Q&A: Research to highlight fertility needs of LGBTQ+ patients

The ASRM recently announced a list of researchers who will receive funding from the ASRM Research Institute in 2022.

Among these, Brent Monseur, MD, ScM, a research fellow studying reproductive endocrinology and infertility at Stanford Medicine, was awarded funds for his investigation of the use of assisted reproductive technology in women of varying sexual orientations, as well as the mental health and reproductive outcomes of fertility treatment in these women, according to a press release.

Healio spoke with Monseur to learn more about his research on assisted reproductive technology outcomes and sexual orientation.

Healio: Why is this research topic important?

Monseur: Fertility and family building care has historically been focused on heteronormative, cisgender, infertile women. As a result, members of the LGBTQ+ community are conspicuously absent from the literature of reproductive medicine. National organizations such as the ASRM have supported LGBTQ+ individuals’ access to care; however, there is a lack of evidence-based recommendations and continued challenges with adequate clinical/staff training in cultural humility.

Healio: What will your research add to the current literature?

Monseur: My research challenges the most common assumptions related to LGBTQ+ family building: one, sexual/gender minority parents negatively impact childdevelopment; two, LGBTQ+ individuals can be treated the same way you treat [other] infertile individuals; and three, LGBTQ+ individuals are not infertile.

First, of the limited research on LGBTQ+ family building, a majority has focused on possible negative impacts on child well-being as a result of having sexual/gender minority parents. This has not been substantiated and there is no evidence to suggest that this is the case.

Second, by treating LGBTQ+ individuals the same way infertile couples are treated, we may be unnecessarily placing them at increased risk of complications such as multiple gestation, which is known to carry a substantial list of prenatal, obstetric and neonatal risks.

Third, by assuming that LGBTQ+ individuals are not/cannot be infertile, providers may avoid testing that delays necessary treatment in order to be successful. One would expect that the rate of infertility in this population is similar to the general population, meaning that even if all testing is not done up front (which can save costs), providers should be prepared to make changes to evaluation and plans if a patient does not achieve success after multiple treatments.

Healio: How do you anticipate your findings will impact clinical practice?

Monseur: My work will also inform the creation of national, evidence-based guidelines for how to best support the LGBTQ+ community when building their families. In addition to specific considerations for diagnosis and management, this will include universal recommendations to collect sexual orientation and gender identity data as well as a sexual organ inventory on all patients.

Healio: Is there anything else you would like to add?

Monseur: Medical professionals are often conditioned to obtain expertise in a variety of topics to best care for their patients. This is reflected in the growing interest of increasing “cultural competence” as part of diversity, equity and inclusion efforts. Instead, I recommend an approach of “cultural humility” that recognizes that even in sameness, there is difference. Only after acknowledging that a clinician will never be fully competent about the evolving and dynamic nature of a minority patient's lived experience can we truly appreciate the necessity of lifelong learning with ongoing self-reflection and self-critique.

Reference:

• ASRM announces eight grant awardees to support advancements in reproductive medicine. https://www.asrm.org/news-and-publications/news-and-research/announcements/asrm-announces-eight-grant-awardees-to-support-advancements-in-reproductive-medicine/. Published May 25, 2022. Accessed June 14, 2022.