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IV - Addressing the Needs of Diverse Populations

Published online by Cambridge University Press:  24 November 2022

Sharon N. Covington
Shady Grove Fertility, Rockville, MD
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Publisher: Cambridge University Press
Print publication year: 2022

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Zegers-Hochschild, F, Adamson, GD, Dyer, S, et al. The international glossary on infertility and fertility care. Fertil Steril 2017;108(3):393406.CrossRefGoogle ScholarPubMed
Mehta, A, Nangia, AK, Dupree, JM, Smith, JF. Limitations and barriers in access to care for male factor infertility. Fertil Steril 2016;105(5):11281137.Google Scholar
Agarwal, A, Mulgund, A, Hamada, A, Chyatte, MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015;13(1):19.Google Scholar
Inhorn, MC, Wentzell, EA. Embodying emergent masculinities: men engaging with reproductive and sexual health technologies in the Middle East and Mexico. Am Ethnol 2011;38(4):801815.Google Scholar
Dolan, A, Lomas, T, Ghobara, T, Hartshorne, G.It’s like taking a bit of masculinity away from you’: towards a theoretical understanding of men’s experiences of infertility. Sociol Health Illness 2017;39(6):878892.Google Scholar
Wischmann, T, Thorn, P. (Male) infertility: what does it mean to men? New evidence from quantitative and qualitative studies. Reprod BioMed Online 2013;27(3):236243.Google Scholar
Naab, F, Kwashie, AA. ‘I don’t experience any insults, but my wife does’: the concerns of men with infertility in Ghana. S Afr J Obstet Gynaecol 2018;24(2):4548.Google Scholar
Petok, WD. Infertility counseling (or the lack thereof) of the forgotten male partner. Fertil Steril 2015;104(2):260266.CrossRefGoogle ScholarPubMed
Babore, A, Stuppia, L, Trumello, C, Candelori, C, Antonucci, I. Male factor infertility and lack of openness about infertility as risk factors for depressive symptoms in males undergoing assisted reproductive technology treatment in Italy. Fertil Steril 2017;107(4):10411047.CrossRefGoogle ScholarPubMed
Culley, L, Hudson, N, Lohan, M. Where are all the men? The marginalization of men in social scientific research on infertility. Reprod BioMed Online 2013;27(3):225235.CrossRefGoogle ScholarPubMed
Martins, MV, Basto-Pereira, M, Pedro, J, et al. Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review. Hum Reprod Update 2016;22(4):466478.Google Scholar
Greil, AL, Slauson-Blevins, K, McQuillan, J, Lowry, MH, Burch, AR, Shreffler, KM. Relationship satisfaction among infertile couples: implications of gender and self-identification. J Family Issues 2018;39(5):13041325.Google Scholar
Wischmann, T.Your count is zero’ – Counselling the infertile man. Hum Fertil 2013;16(1):3539.Google Scholar
Hanna, E, Gough, B. Experiencing male infertility: a review of the qualitative research literature. SAGE Open 2015;5(4):19.Google Scholar
Hanna, E, Gough, B. The impact of infertility on men’s work and finances: findings from a qualitative questionnaire study. Gender Work Organization 2020;27(4):581591.Google Scholar
Arya, ST, Dibb, B. The experience of infertility treatment: the male perspective. Hum Fertil 2016;19(4):242248.Google Scholar
Hanna, E, Gough, B. Emoting infertility online: a qualitative analysis of men’s forum posts. Health (London) 2016;20(4):363382.Google Scholar
Richard, J, Badillo-Amberg, I, Zelkowitz, P. “So much of this story could be me”: men’s use of support in online infertility discussion boards. Am J Mens Health 2017;11(3):663673.Google Scholar
Hanna, E, Gough, B. The social construction of male infertility: a qualitative questionnaire study of men with a male factor infertility diagnosis. Sociol Health Illness 2020;42(3):465480.CrossRefGoogle ScholarPubMed
Hammarberg, K, Collins, V, Holden, C, Young, K, McLachlan, R. Men’s knowledge, attitudes and behaviours relating to fertility. Hum Reprod Update 2017;23(4):458480.Google Scholar
