ASRM Today: Gestational Carriers and LGBTQ+ Family Building

In this episode of ASRM Today, host Jeffrey Hayes and co-host Dr. Lowell Ku continue their season-long exploration of LGBTQ+ issues in reproductive medicine with a conversation about gestational carriers and surrogacy. They are joined by Dr. Bryan McGolgan, founder of Gay Dad Reporter, and Eric Windell, who is a Registered Associate Marriage and Family Therapist (AMFT 142025) with PBA Psychology Group in Los Angeles, CA, who specializes in supporting individuals and families who are navigating the intricate journey of family building through third-party reproduction assistance. Together, they explore the medical, emotional, and relational aspects of working with gestational carriers as LGBTQ+ individuals and couples pursue parenthood. The discussion examines the importance of trust, communication, psychological support, and ethical considerations throughout the surrogacy process, as well as the unique challenges intended parents and gestational carriers may encounter along the way. The episode also highlights the long-term supports that can help foster healthy outcomes for intended parents, gestational carriers, and children alike.

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 discussion of LGBTQ plus issues in reproductive medicine and today we are diving into the topic of gestational carriers. Joining me for the discussion is my co-host Dr. Lowell Ku.

How are you today, good sir? Hey everyone, great to see you guys. Thanks for joining us today. We've got some great experts to talk to you guys about gestational carriers today.

I'm super excited. Absolutely. Joining us is Dr. Brian McGolgan, who is a U.S. board certified endocrinologist who completed his undergraduate and fellowship training at Stanford University and his medical school and residency at Columbia University.

He started Gay Dad Reporter to provide objective, actionable news and information for gay intended and current parents, enabling them to understand the complex and changing landscape of assisted reproduction in gay parenthood. He currently lives in Stockholm, Sweden with his husband Victor and their corgi dog Ruth. Welcome to the show, Brian.

Hi, thank you so much for having me. Wonderful. Also joining us is Eric Windell, who is a registered associate marriage and family therapist with PBA Psychology Group in Los Angeles, California.

He specializes in supporting individuals and families who are navigating the intricate journey of family building through third party reproduction assistance and takes a particular interest in supporting LGBTQ plus individuals on the path to parenthood. Wonderful. Thank you.

So I'll jump in with this question for whoever wants to take it. From your respective perspectives, how do gestational carriers shape the medical, the emotional, the relational experiences of LGBTQ plus individuals in couples building families? I'm happy to. I mean, so I can speak mostly to the relational and emotional, and I would say like they're an essential component, unless one of the intended parents is able to carry.

You know, I think that realizing they are an essential component to the relationship is then also, I'm assuming it's a joint effort between intended parents and the carrier and kind of co-investing in each other's families. So yes, we are building a family for the intended parents, but the intended parents are also helping the gestational carrier fulfill what their dreams and desires are for their family. And I think with that too, like the gestational carrier is such an essential person or role in this process, that with that, they carry a lot of hope, love, and gratitude from that piece.

Because I think it's an immense kind of, not service, but like, you know, it's just for someone to actually be willing to do that and not only put their life, but also their body on the line for another family to grow is something that is just incredible. Yeah, I want to echo that. I think it's just this amazing gift that these women do and provide for the intended parents.

And I think from the intended parent side, it really is this huge letting go of control and this huge amount of trust. And I think through that dynamic, you end up building this extremely profound relationship. And like Eric said, it's not just with her, it's with her partner, it's with her children, her whole social network and family.

As you grow your own family, you're intertwining with theirs and it becomes this one really cohesive, amazing story. To echo, I think Brian's point about the, you know, I think the trust and kind of thing for the intended parents to, you know, it's almost a reimagining of what is this process of building a family and includes more than just the two intended parents. And I think that can be scary at times, but also can yield these really kind of beautiful, unique relationships in this process to building their family.

I totally agree. You know, having cared for and had the honor to care for many couples who have used gestational carriers for building their families, it is an absolute gift for sure. It is a beautiful relationship that is formed and the bonds of trust are super great.

And so I totally agree that there's a development of trust. And how can we as healthcare providers, physicians and our staff, how can we provide and mental health professionals, how can we support and provide more support or better support to support a healthy relationship throughout the process of an intended parent using gestational carriers as their family growing process? Yeah, I think it's really integral, like from the very beginning, all the healthcare teams that are involved in this process, that everyone is just very honest about communication and expectations. So I think that those two things are really, really critical.

And so I think healthcare professionals can really just try and nail down, well, what do you expect from communicating? How often do you want to communicate? How long do you want to communicate for after the delivery? In which ways? Are you good with text? Do you do Zoom? How in person do you need to be? I think even just like we're saying a lot of these times people form this unique, amazing intertwined family, but that isn't also what everybody wants. And I think you have to know what people do want and what their expectations are and really kind of make that crystal clear from the very beginning. And then I think you're going to be set up for success in the long run because nobody's going to be surprised.

