Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. I'm Jeffrey Hayes and welcome to a new season of ASRM Today. This season we will be focusing on LGBTQ plus and family building and reproductive health.
I'm excited to say that joining me on this journey is a new co-host to the program, Dr. Lowell Khoo. Welcome to the show, sir. Thank you for having me.
I'm super excited to jump in this role and it's an honor and a privilege. Fantastic. Well, our topic today is an overview of the psychological, legal, and logistical aspects of LGBTQ plus family building.
Our guests today are Dr. Kim Bergman, a licensed psychologist who's been practicing since 1990 with over three decades of expertise in third party assisted reproduction. She pioneered a proprietary psychological screening support and monitoring process for intended parents, surrogates, and egg donors. Welcome Dr. Bergman.
Thank you. Glad to be Also joining us is fertility law attorney Richard Vaughn, who combined his passion for family formation with over 20 years of experience in business and technology law and founded International Fertility Law Group, one of the most successful and best known law firms in the world, focusing on assisted reproductive technology law. Welcome Richard.
Thank you. Happy to be here. I'll get the ball rolling here with a question that's be open to both of you.
When we say LGBTQ plus family building, what does that really include today? Well, I'm happy to take it first from the sort of non-legal perspective and Rich can jump in. We can interchangeably answer each other's questions, but I'm glad you have us both here. So, you know, I think what we mean by that is anyone who identifies as part of the LGBTQ plus community pursuing parenthood.
So, you know, this is a self-identifying, important that it's self-identifying because there's nuances and things are not always apparent. So anyone who sees themselves as part of that queer community and is pursuing parenthood, motherhood, fatherhood, or any other kind of is in that group. And there are a lot of unique legal, psychological, social, and logistical issues that come into play.
And I know we're going to dive into those today. Yeah. And I would add as well, that includes those who are pursuing parenthood on their own as a single parent, those who are coupled, those who are married, not married, and those who are in multi-parent family situations, whether they're three parents or more.
What are the most common misconceptions people have about how LGBTQ plus families are formed? Well, I would say in the context of assisted reproduction, not fully understanding the legal process that might be involved in having them declared as legal parents. A lot of times they may actually come with the assumption that an adoption is involved, and that's not always the case. In surrogacy in particular, we often are going to the court, of course, to get a court order to declare them as parents, but it's not often an adoption order.
It can sometimes be part of that process, but there's a lot of conflating of the two legal procedures, adoption versus assisted reproduction. Yeah. And I think actually jumping off from that, I mean, one of the misconceptions that LGBTQ plus families face is that non-biological parents are not fully the parents, socially speaking.
And it's really important internally within the family that those feelings and those thoughts are really spoken and resolved before people become parents, because of course the parents are the equal parents and legitimate parents, but there are some misconceptions from the outside looking in. That makes a lot of sense. Whenever I counsel my patients, when I see them in the office, I agree.
I say, you're the mom. You're going to be the parent. This is your kiddo.
And so it's very important that they understand that. Yeah. Yeah.
And particularly in LGBTQ family making in third party in general, but even in particular with LGBTQ, biology is not what makes a family. It's just part of the fabric. Absolutely right.
Absolutely right. Kind of a side note to that as well. Another assumption that is often a part of this at the beginning of the process is an assumption that they have to be married if they're a couple, and that's not always the case.
So it's nice that marriage is available, but it's not always required to become a legal parent. Beautiful. I agree.
We always say love is what makes a family, and it's beautiful. What sort of, not mistakes, but what sort of pitfalls should patients be aware of as they move forward to building their family? I have one. Go Rich.
It just came up yesterday. It comes up more and more frequently these days. Folks will get online and do online research or use AI tools to try to give them the answers.
Certainly in third-party assisted reproduction, expenses are significant, and so it sometimes starts as a way of saving money to see if you can get the advice online. Just like getting medical advice online, getting legal advice online is quite tricky, and some clients I spoke to yesterday went to three different AI platforms to ask the same question. They got the same answer from all three platforms, and all three platforms were wrong.
Oh, wow. They thought that because they got three consistent answers across three platforms... It must be correct. Yes.
Oh, wow. Fascinating. Yeah, you know, I get some of that as well in the medical side, right? I always can feel like when the patient comes walking in and they are asking very sophisticated, detailed questions that I'm pretty certain that's not in their wheelhouse from the original get-go, I'm wondering, yeah, I bet ChatGP probably gave them a little bit of information.
Yeah, 100%. Do legal complications that can arise impact the emotional well-being during the family-building process? First of all, I love that question because there does not need to be any legal complications at all. I tell people, you know, this is a really expensive process.
There's going to be a lot of emotions. Medically, we stack the decks. Your doctor stacks the deck, but, you know, there's risk.