Daumler, D, Chan, P, Lo, KC, Takefman, J, Zelkowitz, P. Men’s knowledge of their own fertility: a population-based survey examining the awareness of factors that are associated with male infertility. Hum Reprod 2016;31(12):27812790.Google Scholar
Grace, B, Shawe, J, Johnson, S, Stephenson, J. You did not turn up … I did not realise I was invited … : understanding male attitudes towards engagement in fertility and reproductive health discussions. Hum Reprod Open 2019;2019(3):17.Google Scholar
Fisher, J, Hammarberg, K. Psychological aspects of infertility among men. In: Simoni, M, Huhtaniemi, I, Eds. Endocrinology of the Testis and Male Reproduction. Switzerland: Springer, 2017, 131.Google Scholar
European Society of Human Reproduction and Embryology. Routine Psychosocial Care in Infertility and Medically Assisted Reproduction – A Guide for Fertility Staff [Internet]. 2015 [cited June 26, 2021]. Available from: [last accessed June 16, 2022].Google Scholar
Ockhuijsen, HDL, van Smeden, M, van den Hoogen, A, Boivin, J. Validation study of the SCREENIVF: an instrument to screen women or men on risk for emotional maladjustment before the start of a fertility treatment. Fertil Steril 2017;107(6):1370–1379.e5.Google Scholar
Boivin, J, Takefman, J, Braverman, A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Hum Reprod 2011;26(8):20842091.Google Scholar
Pattyn, E, Verhaeghe, M, Bracke, P. The gender gap in mental health service use. Social Psychiatry Psychiatr Epidemiol 2015;50(7):10891095.Google Scholar
Taubman-Ben-Ari, O, Skvirsky, V, Bar Shua, E, Horowitz, E. Satisfaction in life among fathers following fertility treatment. J Reprod Infant Psychol 2017;35(4):334341.Google Scholar
Schanz, S, Häfner, HM, Ulmer, A, Fierlbeck, G. Quality of life in men with involuntary childlessness: long-term follow-up. Andrologia 2014;46(7):731737.Google Scholar


Mamo, L. Queering Reproduction. Durham, NC: Duke University Press, 2007.Google Scholar
Wykes, KA. Fertility services for same-sex couples: policy and practice. Br J Nurs 2012;21(14):871875.Google Scholar
Child Welfare Information Gateway. Frequently asked questions from LGBTQ+ prospective foster and adoptive parents. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau, 2021.Google Scholar
Goldberg, AE. Lesbian and gay parents and their children: research on the family life cycle. Washington, D.C.: American Psychological Association, 2010.Google Scholar
Kinkler, LA, Goldberg, AE. Working with what we’ve got: perceptions of barriers and supports among small-metropolitan same-sex adopting couples. Fam Relat 2011;60(4):387403.CrossRefGoogle ScholarPubMed
Patterson, CJ. Children of lesbian and gay parents: psychology, law, and policy. Am Psychol 2009;64(8):727736.Google Scholar
Amato, PR, Jacob, MC. Providing fertility services to lesbian couples: the lesbian baby boom. Sex Reprod Menopause 2004;2(2):8388.Google Scholar
Ethics Committee of the American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons. Fertil Steril 2006;86(5):13331335.CrossRefGoogle Scholar
De Wert, G, Dondorp, W, Shenfield, F, et al. ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people. Hum Reprod 2014;29(9):18591865.Google Scholar
Calhaz-Jorge, C, De Geyter, CH, Kupka, MS, et al. Survey on ART and IUI: legislation, regulation, funding and registries in European countries: the European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod Open 2020;2020(1):hoz044.CrossRefGoogle ScholarPubMed
Corbett, SL, Frecker, HM, Shapiro, HM, Yudin, MH. Access to fertility services for lesbian women in Canada. Fertil Steril 2013;100(4):10771080.Google Scholar
Meyer, IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003;129(5):674697.Google Scholar
Gurmankin, AD, Caplan, AL, Braverman, AM. Screening practices and beliefs of assisted reproductive technology programs. Fertil Steril 2005;83(1):6167.Google Scholar
