According to the National Institutes of Health, about 11% of women of reproductive age in the United States have experienced infertility. That figure runs to about 9% in men. There is no reason to presume these figures are notably different for LGBTQ persons, which would mean, of course, that roughly 90% of lesbians, gay men, bisexuals, and transgender people are fertile and can, if desire and circumstances allow, have children.
It's long been the practice of fertility professionals in the medical community, however, to treat their LGBTQ patients who are looking to have children as if they were infertile, said Dr. Brent Monseur, a gay man who identifies as nonbinary and is a fellow in reproductive endocrinology infertility, or REI, at Stanford University. He's just received an American Society for Reproductive Medicine Research Institute EMD Serono Diversity Fellowship Research Award, a pretty big deal, and one that will help further his immediate work in lesbian family-building and, ultimately, supporting the whole LGBTQ acronym in creating their own families. The $15,000 award is offered through ASRM.
This award, announced May 20, is given to a REI young investigator using evidence-based research to evaluate or affect practice change(s) that result in improved outcomes for patients and families seeking treatment for infertility or other reproductive health related diagnoses, a Stanford news release stated. Applications focused on the safety and quality of patient care, access to care, health disparities, and health services research were also considered.
ASRM did not return a message seeking comment.
The award aligns with ASRM's mission and commitment to expand research opportunities for underrepresented minority populations in the profession and leadership of reproductive medicine, as set forth by the ASRM Task Force on Diversity, Equity, and Inclusion, the release stated.
Winners were selected through a competitive process and reviewed by the ASRM Research Institute Grant Review Committee, according to the release.
Monseur said that he was excited to receive the award.
"As a gay, nonbinary individual who has personally faced the repercussions of discrimination due to my sexual orientation and gender identity," the 35-year-old stated in the release announcing the award, "my insider-status has helped me consider unique aspects of LGBTQ+ family building that are often excluded due to the historically hetero-cis-normative focus of reproductive medicine."
In other words, LGBTQ folks looking to create families haven't had a lot of support generally in doing so, largely because the fertility industry is geared toward those hetero-cis-normative folks. Add to that the absolute dearth of research about LGBTQ people in fertility circles, he said, and you have doctors treating healthy, fertile 30-year-old lesbians as if they were infertile even though the rate of infertility is probably about the same as it is among heterosexuals. More than half of lesbian couples in studies at UCSF and at Stanford were being treated for infertility, he added.
That leads to a number of problems, Monseur noted.
In a phone interview with the Bay Area Reporter, Monseur pointed out that LGBTQ couples often have high rates of multiple births such as twins or triplets because, traditionally, it's been common practice to use ovulation induction agents even if the patient is already ovulatory. The same applies to artificial insemination.
A single vial of sperm costs $1,000, Monseur said, and patients "are needing to do three or four inseminations, six to eight vials."
"It's a huge expense and there's no evidence that it works," he added.
Originally from Roanoke, Virginia, Monseur has lived in the Bay Area for two years now. While he works at Stanford, his fiancé is a professor at UC Berkeley and the two have done what any practical couple might do: they live halfway between the two universities in San Francisco.
Here, Monseur's been building a practice of sorts, although that isn't specifically his aim. Monseur estimated he's helped about 75 couples create their own families in the time he's lived in the Bay Area. His transition to physician-scientist, Monseur said, will allow him to continue his research on a broader basis — working with gay men and transgender people, for example — while creating a place a where LGBTQ people can build families with help from an empathetic and knowledgeable insider.
This sort of work would be difficult in a private practice, Monseur said. "I want to have the job that will have the greatest impact on this population," he explained.
That sort of help goes well beyond just getting someone pregnant. It's also helping patients overcome many of the popular misconceptions about LGBTQ families, he said.
"One of the main things I deal with from other providers or patients is, are children OK with sexual and gender-minority parents?" said Monseur. "There is no evidence there is a problem. Numerous professional organizations have said this. Patients still ask about this."
There has also been more acceptance of transgender people who want to freeze their eggs or sperm to have kids after they've made their transition, as well, he said.
With his grant due to pay out in July, Monseur said the funds will pay for the actual work he's doing, including publications on the data he's compiling, as well as travel to present that data. He's also already received a larger intramural grant through Stanford that would cover his entire salary for a year. In addition, he still sees patients one day a week.
"This has been kind of a long process," he said. "I've been training for the last decade. When I first got interested in this field, I attended graduate school at Johns Hopkins. I was surprised to find at the time that Johns Hopkins wasn't caring for gay couples who wanted to build a family."
Over the past 10 years, Monseur's been compiling data, much of which simply didn't exist when he was doing his residency or earlier studies, he said. Monseur has co-written medical articles on the topic of infertility and the LGBTQ community.
"Not only was there a lack of information, it was the norm to not even try to find that information," he said. "It wasn't even a priority. I'm one of the only people in the country who say this is my focus."
Monseur said a common refrain he hears is that, growing up, most queer people thought they'd never be able to have kids.
"We just grew up thinking it wouldn't be a possibility," he said.
Now that he's engaged the issue of whether or not to have kids is an issue in his life, as well.
"Like most gay men, we do not have insurance coverage for family building to have genetic-related children, which can cost up to $200,000 per child," he said. "We are exploring other possibilities such as co-parenting, foster care, and adoption, while continuing to advocate for better fertility benefits for all."
LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact Eric Burkett at [email protected] The column is off for the Memorial Day holiday and returns June 7.
Updated: 5/25/22: This article has been corrected to indicate Dr. Brent Monseur has received a fellowship award; his finance is a professor at UC Berkeley; a reference has been changed to UCSF (not SF State); and that he has already received a larger intramural award.
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