Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. I'm Jeffrey Hayes and today on the show we continue our season-long look at LGBTQ plus issues in reproductive medicine with a discussion about donor sperm. Joining me is my co-host, Dr. Lowell Kuh.
How are you, sir? Hi, everyone. Doing great. Thanks for having me here today.
I am absolutely excited to speak with our speakers today. So thank you so much. Fantastic.
Our guests today are Liam Kali, who is a licensed midwife and owner of Maya Midwifery Infertility Services, the longest running fertility practice specializing in LGBTQ plus family building via donor conception, originally established in the San Francisco Bay Area in 1991. Liam is the author of The Patient Facing Resource, Queer Conception, The Complete Fertility Guide for Queer and Trans Parents-to-Be, as well as Therapeutic Donor Insemination for LGBTQ Plus Families, a systematic review which was published in Fertility and Sterility in 2024. Now retired from delivering babies, Liam provides family building consultations to prospective parents across the U.S. and Canada, as well as clinical pre-pregnancy care and in-home insemination services in Seattle, Washington.
Liam also provides professional trainings and holds memberships in the Gay and Lesbian Medical Association, the Seattle-Tacoma Area Reproductive Society, and the American Society for Reproductive Medicine. Liam, welcome to the show. Thank you so much for having me.
I'm thrilled to be here. Also, we are welcoming Darlene Pinkerton. Darlene is the CEO and co-founder of Coast-to-Coast Sperm Donation, an FDA-registered sperm bank built to address the need for more transparency in donor conception.
Licensed in California, New York, and Colorado, Coast-to-Coast limits each donor to six families worldwide and encourages known identified donation, facilitating match meetings between donors and recipients. Darlene is also the founder of A Perfect Match, one of the most respected egg donor insurgency agencies in the United States, which she launched in 2000 with the mission to bring open donation, ethics, integrity, and compassion to the fertility industry. Thanks for being able to come onto the show today, Darlene.
Thank you for inviting me. Oh, wonderful, wonderful. Liam, I want to start with you.
So how do you approach counseling and care for LGBTQ plus individuals and couples who are considering or using donor sperm? And what does that look like? How does that process go? Typically, families will initiate care with a family building consultation. And at that initial visit, one of the first things we do is establish sort of a timeline and trajectory for the totality of their family building goals. And the reason we do it that way is because there's so much decision making at the beginning of the process.
And what many people don't realize is with future pregnancies, age becomes more and more of a concern. So if you're already needing to build your family via assisted reproduction, it really makes sense to map it all out over time with some of the financial considerations kind of taken into account, as well as some of the things that are actual barriers to care. However, even just stating it that way carries a little bit too much finality, like how to work around or with or in the context of current barriers.
And from there, there's just a lot of decision making to be made. We talk about sperm banks, known donors, and how to set up directed donor services, how to select a known donor if people are interested in that. And then with all of this sort of initial decision making and some of the real psychosocial and cultural aspects of care sort of tended to, then care kind of looks relatively typical.
The initial fertility visit is all of their pre-pregnancy care and labs and genetic carrier screening. We talk about education around caring for yourself for a healthy pregnancy, supporting your reproductive function, and a little bit about patient-led monitoring of ovulation, because that's what I use for timing IUI. And we'll even discuss the IUI procedure and how that looks, especially given that I typically go people's homes for their IUIs.
So yeah, from there, we're just doing inseminations. And then once folks are pregnant, they're transferring out to their prenatal care provider because I sleep at night now and I don't keep them and deliver the babies. Good for you.
Good for you. Yeah. That's awesome, Liam.
Thank you. And so Darlene, thank you also for joining us today. And I'm excited to talk with you as well.
And so, you know, many of my patients, they first come to see me and they have an idea that they'll need to use donor sperm. But what recommendations do you have for patients to find donor sperm? Because they always ask me, well, where do I find donor sperm? And so I have my little spiel. But I was wondering, what do you recommend and how does your company help these patients maintain compliance with FDA regulations and human tissue cells and all that? And so, yeah, just interested in what your thoughts were.
Well, it's interesting what Liam had to say, first of all, because we are very big proponents of psychosocial help for all of our donors and our families. And so for the known ones, we talk a lot about that. What does known mean to you? What does known mean to your clinic? Are you doing IUI? Are you doing IVF? Because that makes a difference in how many vials they may need.
They might want to go the frozen route if they only need a few for IVF, or we have them go the directed route if it's a same-sex couple, especially, and both want to carry, then we would recommend directed because they can get a lot more vials available from the same donor. And so for us, the educational part of it is first getting to know the recipients and what it is that they want to accomplish in their journey. And then based on that, we make recommendations maybe to meet with a psychologist, or in your case, Liam, I'm very excited about you actually, because I would love to have clients be able to have your kind of insight before they choose a donor.
I've had almost 30 years of experience in matching egg donors. And so we kind of formed the sperm donor program based on the same criteria. We listen to them, we know what they want, we know what's important to them, and then we can direct them toward donors that would meet their criteria.
So we're very hands-on. We do have a database. They can go and look at their leisure, but we're also here should they want to meet with one of our team members and really talk about the donors.
We let all our families meet the donor by Zoom, if that is what they would like. It's very important to us that they want a collaborative relationship. And by meeting ahead of time and talking through some of the issues like, do you want future contact? How do you see this happening with ID release? And us, you know, giving that to a donor conceived person.
And so we talk about those sort of things, and we really recommend a joint psychological session between the parties. So our donors are all screened first with the PAI and the evaluation. And the intended parents have their educational session with the same psychologist.
And then we bring them together and the psychologist talks about boundaries and expectations and that sort of thing to make sure they really are compatible. We've had some donors back out after these meetings, not because they didn't like the parent, but because it really brought home to them what this means to them, to their families. We're not talking about just some child out there that you may never hear from in this day and age with DNA testing, et cetera.