Lawrence, RE, Rasinski, KA, Yoon, JD, Curlin, FA. Obstetrician-gynecologists’ beliefs about assisted reproductive technologies. Obstet Gynecol 2010;116(1):127135.Google Scholar
Carpinello, OJ, Jacob, MC, Nulsen, J, Benadiva, C. Utilization of fertility treatment and reproductive choices by lesbian couples. Fertil Steril 2016;106(7):17091713 e4.Google Scholar
Wu, HY, Yin, O, Monseur, B, et al. Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites. Fertil Steril 2017;108(1):183191.Google Scholar
Gregg, I. The health care experiences of lesbian women becoming mothers. Nurs Womens Health 2018;22(1):4050.CrossRefGoogle ScholarPubMed
Kirubarajan, A, Patel, P, Leung, S, Park, B, Sierra, S. Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives. Fertil Steril 2021;115(5):12941301.Google Scholar
Chabot, JM, Ames, BD. “It wasn’t ‘Let’s get pregnant and go do it’”: decision making in lesbian couples planning motherhood via donor insemination. Fam Relat 2004;53(4):348356.Google Scholar
Yager, C, Brennan, D, Steele, LS, Epstein, R, Ross, LE. Challenges and mental health experiences of lesbian and bisexual women who are trying to conceive. Health Soc Work 2010;35(3):191200.Google Scholar
Goldberg, AE. Gay Dads: Transitions to Adoptive Fatherhood. New York, NY: New York University Press, 2012.Google Scholar
Kawwass, JF, Penzias, AS, Adashi, EY. Fertility – a human right worthy of mandated insurance coverage: the evolution, limitations, and future of access to care. Fertil Steril 2021;115(1):2942.Google Scholar
Englert, Y. Artificial insemination of single women and lesbian women with donor semen. Artificial insemination with donor semen: particular requests. Hum Reprod 1994;9(11):19691971.Google Scholar


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association, 2013.CrossRefGoogle Scholar
Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823. Obstet Gynecol 2021;137(3):e75e88.Google Scholar
Chang, SC, Singh, AA, Dickey, LM. A Clinician’s Guide to Gender-affirming Care: Working with Transgender and Gender Nonconforming Clients. Oakland, CA: New Harbinger Publications Inc., 2018.Google Scholar
Dickey, LM, Ducheny, KM, Ehrbar, RD. Family creation options for transgender and gender nonconforming people. Psychol Sex Orientat Gend Divers 2016;3(2):173179.Google Scholar
Ethics Committee of the American Society of Reproductive Medicine. Access to fertility services by transgender and nonbinary persons: an Ethics Committee Opinion. Fertil Steril 2021;115(4):874878.Google Scholar
American Psychological Association. Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. Am Psychologist 2015;70(9):832864.Google Scholar
American Academy of Child and Adolescent Psychiatry. Gay, lesbian, bisexual or transgender parents. Published 2013. Available from: [last accessed June 16, 2022].Google Scholar
De Sutter, P, Verschoor, A, Hotimsky, A, Kira, K. The desire to have children and the preservation of fertility in transsexual women: a survey. Int J Transgend 2002;6(3).Google Scholar
Wierckx, K, Van Caenegem, E, Pennings, G, et al. Reproductive wish in transsexual men. Hum Reprod 2012;27(2):483487.Google Scholar
Besse, M, Lampe, NM, Mann, ES. Experiences with achieving pregnancy and giving birth among transgender men: a narrative literature review. Yale J Biol Med 2020;93:517528.Google Scholar
MacDonald, TK, Walks, M, Biender, M, Kibbe, A. Disrupting the norms: reproduction, gender identity, gender dysphoria, and intersectionality. Int J Transgend 2021 ;22(12):1829.Google Scholar
Green, R, Money, J. Transsexualism and Sex Reassignment. Baltimore, MA: John Hopkins Press, 1969.Google Scholar
Transgender Europe – Trans Rights Europe Index, 2018. Produced by: The International Lesbian, Gay, Bisexual, Trans & Intersex Association (ILGA) Europe. Brussels, Belgium.Google Scholar
World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender and gender variant people. Version 7. Available from: Published 2012.Google Scholar
