beginning a Conversation

Paper from the AHRA & LGBTQ Working Group

Epstein, Rachel. (2008). The Assisted Human Reproduction Act and LGBTQ Communities. A paper submitted by the AHRA / LGBTQ working group.

Related Resources for LGBTQ People

  • Health Care & Self-Advocacy

    Health Care & Self-Advocacy Info Sheet

  • Sperm, Egg & Embryo donation in Canada

    Sperm, Egg, & Embryo Donation in Canada: Legal Information

  • Guidebook - covers

    A guidebook for lesbian, gay, bisexual trans and queer people on assisted human reproduction in Canada

The Scenes from a Fertility Clinic video was sponsored by CReATE Fertility Centre: Dr. Clifford Librach, Dr. Karen Glass, Dr. Prati Sharma, Dr. Ari Baratz; Mount Sinai Centre for Fertility & Reproductive Health; First Steps Fertility; ReproMed: The Toronto Institute for Reproductive Medicine; LifeQuest Centre for Reproductive Medicine.

  • CReATE Fertility Centre

  • Mt Sinai fertility_centre_logo (2)

  • First Steps Fertility

  • ReproMed

  • LifeQuest