Stanger Sonia, Balsom Ashley A, Gordon Jennifer L
Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada.
Department of Psychology, Memorial University of Newfoundland, Saint-John's, NL, Canada.
Arch Sex Behav. 2025 Apr;54(4):1409-1425. doi: 10.1007/s10508-025-03102-9. Epub 2025 Mar 7.
The purpose of the present study was to explore the experiences of two-spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, or otherwise gender or sexually diverse (2SLGBTQIA+) couples pursuing third-party reproduction (TPR). A sample of 31 2SLGBTQIA+ couples (n = 62) from the USA and Canada attempting to conceive via third-party reproduction were recruited online, underwent a semi-structured interview about their experiences, and completed an online survey assessing fertility quality of life, anxious and depressive symptoms, and institutional betrayal in healthcare. Descriptive statistics were used to assess mean levels of quality of life, mental health symptoms, and institutional betrayal. Rates of clinically significant reductions in quality of life and mental health were assessed. Thematic analysis was applied to the interview transcripts. Data were collected between November 2021 and July 2022. Thematic analysis identified numerous challenges in pursuing TPR, many of which were specifically tied to participants' membership in the 2SLGBTQIA+ community. Two overarching themes were identified: "system-level issues," such as a lack of information pertaining to their unique situation, and "provider-level issues," such as the holding of heteronormative assumptions by providers. Quantitative findings revealed that a large proportion of the sample, 34%, scored in the clinical range on anxiety and depression questionnaires. The intended gestating partners reported poorer quality of life relative to their non-gestating partners. 2SLGBTQIA+ couples attempting to conceive via third-party reproduction experience psychological distress and reduced quality of life and face inequities and challenges at the system and provider level. These findings lead to concrete recommendations for clinicians providing fertility services to cultivate competence and improve care standards for this population according to their ethical responsibility and highlight the need for policy change and the development of targeted supports. Key recommendations include 2SLGBTQIA+-specific training for staff, using inclusive language, visuals, and documentation processes, refraining from hetero- and cisnormative assumptions, developing anti-discrimination policy and a process to assess and respond to clients' mental health needs, and identifying and sharing information and supports.
本研究的目的是探索双性人、女同性恋、男同性恋、双性恋、跨性别者、酷儿或疑问者、双性人、无性恋者或以其他方式在性别或性取向方面具有多样性（2SLGBTQIA+）的伴侣寻求第三方生殖（TPR）的经历。从美国和加拿大招募了31对2SLGBTQIA+伴侣（n = 62），他们试图通过第三方生殖受孕，通过在线方式进行招募，就其经历接受了半结构化访谈，并完成了一项在线调查，评估生育生活质量、焦虑和抑郁症状以及医疗保健中的机构背叛情况。使用描述性统计来评估生活质量、心理健康症状和机构背叛的平均水平。评估了生活质量和心理健康出现临床显著下降的发生率。对访谈记录进行了主题分析。数据收集于2021年11月至2022年7月之间。主题分析确定了寻求第三方生殖过程中的众多挑战，其中许多挑战与参与者属于2SLGBTQIA+社区密切相关。确定了两个总体主题：“系统层面的问题”，例如缺乏与其独特情况相关的信息，以及“提供者层面的问题”，例如提供者持有异性恋规范假设。定量研究结果显示，很大一部分样本（34%）在焦虑和抑郁问卷上的得分处于临床范围。预期的孕育伴侣报告的生活质量相对于非孕育伴侣较差。试图通过第三方生殖受孕的2SLGBTQIA+伴侣经历心理困扰和生活质量下降，并在系统和提供者层面面临不平等和挑战。这些发现为提供生育服务的临床医生提出了具体建议，以根据其道德责任培养能力并提高对该人群的护理标准，并强调了政策变革和制定针对性支持措施的必要性。主要建议包括对工作人员进行2SLGBTQIA+特定培训，使用包容性语言、视觉资料和记录流程，避免异性恋和顺性别规范假设，制定反歧视政策以及评估和回应客户心理健康需求的流程，以及识别和分享信息与支持措施。