But legally, we can really mitigate risk and have it be straightforward if it's done right. It's actually the least risky part of the entire process if it's done right and sequentially and by an expert in the field who knows what they're doing. That doesn't mean your Uncle Bernie, who's a lawyer, you know, a real estate lawyer writing the contract.
But, you know, it's complex, but it is really safe if it's done right. So typically, your question comes to play if people have already not done something right. Now, if they start with someone who knows what they're doing, an agency or a doctor or a psychologist, almost always if there's no lawyer involved, that's the very first step.
Let me introduce you to a lawyer. Here's a lawyer. Here's two or three lawyers.
Pick one of them. They're all good. Because the lawyer is the backbone of the entire process going right and really protecting the process.
And I don't suggest people do these things independently. I think there's a, I mean, I'm biased, but I think there's a very clear role for an agency or an expert. But if people are going to not have an agency and not have an expert guiding them, then the lawyer becomes even more essential.
So, okay. So what emotional things can come is, you know, often when steps were skipped or done in the wrong order or shortcuts were taken. And then often I'm calling Rich on behalf of a client to clean up, clean up on Islay and Rich does the cleanup.
But that cleanup is unnecessary if you just do things in the right order. And, you know, the third party assisted reproduction, which is of course what LGBTQ plus parents have to use one form or another is very straightforward and structured if it's front loaded correctly. It's really very risk free if it's front loaded correctly.
And if it's risk free and front loaded correctly, then the emotional sick will lie that can emerge are mitigated because all the conversations are had early on. All of the psychological conversations are had early on. Everybody's screened.
The parents, the surrogate or the donor or the sperm donor, whichever part you need, whatever the part is that you're adding, they're all very well informed and consenting. They all speak with a lawyer. They all speak with a geneticist.
They all talk to the doctor. There's a lot of things that happen before the actual process of the IVF or the insemination or whatever the medical process is. And then obviously before the parenting process.
So sorry if I stole your thunder, Rich. But this is one of my favorite questions because the legal part is so straightforward if it's done right. If it's planned correctly from the beginning.
Yeah. The number one thing that I'm talking about with new clients, they'll always ask me about the horror stories, like the worst case scenarios. How do we avoid the worst case scenarios? Because they've gone online.
They found these horror stories. They do exist out there. And I do agree with Kim completely.
Usually the consistent theme in all of those horror stories is they skipped steps. It was a DIY, kind of do it yourself sort of thing. They're trying to save money or time.
They think they know better. But if they're skipping steps, then they're likely inviting those problems. And the other thing that's built into this as well is a lot of folks will come to this situation, these arrangements, having talked to someone like they have a friend who's been through it or friends, multiple that have been through it.
And their experience is unique to them and their unique circumstances. They may say, well, they didn't have to do X, Y, Z. Why do we have to do it? Because your circumstances are different. And we're looking at a lot of different variables.
We're looking at where do they live? Where do they have citizenship? A lot of people have multiple citizenships and you have to factor all of those in at the very beginning. Whose genetics are being used? Where's the clinic? Where's the surrogate or the donor if they're using a surrogate and donor? So all those things really factor into how to plan their legal case properly. And that's why it's so important to talk to someone early.
That's really good. Thank you for all that inference. It's excellent as a physician and hearing you guys speak about it.
In patients who do skip the steps, you said that some of them are trying to save money. But in other cases, could it be that, well, perhaps even the physician makes me anxious, like, geez, I don't want to miss a step for the patient. What do you recommend for us physicians? How can we make sure that we're not going to let the patient skip or miss a step? I think it is about the collaboration with other professionals.
I mean, third party assisted reproduction in a team sport. It should not be undertaken alone. It is a true village experience.
So there is a role for multiple experts. And I think there's always a role for a lawyer, always a role for a lawyer in third party assisted reproduction because there are extra legal steps that need to be taken. And then there is always a role for a mental health professional when there is a third party involved.
So not having anything to do with LGBTQ, except that LGBTQ people have to have a third party involved in order to be parents. So anytime you're using a donor gamete or a gestational carrier, you need a mental health professional involved in the process. And so I think the safest thing you can do as a physician is just counsel people to, well, back up and say, the safest thing you can do as a physician is to have in your back pocket some experts that you trust, some mental health professionals that you trust, some lawyers that you trust, some agencies that you trust, and then have those early conversations with their clients.
Have you consulted a lawyer? Have you thought about this? Have you talked about this? There are some steps that are important to get done at the beginning. Have a consultation. All of us will do consultations, either free or very inexpensive, just to get the ball rolling in terms of putting all the pieces together.
So I think that is what you can do as a physician. And it's less obvious because I think often people do start with their doctor, but it's the same thing. I mean, I have in my back pocket doctors that I trust completely, geneticists that I trust.
I've been texting all day with a geneticist about a case. That's my posse of people that I trust that I can go to because there are so many pieces involved in this process. And for LGBTQ, it can be as simple as just the addition of a sperm donor, but it can also be everything that every other person engaged in third-party assisted reproduction needs.