Nobody's going to like change their mind or say they were okay with something when they weren't. And I think as you go through the legal steps and all of the contracting and all of that detail, everyone's just going to be more honest. And I think that clarity can really be driven home from the first visit with a healthcare provider, whether it's a medical doctor, psychologist, psychiatrist, everybody who's involved.

Yeah. I mean, I completely echo what Brian said. And I think on top of that too, I think really for the intended parents, definitely a lot of kind of, I think working with a psychotherapist or psychologist beforehand to kind of process any of the multitude of feelings they might be feeling about this, right? Like as we said earlier, there might be concerns around trust, but also there might be grief.

The fact that they have to, you know, it's a gift that we can pursue this process, but also there might be grief and having to have all of these parties involved. And I think also working with untend parents to kind of understand, yes, this person, it's a unique relationship, but also the human component of the carrier as well. And like, yes, there may be things that you want to prescribe or be frustrated with, but understanding that there's going to be an emotional impact on any of those things and decisions.

And I think I would extend that to the healthcare team as well, especially when it comes down to failed transfers or anything that might mean the relationship has to end, being really mindful of how that's communicated and really letting the intended parent and gestational carrier lead those discussions rather than the provider. This has come up quite a bit this season, the psychosocial dynamic of a lot of these things. And I'm curious about how do medical protocols and psychological screenings, how do those work together? Yes.

I'm not as familiar with kind of the don't like egg donor or gestational surrogate like screenings. I do believe within those there is a psychological evaluation as well as some other tests. But really that is looking at kind of fitness for doing this type of work.

On the IP side, it really is, it is an initial psychological consult with a therapist or psychologist. And really that session's focused on psychoeducation. So really kind of seeing what the parents or individual understands about this process and their expectations.

And an assessment component around, is there anything kind of ongoing in their life or relationship that might be something that needs to be reflected on before pursuing this process? So some extremes like an active addiction or if a relationship instability, if it's a couple. But I think outside of that, that's pretty much the main touch points unless the individuals themselves seek psychotherapy support. I think another big touch point here is the agency.

And this is something where I would suggest like it's important to work with agencies that both have an advocate for the intended parents as well as the carrier. And because those are usually where the support networks are built. But I would say outside of that, it's really going to be driven by the parties involved if they want to seek more like psychosocial support.

And I think one thing that's interesting, you know, Eric, you're mentioning the agency part and I completely agree with that in terms of that role. However, I think there's kind of an emerging or more of a trend now for people doing independent journeys. And a lot of that's unfortunately driven by cost because the cost is so high in the US.

And so I think it's going back to like the medical actual screening part. I think that's really an interesting thing for these independent journeys and places where the medical team can play a real clear role. I think being really clear on the strict medical guidelines and criteria for the gestational carriers and that those are there to minimize any and all risk for what is, you know, inherently not a risk-free process.

And so I think that with all the psychological aspect that you're saying, which is hugely critical, I think especially with independent journeys, there's like this additional emphasis on the medical component to explain that to the IPs and the gestational carrier going through it. So that they both understand and know why all those are in place and also don't get frustrated if they get too far or think something's progressing, but actually it's not going to be able to move forward because of medical criteria that she may not pass. Yeah, absolutely.

And I think with that, keeping that and then you can always try and depersonalize like the medical criteria from the person's like intent or value, which you can filter in through the conversation with all providers. But I think there really is like you're saying like this interplay, which is so important of like the medical but psychological like woven throughout it in terms of that support and really encouragement, but also objectivity that you need to have. Just like personally, I loved my and my husband's consultation with our psychotherapist before starting our journey.

We're both big into therapy just ongoing for mental health, but it was fun to get together and our therapist really made us realize that we're just building a story for our child and like this is the story we're going to tell our child. So whenever we're making a decision throughout our journey, we're like, well, how do we want to explain this and how are we going to feel good about explaining this? And I think that goes for all sides, right, in terms of making their decisions. But that was just a really like amazing turning point for us early on and it was due to this consultation that we had.

Yeah, I mean, I think that's a beautiful point that you bring up around just kind of like what is the narrative around your child coming into this world and like the uniqueness that there's so many people who are wanting, you know, want to bring this child into the world and are bringing love into this journey and like how to craft that. And I think, you know, sometimes we might get and maybe this is more for heterosexual couples, but kind of marred in like how this looks differently from a traditional pregnancy, but realizing that there's actually a more expansive community that is for this child. And so I love that, Brian, too, of like thinking about kind of claiming the story and let it as a positive.

I love that, writing the story of your family. It's beautiful and I love that. And, you know, for our audience who are not only healthcare professionals, but also nurses and maybe even, you know, the general public audience, you know, how do they start? Where do they begin this journey to find a gestational carrier? I mean, a lot of times my patients come to me, they don't even know what a gestational carrier is.