There's a really good chance that that donor is going to find you. So if you're not willing to be found, this is not the right thing for you to do. That's our philosophy for our program.
And we spend a lot of time with the donors before we ever accept them talking about all of those things. That's very good. Yeah, the thoughtfulness and the care you guys go through with the process is really, really impressive.
Thank you. Thank you. It's important, especially for the donor conceived child person.
They're the innocent ones in all of this. And so because of that, we feel that we really need to explore all those thoughts with the donor, with the intended parents. Some parents come into us and they don't want to know the donor at all.
And, you know, I'm just, you know, that's when we really recommend, why don't you talk to somebody about this, about the known factor, about when you would disclose and what you would disclose. For me as a physician, like, what would you like to say to our physician audience and just let them know, like, how can we be better? What can we do to make this better? Excellent question. And some colleagues of mine and yours and mine just published in Fertility and Sterility, a new guideline titled Inclusive Language and Environment to Welcome Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex and Asexual Plus Patients.
So talk about inclusivity. It is extremely thorough. I will say that in order to properly establish a welcoming clinical environment, the training and implementation needs to happen at all levels of care.
And I know that, or what I've been told, is that a lot of medical practices are engaging in the Human Rights Campaign's Healthcare Equality Index. It's a kind of multi-categorical checklist for implementing gender inclusivity in your medical facility. And I believe it comes with a certification program.
Some of my local colleagues here in Seattle at Pacific Northwest Fertility have been implementing that program. And it's a years-long, dedicated process within, you know, if your clinic has been established in, like, these heteronormative ways, just undoing all of that at all levels of the organization. It takes time and energy.
And I think that's a good way to put your money. But yeah, if you're dedicated and really, you know, you can just follow the guidelines and just make sure you're training everybody. There's an old set of videos that, maybe a decade old, maybe mid-20-teens, that an organization in Toronto put together.
It was an organization centered on queer family building and it since has disbanded. But those videos are still out there on YouTube. And they are called Scenes from a Fertility Clinic.
It was a nonprofit. They got funding. Everybody in Canada has funding.
I love to speak in Canada. But they, like, literally had people act out these scenarios, everything from the initial phone call, to sitting in the waiting room, to the initial sit down with the nurse, to the conversation with the doctor, and people of all different backgrounds just completely being, like, not seen. And so I feel like even that is just really eye-opening in a kind of real down-to-earth, seeing it all unfold in front of your eyes and being like, oh.
You know, I feel like we kind of have to be able to put ourselves in a situation or, like, see ourselves there in order to really, like, affect the kind of change in our hearts and minds that then we can really just carry out in a wholehearted way. And I think people who help folks make families, you got to have your heart in it somewhere. So, like, just listen to those astronauts, man.
It's all about love. Yeah, when you go to space and you see Earth from that angle, it puts a lot of things into perspective. Yes.
Yeah. So very similar. May I add something here? Absolutely.
I've been around for a long time, and when I first started, even finding a clinic that would work with someone from the LGBTQ, without all the pluses and everything else, just all you had to say was you were gay or lesbian, and they would not work with you. Because I was with egg donors and it was an open situation, I had couples come to me and they would say, do you have any egg donors willing to help a gay couple? And I was like, why wouldn't they? Well, I found out quickly it wasn't the donors, it was the clinics that were not open to helping the gay community. And my donors were perfectly fine.
They were like, yes, of course, no problem. And they were willing to be known and stuff. We still have issues today.
And I would say it's not so much the clinics not wanting to work with that community, but I don't know that they listen really well to what's important in their selection of a donor, in their experience with getting to know a person. They just pick a donor, any donor, it's okay. Not all clinics, but I mean, I'm still seeing that.
And then of course, FDA, with their not allowing men who have had sex with men in the past five years be donors. It's like, we're just starting to butt heads now and saying we're going to do this anyway. But it was heartbreaking to see beautiful men who wanted to help people be rejected simply because of their sexual either preference or lifestyle.
Married men who are committed in committed relationships and not a high risk type person, they were rejected just hands down. So I'm seeing some change there. But it's still very, very difficult because of the known and this is where it comes down to physicians.
Dr. Koo, like you, FDA does not describe what is known, not clearly. And so it's up to the clinics to determine that. And the clinics are all over the place.
There's no uniformity in what that actually means. So we have to work really hard to work with clinics that will define it for us very clearly. We know the quarantine time based on their decision of how that known means, because that determines what we have to do.
Do we have to have everyone sign legal contracts with their full name? Do we have to do the joint psychosocial session? And so not everyone is real friendly still to this day. And I find it sad. But I want to let you know, too, that we, my husband was one of the first reproductive attorneys in the nation.
He got the first judgment for a gay couple to have their names on the birth certificate. Yes. And so we've been, you know, very supportive since, gosh, I'm trying to think that was maybe 1998, 99 when he first did that.
And so huge changes, but not enough. Still not enough. And I think everything's changed so fast that people that are having babies today don't really realize how far we've come just in three decades.
Yes, yes. Well, we're almost out of time. This has just flown by.
Again, thank you both so much for being able to take time out and to be on the show today. Yes, thank you. Good to meet you all.
Oh, absolutely. And if you have questions about what we discussed in this show or questions about the show in general, it's asrm at asrm.org. And of course, it doesn't hurt to subscribe to the show. Press the subscribe button and it will pop into your feed magically.
And you'll get able to hear all these wonderful speakers and all these wonderful topics at the press of a button. And until next time, I'm Jeffrey Hayes. And I'm Lowell Coon.
And we'll see you then. This is ASRM Today. This concludes this episode of ASRM Today.
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