LGBTQ people make up a significant proportion of assisted human reproduction (AHR) service users in some parts of Canada. Currently, the majority of donor insemination cycles are for same-sex couples and single people. Some Toronto clinics report 15-30% of their patients are LGBTQ identified.
However, unlike heterosexual, partnered people seeking fertility treatment, the vast majority of LGBTQ people are not experiencing infertility. This results in a lack of fit for LGBTQ patients. Because fertility clinics were originally developed to treat heterosexual infertility, many continue to operate within that framework. The impact of this social context on LGBTQ people considering assisted reproduction has not been well studied.
In 2008 an expert panel convened by the Ontario Ministry of Children and Youth Services examined the barriers to accessing fertility services in Ontario and specifically recommended the removal of social barriers to AHR for LGBTQ people. Further, the Assisted Human Reproduction Act (AHRA) includes a non-discrimination clause barring discrimination based on sexual orientation or marital status. However, much of the legislation and regulations that structures how AHR services is heterocentric, and is in fact a barrier in itself.
In this context, it is critical to determine to what extent AHR services are meeting the assisted human reproduction needs of LGBTQ people in Ontario.
To what extent are Assisted Human Reproduction (AHR) services are meeting the family creation needs of LGBTQ people in Ontario?
This research aimed to:
a) Describe the experiences of LGBTQ people with AHR services in Ontario;
b) Identify perceived barriers and supports to AHR service access for LGBTQ people;
c) Determine similarities and differences in the experiences of lesbian, gay, bisexual and trans people; and
4) Use the knowledge gained to inform AHR service delivery in Ontario. Particularly, we wanted to provide recommendations to AHR service providers to better meet the needs of LGBTQ people.
Data & Methods
We conducted 40 interviews with 66 LGBTQ individuals.
Interview participants were recruited between July 2010 and March 2011 through online networks, flyers posted at relevant service organizations, and in person at Pride celebrations across Ontario. Interested individuals contacted the study office and were screened by telephone to determine eligibility. Participants were eligible if they identified as LGBTQ, were aged 18 years or older, had used or had considered using AHR services since 2007, and used health services in Ontario. Purposeful sampling was used to select a group of interviewees who were reflective of the broader screened group.
Interviews took place between December 2010 and August 2011. Before the interview, each participant completed a sociodemographic questionnaire. After written informed consent was obtained, interviewers followed a semistructured guide in conducting interviews that lasted 60 to 90 minutes.
The interviews focused on donor insemination, IVF, gamete freezing, and surrogacy.
Research to Interactive Theatre
We developed a piece of ‘forum theatre,’ a form of interactive theatre designed to give audience members the opportunity to interact with the play, by getting on stage and changing, adding to, or improving what happens in the scene. The purpose of forum theatre is to engage participants to create positive social change. It allows knowledge to be disseminated in an accessible way and creates an opportunity to implement research findings.
Two forum theatre workshops took place on May 27-28, 2012. The first of these was intended for LGBTQ community members, and the second was a CME-accredited workshop for service providers. Counsellors, clinic managers, nurses, doctors, technicians and LGBTQ community members came on stage to explore how these scenes could play out differently.
“The hands-down best presentation regarding ARTs (assisted reproductive technologies) that I have been to all year…it was incredibly effective. The experiences as performed in the workshop were shocking, eye-opening and traumatic. This presentation highlighted practical ways in which we can make ART services truly accessible to the LGBTQ community.” – Clinician comment
“The forum theatre experience gave me a feeling of hope …. I learned that the research hadn’t just ended up in a journal I would never read. I actually saw my story and many other queer and trans stories out there in a real way.” – Community member comment
Actors: Lori Ross, Rachel Epstein, Scott Anderson, datejie green, Chris Veldhoven
Coordinator and Stage Manager: Lesley Tarasoff
Script Writer: Jessica Bleuer
Theatre to Video
Since the original performances of the theatre piece we have received numerous requests for presentations from individual fertility clinics, reproductive medicine conferences and other professional development and community settings. Producing a series of online videos and associated educational materials will make this work widely accessible, available at anytime, anywhere.
In collaboration with director Pamela Baer, we have now transformed the theatre piece into Scenes from a Fertility Clinic a series of online videos with accompanying educational materials which will make this work widely accessible.
Each of the five scenes is accompanied by supplementary materials, including a set of questions for service providers, and a set of questions for LGBTQ people, all available in our library.
We have created numerous resources, some for service providers and some for LGBTQ people, and informed policy makers. Many of the resources can all be accessed through our library.
