A look at key priorities in family building for gay men

Pathways to fatherhood: evaluating the priorities of self-identified gay and bisexual men pursuing family building options (Hanson, 2022)

Hanson, B. M., Leondires, M. P., Glatthorn, H. N., Kaser, D. J., Hotaling, J. M., & Cheng, P. J. (2022). Pathways to fatherhood: evaluating the priorities of self-identified gay and bisexual men pursuing family building options. Fertility and Sterility Reports, 3(2S), 91-99. https://doi.org/10.1016/j.xfre.2021.09.003

Geographic Region: United States (86% of respondents) and additional respondents from Canada, UK, Sweden, Spain, Denmark, China, Israel, New Zealand, and Portugal.

Research Question: What are the priorities and decisions of gay and bisexual men pursuing fatherhood, including preferred methods?

Design: Cross-sectional study using an internet-based survey. Data collected between April 2019 and May 2020. Analysis included descriptive statistics for categorical variables and means/standard deviations for continuous variables.

Sample: 110 gay and bisexual men. Mean age was 37. Mostly white (72%) and highly educated (42% held doctoral/advanced professional degrees). 94% were partnered with an average relationship duration of 9.8 years.

Key Findings

• 68% preferred achieving parenthood via oocyte donor and gestational carrier.

• 53% rated genetic link to child as "extremely important" or "important". 87% of couples planned to use sperm from both partners.

• 41% preferred twin gestation as ideal pregnancy outcome.

• Medical history was most important factor in selecting oocyte donor, and pregnancy history was most important factor in selecting gestational carrier.

• Most respondents did not prioritize known donors or carriers. Only 18% considered known donor status important. 63% rated having a known gestational carrier as "not important at all".

• 89% reported having access to desired fertility services; 33% needed to travel to another state for care.

Limitations: Sample may not be representative of broader LGBTQ+ community. Geographic concentration in Northeast and West US. Survey only captured those seeking fertility center care. Limited representation of single men. Respondents were at different stages of family planning process. No exploration of disclosure intentions to future children. Limited investigation of attitudes toward donor identification and information sharing. Did not address perspectives on long-term information access for donor-conceived offspring.

Applications: While access has improved and stigma has decreased, there is still work to be done to ensure that cost and legal obstacles don't become excessive barriers to gay and bisexual men pursuing parenthood.

Funding Source: Not explicitly stated in article

Lead Author: Brent Hanson is a reproductive endocrinologist and infertility specialist currently practicing at CCRM Fertility of Minneapolis.

Regulatory Context

• There are no comprehensive federal laws regulating gamete donation or donor conception in the U.S. The process is largely self-regulated by the fertility industry.

• The Food and Drug Administration (FDA) does have some oversight, primarily related to screening and testing of donors for infectious diseases.

• The American Society for Reproductive Medicine (ASRM) provides ethical guidelines and recommendations for donation practices. However, these are not legally binding.

• There are no legal limits on compensation for donors. A 2011 court ruling (Kamakahi v. ASRM) determined that price caps on donor compensation violate antitrust laws.

• ASRM recommends a minimum age of 21 for gamete donors, but this is not legally mandated.

• The U.S. does not have laws prohibiting anonymous donation.

• Some states have enacted their own laws regarding aspects of assisted reproduction, and parentage, but these vary widely.