Many people who have trouble conceiving a baby have a story they can tell through numbers. For Dahlia Riback, it was: Six years, 10 rounds of intrauterine insemination, three rounds of in vitro fertilization (IVF) with her own eggs, one round of IVF using a donor egg, and finally, nine months later, one newborn with two doting mothers.
But the numbers don't tell the whole story — they leave huge, emotional gaps. Riback emphasized fertility challenges can elicit complex emotions in everyone, regardless of sexual orientation or gender identity. Isolation, mourning, hopelessness, and resentment are all so common. But as an active member of Toronto's queer community and a prior facilitator of LGBTQ infertility support groups, however, she knows there are additional stressors for sexual and gender minorities.
"For (queer people) who are having to go outside their bodies for something in order to conceive this child, it's no longer an intimate act, it's no longer personal, you're bringing someone into the fold, whether it's anonymous or not, and it can be really emotional," Riback, based in Toronto, told HuffPost Canada.
WATCH: How assisted reproduction can help LGBTQ people conceive. Story continues below.
There are many reasons that LGBTQ individuals end up in a fertility clinic; only some are related to medical infertility. Those who don't have access to sperm may choose to do intrauterine insemination (IUI) at a clinic, for example, if they prefer the medical setting to a home-based method, or would like any medical services or tests.
Trans men looking toward gender-affirming medical procedures might go to a clinic to preserve their fertility by freezing their eggs. Some cis gay men may choose surrogacy, and would require a clinic for IVF procedures.
"I started the process like all queer people do who want to conceive a child — none of us walk into a clinic because we need to, none of us walk in thinking we have fertility issues," Riback said.
"We're going there because we need some assistance. I just walked into the clinic with my little vial of sperm, just thinking, 'OK! I just need someone to put this inside, and I'm good to go.' And that experience is entirely invisible."
Fertility clinics are geared toward heterosexual couples
When these individuals and families enter a clinic, they "are entering a system set up to serve heterosexual, cisgender couples dealing with infertility," writes Rachel Epstein, along-time LGBTQ+ parenting activist, researcher and educator. "And there is often a fuzzy line in our own treatment between 'fertility' and 'infertility.'"
When medical professionals aren't culturally informed, these nuances can be overlooked. For a community that already experiences invisibilization and ignorance, experiencing that in spaces designed for support at such a vulnerable time can feel doubly discriminatory.
Samantha and Lisa Palmer, from Calgary, describe their four-year fertility experience as incredibly trying on both their relationships and finances.
"I found that the medical professionals weren't necessarily well-equipped or well-versed in dealing with same-sex couples ... and we found a lot of the professionals insensitive," Samantha told HuffPost Canada.
She described heteronormative paperwork, references to an assumed husband, and "one time, probably, I don't know, near our eighth or ninth [IUI], the doctor looked at us, and said, 'If it doesn't work for her, then you can probably try.'"
The choice of which partner will try to conceive is incredibly personal and deliberate, and some don't even see it as a choice. For the Palmers to hear this question asked in a flippant way with no authentic follow-up "was really kind of gutting to our family," Samantha said.
WATCH: How to support someone experiencing infertility. Story continues below.
Culturally competent clinics do exist. Eileen McMahon is a Nurse Practitioner at Mount Sinai Fertility in Toronto, where she says they prioritize inclusion, and train all staff in diversity and equity. The clinic works hard to appreciate the needs of its gender-diverse patients in these settings, McMahon said, from trying to use correct pronouns and names, to providing separate change spaces or waiting areas for those who feel uncomfortable in a gown.
"We certainly don't feel like we get everything right, and we are always learning," she told HuffPost Canada.
It's not an easy journey
Fertility specialist Dr. Marjorie Dixon founded Anova Fertility and Reproductive Health to welcome people from all backgrounds, identities, and orientations, wherever they are along their journey of creating a family. The clinic provides culturally-competent procedures, such as reciprocal IVF (where one partner provides the egg and the other carries the pregnancy) for same-sex female couples, or fertility preservation(such as egg freezing) for trans individuals.
"The fact that you're consulting medical professionals, and you're in the vulnerable position of needing them to grow your family, is unnerving and disarming," Dixon told HuffPost Canada.
"Whether you're a single woman, or a single dad, or a gay, lesbian, or trans person — it doesn't matter. The medicalization of your family's growth is disarming, and needs to be supported and acknowledged."
Riback is extra sensitive to this need for support, and wants people in the queer community to feel safe talking about it.
"You see us all walking around on the street with our babies and our things, and it's all, you know, it looks really great, and it is really great — and there are so many wonderful parts about it. But it's a really, really hard journey. And it's OK to say that, and to need support."
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