SART Fertility Experts - Reproductive Challenges Facing the LGBTQ Community

In this episode Dr. Mark Trolice speaks with Stacey Stevenson, the CEO and president of Family Equality, a national LGBTQ foundation, along with Robert Terenzio, who is a Reproductive Healthcare Attorney on the infertility challenges facing the LGBTQ community.

Hello again, everyone. I'm Mark Trolice. I'm a board-certified reproductive endocrinology and infertility specialist in Orlando, Florida.

I'm founder and director of the IVF Center as well as professor at the University of Central Florida College of Medicine. And I'm delighted to be performing another SART podcast, this one entitled Reproductive Challenges Facing the LGBT Community. I'm blessed to have two superb guests with me today to be able to answer all of your questions and give you guidance to what you have been looking for.

My first is Stacey Stevenson. Stacey is, her resume is very, very impressive. She is the CEO of Family Equality, and that made her the first black chief executive officer.

That was back in 2021. She is a trailblazing leader. Stacey was selected as one of the Out Magazine's Out 100 list, compilation of the year's most impactful and influential LGBTQ plus people in the fall of 2022.

Prior to joining Family Equality, Stacey worked in the corporate sector, where she had a long history of senior roles in the defense technology and finance industries. She decided to turn her business acumen and experience and passion for the LGBT community into joining Family Equality. I am absolutely delighted to welcome Stacey to the podcast.

Thank you. In full disclosure, Stacey and the committee appointed me to the board of directors of Family Equality recently, and I am profoundly honored for that title. Thank you for that, Stacey.

Absolutely. We also have with us Robert Terenzio, a longtime colleague of mine. We go back many, many years.

Robert is an exclusive assisted reproductive technology attorney since 1997. We go way back to the same time, Robert. He has a large percentage of LGBTQ patients who he has guided through, personally, my experience with him, with our patients, as well as really around the country and the world.

He belongs to the family law section of Florida and Connecticut. He is an ART fellow of the Academy of Adoption and Assisted Reproductive Attorneys. I also want to talk with him about his recent trip to Italy, where he spoke about lesbian families who have come under attack in building families.

So, Robert, thank you for joining us today and welcome to the podcast. Well, I'm honored to appear, and thank you for the invitation. My pleasure.

My pleasure. Let me first ask Stacey, Stacey, as a significant advocate for the LGBT community, what do you think is the most pressing challenge that they are facing in wanting to build families? I think the most pressing challenge is that there are still challenges in building our families that are legal, social, and economic. And I believe that there is a thought process out there that because we can marry, that we do not have challenges when we're building our families.

But the fact of the matter is that we still do. There are many parentage laws that are not updated or up to date that do not consider our families. There are still 13 states that can discriminate against an LGBTQ plus person who wants to foster or adopt.

I think that the biggest challenge, well, hold on, let's talk about the financial challenges too, economic challenges too, right? Because many of the ways in which we build our families, private adoption, surrogacy, et cetera, are just financially just out of reach for most people. So the most pressing really is that there continue to be challenges in terms of even creating your family. And then when you have your family or you have the child, then it's navigating the schools, then it's navigating the parentage laws.

There's many challenges. And I'd say it's like in a nutshell, it's just not equally, it's just not equal yet in terms of how we build our families. So we are facing access problems, we're facing acceptance problems, and we're also facing legal problems along the way.

The clinics are unfortunately not universally welcoming to LGBTQ in order to enforce the diversity, equality, and inclusion and belonging of these patients. Robert, what are you seeing as the major obstacles in this community? And when you get involved, what are you noticing as the real hurdles? When we're talking about couples in particular, there is the non-carrying, non-biological parent that's getting excluded. And Stacey just mentioned the financial side of this.

When I have someone come in and we're talking about these sorts of things, and even if they're married, I will say to them, hey, you really have to give a thought to adopting. On top of the birth certificate that you're obtaining through the state where the delivery is going to occur, the question, of course, is why do we have to do that? A lot of people don't appreciate the fact that birth certificates are themselves administrative acts, not necessarily grounded in the law. So that non-carrying, non-biological mom can be excluded.

And you mentioned Italy a few moments ago. That's exactly what's going on in Italy now. The Italian government is on a rampage to find those female couples who have non-carrying, non-biologically related parents and removing them from the birth certificates, excising them from their right to be a parent to their child.

It's a travesty. Absolutely. I'm thinking a gay male couple is probably the most at risk of these type of legal barriers.

