Open the episode block below to read a transcript of the show.

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

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

My first is Stacy Stevenson. Stacy's resume is very impressive. She is the CEO of Family Equality, which made her the first black chief executive officer.
That was back in 2021. She is a trailblazing leader. In the fall of 2022, Stacy was selected as one of Out Magazine's Out 100 list, a compilation of the year's most impactful and influential LGBTQ+ people.

Prior to joining Family Equality, Stacy worked in the corporate sector, where she held senior roles in defense technology and finance industries. She decided to use her business acumen, experience, and passion for the LGBT community to join Family Equality. I am absolutely delighted to welcome Stacy to the podcast.

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

Absolutely.

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

Robert has been 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 whom he has guided through my experience with him, with our patients, and 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. I'm honored to appear and thank you for the invitation. It's my pleasure.

It's my pleasure. Let me first ask Stacy. 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 legal, social, and economic challenges to building our families. I believe that there is a thought process out there that says because we can marry, 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+ 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 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 are many challenges. And I'd say it's like, in a nutshell, it's just not equal; 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, 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, the non-carrying, non-biological parent is getting excluded. Stacy 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 non-carrying, non-biological moms 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 remove them from their birth certificates, excising them from their right to be a parent to their child.

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

Well, they are and they aren't. We find that in 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 Stacy mentioned schools earlier. There could be nothing worse than having your children in school, and the school person saying, I'm sorry, but we don't recognize your authority over this child.

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

Yeah. We've talked about personal patients who have reciprocal egg sharing with a lesbian couple that you had recommended that they would need to adopt to ensure that they are legal parents 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 who 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, that the birth certificate is not enough, essentially.

And just a real-life example, you've all heard about the mother in Oklahoma who 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 nonbirth mother did not understand was 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, and 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, Stacy, 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 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, and 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 a 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 almost 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 Stacy, 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 Perel Dweck's book, Growth Mindset. That's what we need to be having when we're dealing with this.

Yeah, we do.

Stacy, 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 the Dobbs decision, when Roe was overturned, I hear 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 how 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. 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.

Robert, are there any laws that are pending or that are circulating 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 briefly 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 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 what can they 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 legislators. So, I think we are positioned to win. We just have to ensure that we stay focused, inform people, and educate them.

And Family Equality in our policy work and continuing to work on family creation policy, marriage policies, and child welfare. So, we can ensure that these kids who are in the foster care system and desperately need families can be adopted by LGBTQ 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 the time to really hopefully empower the LGBT community and encourage all listeners to embrace diversity, equality, inclusion, and belonging. So I'd like to thank you all for listening. I'm Dr. Mark Trolice.

My guests today were Stacy Stevenson, the CEO of Family Equality, an amazing organization, familyequality.org. Please visit their website to learn more about how you can 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 episodes are provided as a source of general information and are not a substitute for consultation with a physician.