- Guidebook for LGBTQ people
- Fact sheet for AHR service providers on providing care for LGBTQ people;
- Fact sheet for researchers and clinicians: Reproductive options for trans people;
- Videos: Scenes from a Fertility Clinic videos and related materials
- Academic journal articles;
- two doctoral dissertations;
- Presentations at key conferences, including the 2013 and 2014 meeting of the Canadian Fertility and Andrology Society (CFAS), the 2014 Rainbow Health Conference, the 2012 Meeting of the North American Society for Psychosocial Obstetrics & Gynecology and the Canadian Institutes of Health Research-Institute of Gender and Health Conference; and in-service trainings for fertility clinics.
- Policy initiatives, Ministry of Health advisory committee on the implementation of IVF/IUI funding in Ontario.
The Creating Our Families project is a community-based research project led by Re:Searching LGBTQ Health. The project includes an advisory committee of relevant stakeholders, including LGBTQ parenting experts and AHR service providers.
Principal investigator: Principal Investigators: Dr. Lori Ross and Dr. Leah Steele
Co-Investigator: Dr. Rachel Epstein
Co-Investigator/Interviewer: Stu Marvel
Interviewer: datejie green
Recruitment and screening coordinator: Lesley Tarasoff
Additional staff: Scott Anderson, Nael Bhanji, Mika Atherton, Andrew Ross, Emily Chen, other students and volunteers who helped recruit and screen participants and transcribe interviews.
The primary research component of the project was supported by a Canadian Institutes of Health Research Catalyst Grant: Psychosocial Issues Associated with Assisted Human Reproduction.
Dr. Lori Ross was supported by a New Investigator Award from CIHR and the Ontario Women’s Health Council.
Support to the Re:searching LGBTQ Health team, Centre for Addiction & Mental Health (CAMH) and to LGBTQ Parenting Network, Sherbourne Health Centre, for salary and infrastructure, has been provided by the Ontario Ministry of Health and Long Term Care.
The Research to Interactive Theatre component of the project was funded by a Canadian Institutes of Health Research, Meetings, Planning and Dissemination Grant.
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.
James-Abra, S., Tarasoff, L.A., Marvel, S., Green, D., Epstein, R., Anderson, S., & Ross, L.E. 2015. Trans people’s experiences with assisted reproduction services: a qualitative study. Human Reproduction; 30(6):1365-74.
Ross, L.E., Tarasoff, L.A., Anderson, S., Green, D., Epstein, R., Marvel, S., & Steele, L. (2014). Sexual and Gender Minority People’s Recommendations for Assisted Human Reproduction Services. Journal of Obstetrics and Gynaecology Canada, 36 (2), 146-153.
Tarasoff, L.A., Epstein, R., Green, D., Anderson, S., & Ross, L.E. (2014). Using Interactive Theatre to Help Fertility Providers Better Understand Sexual and Gender Minority Patients. Medical Humanities.
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. Available on our site with permission of the publisher.
Epstein, R. (2014). “Married, Single, or Gay?” Queerying and Trans-forming the Practices of Assisted Human Reproduction Services. (Unpublished doctoral dissertation). York University, Toronto. http://yorkspace.library.yorku.ca/xmlui/handle/10315/27697
Marvel, S. (2013) Polymorphous Reproductivity and the Critique of Futurity: Toward a Queer Legal Analytic for Fertility Law. Jindal Global Law Review, 4 (2), 296-314.
Marvel, S. (2013) “Tony Danza Is My Sperm Donor?”: Queer Kinship and the Impact of Canadian Regulations around Sperm Donation, Canadian Journal of Women and the Law, 25, 221-248.
Ross, Lori E. 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
Ross, L.E., Steele, L.S., & Epstein, R. (2006). Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period. Journal of Obstetrics & Gynaecology Canada, 505-511.
Ross, L.E., Steele, L.S., & Epstein, R. (2006b). Lesbian and bisexual women’s recommendations for improving the provision of assisted reproductive technology services. Fertility & Sterility, 86(3), 735-738.
Marvel, S., Tarasoff, L.A., Epstein, R., Green, D., Steele, L.S., & Ross, L.E. Listening to LGBTQ on Assisted Human Reproduction: Access to Reproductive Material, Services and Facilities. In Lemmens, C. Milne, & I. Lee (Eds.), The Regulation of Assisted Human Reproduction: Legal, Ethical, and Social Implications of the Canadian Supreme Court Reference. Toronto: University of Toronto Press.
James-Abra, S., Tarasoff, L.A., Marvel, S., Green, D., Epstein, R., Anderson, S., & Ross, L.E. Access to Assisted Human Reproduction (AHR) Services for Trans People in Ontario. Human Reproduction.