Hembree, WC, Cohen-Kettenis, P, Gooren, IJ, et al. Endocrine treatment of gender-dysphoric/gender incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocr Metab 2017;102:38693903.Google Scholar
Moravek, MB. Gender-affirming hormone therapy for transgender men. Clin Obstet Gynecol 2018;61(4):687704.Google Scholar
Defreyne, J, Vanwonterghem, Y, Collet, S, et al. Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: a prospective cohort study (ENIGI). Int J Transgend Health 2020;21(2):163175.Google Scholar
Taub, RL, Ellis, SA, Neal-Perry, G, Magaret, AS, Prager, SW, Micks, EA. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol 2020;223(2):229.e1–229.e8.Google Scholar
Randolph, JF Jr. Gender-affirming hormone therapy for transgender females. Clin Obstet Gynecol 2018;61(4):705721.CrossRefGoogle ScholarPubMed
Adeleye, AJ, Reid, G, Kao, CN, Mok-Lin, E, Smith, JF. Semen parameters among transgender women with a history of hormonal treatment. Urology 2019;124:136141.Google Scholar
Kent, MA, Winoker, JS, Grotas, AB. Effects of feminizing hormones on sperm production and malignant changes: microscopic examination of post orchiectomy specimens in transwomen. Urology 2018;121:9396.CrossRefGoogle ScholarPubMed
Matoso, A, Khandakar, B, Yuan, S, et al. Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery. Hum Pathol 2018;76:9199.Google Scholar
Li, K, Rodriguez, D, Gabrielsen, JS, Centola, GM, Tanrikut, C. Sperm cryopreservation of transgender individuals: trends and findings in the past decade. Andrology 2018;6(6):860864.Google Scholar
Marsh, C, McCracken, M, Gray, M, Nangia, A, Gay, J, Roby, KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet 2019;36(8):16391648.Google Scholar
Light, AD, Obedin-Maliver, J, Sevelius, JM, Kerns, JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol 2014;124(6):11201127.Google Scholar
Moravek, MB, Kinnear, HM, George, J, et al. Impact of exogenous testosterone on reproduction in transgender men. Endocrinology 2020;161(3):bqaa014. Scholar
Grimstad, FW, Fowler, KG, New, EP, et al. Ovarian histopathology in transmasculine persons on testosterone: a multicenter case series. J Sex Med 2020;17(9):18071818.Google Scholar
De Roo, C, Lierman, S, Tilleman, K, et al. Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod Biomed Online 2017;34(6):557566.Google Scholar
Leung, A, Sakkas, D, Pang, S, Thornton, K, Resetkova, N. Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Fertil Steril 2019;112(5):858865.Google Scholar
Adeleye, AJ, Cedars, MI, Smith, J, Mok-Lin, E. Ovarian stimulation for fertility preservation or family building in a cohort of transgender men. J Assist Reprod Genet 2019;36(10):21552161.Google Scholar
Rothenberg, SS, Witchel, SF, Menke, MN. Oocyte cryopreservation in a transgender male adolescent. N Engl J Med 2019;380(9):886887.Google Scholar
Martin, CE, Lewis, C, Omurtag, K. Successful oocyte cryopreservation using letrozole as an adjunct to stimulation in a transgender adolescent after GnRH agonist suppression. Fertil Steril 2021 (online). Scholar
“USTS Reports – 2015 U.S. Trans Survey.” Available from: [last accessed 16 June, 2022].Google Scholar
Mendoza, NS, Moreno, FA, Hishaw, GA, et al. Affirmative care across cultures: broadening application. Focus 2020;18:3139.Google Scholar
Gates, TG, Brian, K. Affirming Strengths-Based Models of Practice. Social Work Practice with the LBGTQ Community, 2017, pp. 235248. Retrieved from Loyola eCommons, Social Work: School of Social Work Faculty Publications and Other Works.Google Scholar
Hidalgo, M, Ehrensaft, D, Tishelman, A, et al. The gender affirmative model: what we know and what we aim to learn. Hum Develop 2013;56:285290.CrossRefGoogle Scholar
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.Google Scholar


Culley, L, Hudson, N, Rooij, F van, Eds. Marginalized Reproduction: Ethnicity, Infertility, and Reproductive Technologies. London: Earthscan, 2009.Google Scholar