And it can be quite complex. And I think what I would add to that, maybe phrasing it a little bit differently, but in a similar vein, because this is a team sport, we are all individually gatekeepers in a team approach. And so to ask, for the lawyer to ask, do you have a doctor? Do you have an agency? Have you talked to a psychologist? To ask those questions as part of the intake.
And so you as the physician ask the same question. If they don't have someone in place, then you can make the recommendations. And certainly for LGBTQ+, asking if they have someone who they feel comfortable with, who's competent in working with LGBTQ plus individuals.
Not everybody is. Not everybody's familiar with the terminology and the special legal circumstances and risks that they're going through. So it's important to make sure they're also teamed up with somebody who's LGBTQ plus competent.
Yeah. And competent and also welcoming and friendly. I mean, nothing's worse than sending a LGBTQ patient to a doctor.
And the very first thing on the form is like husband and wife, you know, and it's just, you know, it's just not a welcoming, I belong here kind of experience. So all of that kind of cultural competency in the LGBTQ plus community, and there are many people, and you don't have to be in the LGBTQ plus community to be competent. You just have to be competent.
Very good point. Very good point. Thank you guys.
What gives you hope about the future of family building? Where would you like, where do we see it going? What are our indicators? What's happening? I'm constantly inspired by clients who are absolutely resolute in their mission to become parents, to overcome whatever obstacles there are. And it seems that we're constantly getting new obstacles thrown at us all the time. And so that inspires me, that emboldens me to work harder, to make sure that they're protected.
And so there for me lies the hope, like that, that desire, that passion to be a family will never go away. And we need to not let anyone talk us out of, out of those dreams. And really along those lines, what really inspires me, you know, and I've been doing this for 30 years, is that more and more LGBTQ plus folks are following what would be called a typical or traditional trajectory.
And I love that. They are young, they are dreaming of being parents young, they are getting married or partnering and pursuing parenthood earlier. You know, back in the day when I first started, and we first started specifically to help gay men, most of our clients were older, they had come out, given up the idea they'd be parents, but in the back of their hearts, they always wanted to be.
And then, you know, later in life, they realized, okay, maybe there's a path for me. Now I see more and more people in the queer community never giving up. They don't come out and give up that they can be parents and then come back to it.
They just assume, of course, I can be a parent. And that is, I mean, I'm getting chills. I, you know, my, I love that about working with younger and younger people who are, okay, like, we want to, we always wanted to be a mom, I always want to be a dad.
And it's, it's very lovely that, that doesn't have to be such a disconnect for people now when they come out. And they've grown up knowing that this was an option. So that's, that's, yeah, that gets chills going for sure.
Yeah, me too. Yeah, thanks for sharing those inspirations. Those are absolutely wonderful and beautiful.
And I love hearing that the thought has changed from, oh, I don't know if it's possible to, yeah, it's, we just have to, you know, go get some help. And we're going to have our family. So that is, that is awesome.
I love that. And I think, I think, you know, to take it one step further along, along with that, I think people are much more open about being LGBTQ families. I mean, of course, social media has helped out a lot.
There were no, there was no social media when I had my kids. So, you know, we had a little lesbian underground that we consulted with. But now, you know, there are so many people out there and, and people are so much more comfortable sharing their stories right from the outset, you know, with no shame, with no secretive.
And of course, that's so much healthier for the kids, you know, that this is just who we are right from the beginning. And this is our story. And it's very beautiful.
It is beautiful. And, you know, if you could leave listeners with one piece of advice or encouragement, what would, what would that be? On the legal side, I think Kim has already said it. There may be complications, but if you talk to a lawyer early, you plan things out carefully, you can do it safely, you will be protected, you will be the legal parents of your child.
And I would say, parenthood, through third party sister reproduction is completely doable, more than possible, very doable. And that if you parenthood is not for everyone, but if it is something that you want, you will find a way. And there are lots of people and lots of resources that can help you do not give up.
Because parenting is the best thing ever. It's beautiful, guys. It's lovely.
Yes. And absolutely having a family building family is the best. Well, I'd like to thank everyone for their time today.
And coming on, I'm sure our listeners really, really appreciate it as well. To our listeners, if you have questions for us, please email us asrm at asrm.org. Also, if you please subscribe to the show, if you have not done so already, that is greatly appreciated as well. So again, thank you to everyone here.
Welcome to Dr. Koo, who's joining us on this on this journey of podcasting as we go. And until next time, I'm Jeffrey Hayes, and this is... Not LOL Koo. Yeah, I was going to say, I didn't know.
There we go. I took the pause. You'll get that.
You'll get that. I'll get a timing down. Yeah, we'll get a timing down at some point.
Anyway, thank you for joining us. 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.
