Fertility Treatment Methods for LGBTQ+ Patients

In an article published in Fertility and Sterility, Liam Kali outlines which treatment methods might best serve LGBTQ+ patients.1

In 2023, the American Society for Reproductive Medicine (ASRM) updated the definition of infertility to include any person in need of donor gametes to achieve pregnancy, “based on a patient’s medical, sexual, and reproductive history.”2 ASRM’s acknowledgement that a medically necessary intervention is required for LGBTQ+ people to achieve pregnancy has broadened the definition beyond cisgendered, heterosexual couples who are trying to conceive.

One potential unintended consequence of this change, Kali notes, is “the conflation of same-sex orientation to a diagnosis of pathological infertility,” thus exposing same-sex assigned female at birth (AFAB) couples to unnecessary and costly procedures when no actual indication of infertility is present.

In contrast to IVF procedures, TDI is less invasive and technologically simpler. TDI is performed by using a basic catheter to deposit a donor sperm sample into the uterus. TDI can be performed by a midwife, a doula, or a physician, and the procedure’s success “has not been shown to be influenced by provider type.” LGBTQ+ patients report a high level of satisfaction with midwives, doulas, and other public health nurses. 

On average, AFAB couples require three cycle attempts using TDI, which is significantly fewer than the number of attempts noted in the definition of infertility for heterosexual couples (6-12 unsuccessful attempts). Multiple studies have shown that AFAB couples “have equivalent or higher [live birth] rates than heterosexual female partners seen at fertility clinics.”

ASRM guidelines emphasize the importance of starting fertility treatment using “the least invasive methods for the most common causes of infertility.” This is especially noteworthy for AFAB couples, as they may not have experienced unsuccessful attempts to become pregnant prior to seeking fertility treatment.
Due to the expense of and limited access to fertility clinics, Kali concludes that “TDI care can be safely and appropriately performed in community-based and primary care settings,” providing that the practitioners have the skills to perform TDI.

1 Therapeutic donor insemination for LGBTQ+ families: a systematic review
Kali, Liam
Fertility and Sterility, Volume 122, Issue 5, 783 – 788

2 Definition of infertility: a committee opinion
Fertility and Sterility, Volume 120, Issue 6, 1170