Lo, MCM, Stacey, CL. Beyond cultural competency: Bourdieu, patients and clinical encounters. Sociology Health Illness 2008;30(5):741755.Google Scholar
Bradby, H, Nazroo, J. Health, ethnicity and race. In: Cockerham, WC, Ed. The New Companion to Medical Sociology. Malden MA: Blackwell, 2010, 113129.Google Scholar
Hampshire, K, Simpson, B, Eds. Assisted Reproductive Technologies in the Third Phase: Global Encounters and Emerging Moral Worlds, Vol. 31. New York and Oxford: Berghahn Books, 2015.Google Scholar
Funk, M, Varghese, R, Zuniga, X. Racism. In Adams, M, Blumenfeld, WJ, Catalano, C, et al., Eds. Readings for Diversity and Social Justice, 4th ed. New York, NY: Taylor & Francis, 2018.Google Scholar
Suyemoto, KL, Curley, M, Mukkamala, S. What do we mean by “Ethnicity” and “Race”? A consensual qualitative research investigation of colloquial understandings. Genealogy 2020;4(81):124.Google Scholar
Zanting, A, Meershoek, A, Frambach, JM, Krumeich, A. The “exotic other” in medical curricula: rethinking cultural diversity in course manuals. Medical Teacher 2020;42(7):791798.Google Scholar
Phillips, A. What’s wrong with essentialism? Distinktion 2010;11(1):4760.CrossRefGoogle Scholar
Inhorn, M, Van Balen, F, Eds. Infertility around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies. Los Angeles, CA: University of California Press, 2002.Google Scholar
Van Balen, F, Bos, HM. The social and cultural consequences of being childless in poor-resource areas. Facts, Views Vision ObGyn 2009;1(2):106.Google Scholar
Inhorn, MC. America’s Arab Refugees. Vulnerability and Health on the Margins. Stanford: Stanford University Press, 2018.Google Scholar
Hörbst, V. Male perspectives on infertility and assisted reproductive technologies (ART) in sub-Saharan contexts. Facts, Views Vision ObGyn 2010;8:2227.Google Scholar
Gerrits, T. Infertility and matrilineality. The exceptional case of the Macua. In: Inhorn, MC, Van Balen, F, Eds. Infertility around the Globe: New Thinking on Childlessness, Gender and Reproductive Technology. Los Angeles, CA: University of California Press, 2002.Google Scholar
Inhorn, MC, Patrizio, P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015:21(4):411426.Google Scholar
Donkor, ES, Sandall, J. The impact of perceived stigma and mediating social factors on infertility-related stress among women seeking infertility treatment in Southern Ghana. Soc Sci Med 2007;65(8):16831694.Google Scholar
Gerrits, T. Reproductive travel to Ghana: testimonies, transnational relationships, and stratified reproduction. Med Anthropol 2018;37(2):131144.Google Scholar
Kirubarajan, A, Patel, P, Leung, S, Prethipan, T, Sierra, S. Barriers to fertility care for racial/ethnic minority groups: a qualitative systematic review. Fertil Steril Rev 2021;2(2):150159.Google Scholar
Jackson-Bey, T, Morris, J, Jasper, E, et al. Systemic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today. Fertil Steril 2021;116(1):169188.Google Scholar
Inhorn, MC, Fakih, MH. Arab Americans, African Americans, and infertility: barriers to reproduction and medical care. Fertil Steril 2006;85(4):844852.Google Scholar
Gerrits, T. Introduction. ARTs in resource-poor areas: practices, experiences, challenges and theoretical debates. In: Hampshire, K, Simpson, B, Eds. Assisted Reproductive Technologies in the Third Phase: Global Encounters and Emerging Moral Worlds. Oxford: Berghahn Books, 2015, 94104.Google Scholar
Finn, JL. Just Practice: A Social Justice Approach to Social Work, 3rd ed. New York, NY: Oxford University Press.Google Scholar
Morgaine, K, Capous-Desyllas, M. Anti-Oppressive Social Work Practice: Putting Theory into Practice. California, CA: Sage Publications.Google Scholar
Comas-Diaz, L, Jacobsen, FM. Ethnocultural transference and countertransference in the therapeutic dyad. Am J Orthopsychiatry 1991;61(3):392402.Google Scholar

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