Well, they are and they aren't. We find that most of our male couples, one is going to be biologically related to the child, even though they obviously are relying on a gestational carrier or maybe a genetic carrier, at least one father will have that connection. That creates a different dynamic because that particular parentage track can never be erased.

That biological father will always be the biological father, but his husband or partner will have to adopt to ensure that he's not going to be excised at some point. Or Stacey mentioned schools earlier. There could be nothing worse than having your children in school and the school person says, I'm sorry, but we don't recognize your authority over this child.

So you cannot pick him or her up. You can't provide medical consent because they fell down and hurt their knee. There's a myriad number of things that can happen.

Yeah. We've talked about personally patients that either reciprocal egg sharing with a lesbian couple that you had recommended that they would need to adopt to ensure that they are legal parent of the child, which places such a significant burden on an already involved process to how to conceive. Absolutely.

And I'm sorry, I want to interject this. We do these certainly, and we call them generally confirmatory adoptions. We're confirming the parentage relationship that already exists.

But I run into judges that don't even get it. Even today, even in some of the more advanced courthouses in Florida, some of the judges go, wait a minute, what are you really trying to do here? And it takes me a few moments to walk them through all the steps because they don't necessarily understand all of the parameters of what's going into being a parent if you're in a same sex relationship. And I want to just reiterate, Mark, if you don't mind, Dr. Mark, about the point you just made, on that the birth certificate is not enough, essentially.

And just a real life example, if you've all heard about the mother in Oklahoma, who she and her wife had a baby, so she was not the birth parent, but they got married. And both of the names were on the birth certificate. They later split.

And when they split, what the non birth mother did not understand is that she needed to do a second parent adoption. And what happened to make a long story short is that the judge in Oklahoma wiped her name off the birth certificate, making the donor the legal parent, the sperm donor, the legal parent, not the woman who'd been raising this child along with her wife. So the real life example of those things actually do happen in the courtrooms and we have to do second parent adoption, confirmatory adoption.

And I was going to add, you know, the problem doesn't exist solely with coupled folk. It also exists with single parents trying to raise a family. I had a French lady who went to Illinois and she had multifactorial infertility.

So she required a surrogate and an ova donor and obviously a sperm donor. Illinois didn't recognize her parentage at all. We had to do a full blown adoption to finalize her parentage with her child.

Luckily, the carrier was in agreement with everything that had to occur. But could you imagine the brouhaha if she decided to change her mind? What do you think are ways that we can increase equal access, diversity, equality, inclusion? How do we try to lower these barriers for something that is as simple as just wanting to build a family? What are you seeing out there, Stacey, as such a strong advocate for the LGBTQ community? What are they telling you are their challenges and what is your approach to try to lower the barrier? Yeah. Well, as I mentioned, there are many challenges.

And I'd say if I, to give one example, because I mentioned that the laws are not applied equally across states when it relates to our families. And when we think about IVF, for example, I remember hearing from a lesbian couple in Massachusetts of all places who had established infertility with their diagnosis, if you will, of infertility with their first child and at birth their first child. Now they were on the path of parenthood with their second child, but their insurance company changed.

So now they have to establish the diagnosis of infertility again. And what happened is that that insurance company did not apply the definition or had a very heteronormative definition of infertility, which means that until that benefit, that benefit could not be applied until they actually proved that she was in fact infertile. And so when I think about that, they had to spend loads of money, months on end, to prove that she was not infertile.

Now there was a straight couple that wouldn't have happened, right? And so those are challenges that we see across the board. And so I think the way that we are approaching the challenges in terms of laws not being accessible across the board, we're thinking about how do we ensure that Massachusetts law and other laws are actually updated? Their parentage laws are 40 years out of date. We are looking into passing the John Lewis Every Child Deserves a Family Act, which is going to end discrimination in foster and adoption care.

And then we just put out a really good resources called Know Your Rights or Protecting Your Children, I'll have to find it, but it's all about parentage and the state of parentage and how you establish legal parent-child relationship from state by state. I'm going to put you both on the spot right now, okay? Do you think that this is purely bureaucratic? In other words, it's being bogged down from the system that they are trying to understand the process? And we've talked about outdated laws, but it's a round peg in a square hole. It's 2023, things from years ago are clearly not applicable, but is it the updating of outdated thinking or is it truly persistence of not accepting DEI, right? Is there still the discriminative prejudiced mindset? I hate to think that, but are we dealing with that or are we bogged down in red tape from outdated policy or is it a combination of both? Let's just entertain that a little bit.