Like, how do they begin writing this story? Yeah, that's a great question. There's no wrong way to go about it. I would say the Internet can both be your best friend and your worst enemy when it comes to this, because there's a lot of social media groups, a lot of Facebook groups, a lot of Reddit threads, a lot of places online that people can go and either, you know, be looking for or try and connect with and partner.

It comes with, I think, not having the backing of like an agency or a vetting process, you know, so that can be really challenging. Other people go through family or friends, you know, and ask if someone will be willing to do it for them, someone they're very close with. And I think that's beautiful and can be done as well.

And then others go through, like my husband and I went to a conference to learn about it. And I think that was like a great weekend where we just kind of dove in and learned everything about it, like soup to nuts, in terms of how it would work and the logistics and the teams and the legal teams and the agencies and everybody and meet with them and talk about it. So I think there's a number of ways you can go about it.

And there's no right or wrong way. But I think you just have to do what you're comfortable with. And I think you have to make sure that, again, you're comfortable with the story you're going to tell eventually to your child and making the decisions that you feel good about along the way.

Yeah, and I think to echo like Brian's point, like, it is a challenge. There's not, there aren't a lot of like consolidated sources of information on this process, right? And then like, depending on your journey, it will vary. But I think that tapping into like these conferences or the ASRM websites, also like your local community, like I know my husband and I, we've hosted dinner with a few other couples who like have started this journey or are curious about this journey and just kind of giving them our 411.

Of course, it's unique to us, but like sharing that because I think there also is sometimes maybe a concern or a fear of like not knowing, like, should I know these things already? But really, like, this process is really intense and complex. So I think also not being afraid to ask questions and like that it's okay that you don't fully know the story from the get that like it's going to unfold. So is it safe to say then that these supports that come in throughout this journey that that information is the most important thing? Good information is the most important thing.

Do you both have any recommendations of places that people can go to or maybe a journal or something along those lines? I'm embarrassed to say that I've my network. We have switched. So we mentioned, Jeff, in our bio, we had some hurdles.

And one of that was we actually ended up switching fertility clinics. We had a progeny benefit. So certain companies, a lot of the bigger kind of like tech companies think that have the fertility benefit progeny, which will have a network that you can look at.

In that also, I had a few friends who had used IVF before and kind of used for me to like do the resources. And I think then by also just kind of vetting and understanding how people approach you. So when you're talking to your clinic or you're talking to an agency, are they trying to sell you? Are they being like considerate? Are they being patient? Are they rushing you? Like I think use your gut feeling in a lot of those.

I know that's not like a great resource because it requires effort, but that's so far how I've we've navigated this journey. But I think really being mindful because like there is a, you know, this is also something that people do for business. And so there's going to be different incentives.

So kind of being mindful of being trying to be perceptive of like when you hear that. Yeah. And from my side, not to give a shameless plug, but I would say a lot of this information is things that I write about on Gay Dad Reporter.

So, and to be fully transparent, I don't take any money or get any money from any clinic or agency or fertility company. And that's completely because I don't want to have any bias in what I'm writing. I have done interviews with current parents who have gone on journeys in the US, in Mexico, in Colombia, and write about ethical aspects, write about the logistics and write about our own journey, which has been going on for three years.

And we actually, unfortunately, just ran out of embryos. So we're actually restarting our entire journey again. So I'm going through it again, without having completed really the first journey.

And so I think I would encourage anyone to go to the website and reach out to me. The other I would say is, I know I may have been a little bit dismissive to the Facebook groups, but actually there are a lot where you can go and meet people and do like what Eric's saying is reach out and just talk to people who have been through the process or are going through it, meet them and ask them all the questions, just like Eric's saying. I think there's no substitute for that personal information.

And they may not be close friends right now, but they could become close friends. And I've met people that way as well through even a gay dads group in Sweden that I joined when moving here. And so I think those personal connections like Eric was saying, and then online resources like my website, there are reputable websites that you can go to.

And also like Eric said, just make sure that it's not coming from a place that's maybe influenced by the business aspect and is objective. Absolutely. And we will make sure to put your website in our show notes so that people can just scroll real quick, click on it and go find all this wonderful information.

Dr. Ku, do you have any other questions today? No, it's beautiful. Thank you guys both for sharing your journeys, your expertise and all the online resources. So thank you so much guys.

It has been an absolute pleasure. Yes. Thank you both Brian and Eric.

I hope we can have you back to talk a little bit more about everything, but I also would just like to say thank you both again so much for being able to be here on ASRM today. Thank you so much. Wonderful.

Well, if you want to ask us questions about the show or find out some more information that might not be in our show notes or on a link that we may have previously provided, you can email us asrm at asrm.org. Of course, it doesn't hurt either to subscribe to the show so that it can always be in your queue and you can always find these wonderful stories and conversations and journeys and just keep it open as it were. But until next time, I'm Jeffrey Hayes. And I'm Lowell Ku.

We'll see you then. This is ASRM Today. This concludes this episode of ASRM Today.

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These are provided as a source of general information and are not a substitute for consultation with a physician.