Inspired by Chloe’s research of embryo development in any early stage, Iris first designed the research question in a more optimistic light to explore how potential parents feel if there were close monitoring and high levels of medical care involved in their parenthood journey. However, after some research, the research question has been modified in a more neutral tone to investigate fertility care barriers faced by the LGBTQ+ community. The earliest stage of family planning does not start in the lab, but the conceptualisation and understanding of ‘family’ and ‘family building’ on an individual level.

Methods

Participants were recruited through convenience sampling. Two researchers, Tsang and He recruited participants between August and September 2022 through Splash and instagram, posting an event page link with a project brief. The event page invited interested participants to submit their email address. Resounding emails were sent to potential participants, containing detailed project information, content form, focus group time and location, information and contact of researchers, and a pre-workshop demographic questionnaire. 6 out of 9 potential participants participated in the focus group.

The interviews focused on the meaning of family and family building. All participants were asked to share what does family and building a family mean to them while creating a textile art piece. The interview guide then allows participants to reflect on different stages of their path to family building and parenthood. Two focus groups were held, audio recorded and lasted between 120 and 180 minutes.

The audio-recorded interviews were transcribed by the interviewer. Themes and subthemes were extracted from the transcript.

Textile art workshop as Practice-led Method

Two out of six participants shared that they do not carry any art or craft activities regularly. All participants shared engaging in the textile art creative activity helps them to talk and articulate thoughts during the focus groups. It allows them to engage with the conversation and the art activity, removes pressure in the focus group, releases anxiety, keeps calm and focused. Participants generally expressed they felt more relaxed and content after the workshop. One participant shared that the art activity is therapeutic and helped him realise and better understand his value on family. Participants were satisfied about their textile art and felt proud of themselves.

‘What does family or family building mean to you?’

The participants reflected on four themes of meaning of family and family building, including 1) creation of a supportive family, 2) passage of family heritage, 3) realisation of family possibilities and 4) contribution in research for future options.

1) Creation of a supportive family

Multiple participants defined their idea of family as ‘expansive’, including an ‘extended’, ‘chosen family’. A queer and a gay participants shared their journey of building a supportive, chosen family when their biological family might not be as understanding due to their identity. They shared the dream to build their own family means providing a safe and caring enviornment to their children with queer awareness, so their children would have have to only seen acceptance in a chosen family. A gay participant shared his upbringing experience in a loving, biological family, but have limited discourse of a loving gay family. Building a family means discovering a ‘blueprint’ or possibility of what a family means to people like himself. One participant shared her lonely childhood as an only child, and her dream to build a family with multiple children. Finally, one participant shared her background of having adopted relatives and growing up in an environment with a multicultural background. She considers family building with both biological and adopted children.

2) Passage of family heritage

Multiple participants considered passing on family legacy, heritage and memory as a key factor of family building. This includes genes, physical and intellectual attributes. A participant also shared her partner has lost multiple family members, therefore passing on the family legacy is significant to them.

3) Realisation family possibilities

As mentioned earlier, a gay participant shared he would like to explore what does a loving family mean to him. He mentioned he is on a journey to knowing more role examples in the gay community and constructing his own family will also allow people like him or his younger self ‘in the future to have something to reference on’. Multiple participants shared that they grew up in a nuclear family narrative, it takes them some years to accept and understand their uniqueness, that the nuclear family narrative does not apply to them, and gradually on the journey of exploring what possibilities of family mean to them.

4) Contribution in research for future options

Both a queer participant and a participant who is in transition shared the unknown of fertility options they and their partner face. They shared contributing in an ART research or advocate process, which can help them have (more) family building options in the future. They mentioned they might be a pioneer or a case study, their experience might lead to new information and ‘be able to open that door for other trans men to be able to have their own biological children.’ They see their participation or contribution as ‘an investment in the future of humanity.’

Personal concern

The two major challenges related to fertility services as an LGBTQ+ person are 1) fertility care environment causing emotional pain, 2) systematic exclusion of LGBTQ+ people.

1. Heteronormativity fertility care environment caused emotional pain

Systematic exclusion of LGBTQ+ people in fertility care and service could be shown systematic inequality of access and limitation in research. Systematic inequality of access includes economical, legal and geo-political access. A participant shares that she and her partner were quoted $10,000 for an introductory of ART on egg freezing (mature oocyte cryopreservation), that access to ART is ‘classised’. Service users will also be affordable for emotional therapies and support as ART treatments and experiences could be very stressful. ART policies are varied in different countries. For example, commercial or paid surrogacy is only legal in America, Ukraine, Colombia, Mexico and Georgia. Commercial surrogacy arrangements are illegal in the UK. On top of gender and, sexual orientation identities, it is worth noting that other attributes of identity intersectional could also be further affect one’s access to ART treatment, including ethicity and socioeconomic status. Therefore, inaccessibility to affordable ART services restricts family-building options of LGBTQ+ people.

On the other hand, participants shared the lack of reference and data in ART treatment that cater to their specific needs. Although LGBTQ+ people experience higher infertility rate than cis couples, research on LGBTQ+ and infertility is significantly fewer. This indicates a significant research gap, and the LGBTQ+ population is marginalised and undervalued in this research field. Participants also expressed a distrust in professional fertility medical staff as they were treated with lack of knowledge or awareness in LGBTQ+ fertility care. For example, black mothers might need specific material care, and people in transition might require specific support in their journey of identity and fertility transition. The limited research in ART for LGBTQ+ people leads to a knowledge gap in specific information, an underdeveloped medical and community framework, and a service gap in medial, emotional and social support for the LGBTQ+ populations.

This study also discussed personal concerns of family building and parenthood in a post-pandemic time for individuals under 30s; challenges faced by LGBTQ+ people in fertility services, including heteronormativity terminology, facilities and infrastructures; as well as systematic exclusion in terms of access inequality and lack of research.