I would say that the bureaucrats, the people that I deal with in vital records are very open to most anything that I present to them. But when I talk to the legislators who are old and generally white males, either they don't get it or they don't want to get it. And it's very frustrating to be sitting, kind of like we're sitting here today, talking to a white guy that even might be younger than me, and the mind is totally closed.

And I can't tell you as we sit here, if it's closed because he doesn't wish to learn or because he's decided that he can't learn. I don't know what it is, but it's frustrating either way, because there are some states, and Stacey, you would know this, like Colorado, that have been very progressive in pushing new laws through. And when you look at the legislatures there, it's generally a younger crowd.

They're less inclined to stay in the legislature, so they're younger. There's a turnover. And because there's this turnover, you're getting younger folks who are more aware of what's going around in the world and more educated in the reality of society as it exists today.

I'm going to make a plug for Carol Dweck's book, Growth Mindset. That's what we need to be having when we're dealing with this. Yeah, we do.

Stacey, did you want to add some? I was going to say, I agree with Robert. It is the red tape. A lot of times it takes a while to get some of these things passed, as we all know, but we know specifically in our work at Family Equality, there are people who do not want us to have access to family building.

There are people who want to complicate our path to family building. We hear it all the time. And when we think about when the Dobbs decision happened, when Roe was overturned, I heard from so many families that they just knew that this was going to complicate their path to parenthood.

They listened to what Justice Thomas said about, we should revisit these key cases, and people are afraid. And so when I hear that at the top from the Supreme Court, that type of stuff trickles down. It trickles down to the states.

It trickles down to other lawmakers. And so simply put, there are people who do not want us to family build and are doing all they can to overcomplicate and complicate what should be a very simple process, people. Robert, are there any laws that are pending or there is circulating in legislation that the LGBT community needs to be concerned about or can feel encouraged about? Well, I think that, again, like Colorado, there are some progressive states that are making things easier for everybody.

The big, and I'm excluding Europe for the moment, but the big push now on the conservative side of the spectrum is personhood law. And personhood law is going to get in the way of everything, including, and I hate to say this, doctor, your practice. It's going to impact every level of fertility from those wanting to create their family to those that are helping parents or prospective parents create their families.

Can you just briefly, for our listeners, just very, very brief explain personhood law? Absolutely. So there is a push that a fetus should have the same rights to life, liberty, and the pursuit of happiness as an adult. And the ASRM has been very, very active at pushing back at those sorts of things, but there are 13 states, I believe at the moment, that have them, including our neighbor to the north, Georgia.

You have to factor that kind of perspective into your treatment plan as a doctor, and certainly in any legal theory that I might have to help folks expand their family. I'm going to let you have the last word. What can you provide optimistically to our community and to what they can look forward to? And is there anything that you want to share that family equality is doing that's going to try to work through these obstacles? What I will say is that there are about 700 pro-LGBTQ plus bills that have been introduced.

So I think that's a good thing. The other thing I think it's good as we're moving into an election year is that we do know that, I believe it's 62 million American voters prioritize LGBTQ plus rights when deciding who to vote for. So I often tell people the American people are on our side.

It's about getting those folks to the polls to vote for pro-LGBTQ plus legislators. So I think that we are positioned to win. We just have to ensure that we stay focused and that we inform people and that we're educating people.

And family equality in our policy work and continuing to work on family creation policy, marriage policies, child welfare. So we can ensure that these kids that are in the foster care system who desperately need families can be adopted by LGBTQ plus people. And then ensuring that folks know how to establish a legal child-parent relationship.

We'll continue to work on that work. Well, we'll end with that and very eloquently. And I think cautiously optimistic in terms of your sharing the wonderful work that family equality is doing.

I can't thank you both enough for taking time to really hopefully empower the LGBT community and encourage all listeners to embrace diversity, equality, and inclusion, and belonging. So I'd like to thank you all for listening. I'm Dr. Mark Trolice.

My guests today were Stacey Stevenson, the CEO of Family Equality, an amazing organization, familyequality.org. Please visit their website to learn more on how you can be a part of this and to contribute. And my dear friend Robert Terenzio, a representative health attorney in Florida who has embraced the LGBT community. He's a national and international expert.

Reach out to both of them if you need resources in terms of working through your family building. Until next time, take care. The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates.

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