Baby on board

Daniellle Macario and Tanya Borsuk with their children, William and Michayla
Daniellle Macario and Tanya Borsuk with their children, William and Michayla. Photo courtesy of RMANJ

LGBTQ family building is on the rise. Are fertility practices ready?

For most of her adult life, Tanya Borsuk knew at least two things to be inalienably true: she was gay, and she wanted to be a parent. The only thing she didn’t yet know was with whom. A classic romantic, she dreamed of finding “the one” and starting a family.

Daniellle Macario and Tanya Borsuk with their children, William and Michayla
Daniellle Macario and Tanya Borsuk with their children, William and Michayla.

And, in April 2006, then 27-year old Tanya found the last piece to her puzzle. Her name was Danielle Macario, and she, like Tanya, was a scientist pursuing her PhD at Rutgers University. Their first meeting at a student event on campus wasn’t exactly full of fireworks for Danielle, who had never been attracted to a woman before, but for Tanya, it was “love at first sight.”

“I got butterflies when I saw her,” Tanya said about Danielle. “I was so nervous.”

After an awkward start, the two became close friends, then a couple, then a married couple, then, in 2016, parents to a twin boy and girl conceived through in vitro fertilization (IVF). Tanya and Danielle sought help from the doctors at Reproductive Medicine Associates of New Jersey (RMANJ) to have a biological child where both women could take part in the pregnancy. They used Tanya’s eggs and donor sperm to create embryos, and decided Danielle would carry the pregnancy. After several attempts, the couple celebrated a successful pregnancy, and nine months and 42 hours in labor later, welcomed twins Michayla and William.

“I finally have life,” Tanya said about the birth of her two children with her life partner. “This is what my life was meant to be.”

That type of family sentiment is no longer rare among couples like Tanya and Danielle.
The desire to build a family is growing in the LGBT community, particularly among millennials, who are planning to grow their families at nearly the same rate as non-LGBT millennials.

According to a survey by the Family Equality Council, a leading LGBT family-building organization, 63 percent of LGBT millennials are considering expanding their families or becoming parents for the first time. What’s more, 48 percent of LGBT millennials are actively planning to grow their families, compared with 55 percent of non-LGBT millennials—a gap that has narrowed significantly compared to older generations.

And the methods of family-building are changing, too. The survey found that a majority of LGBT people planning their families—63 percent—plan to do so through either adoption, foster care, or assisted reproduction services like IVF or intrauterine insemination (IUI). Intercourse, which was the preferred method for family building for existing LGBT families that conceived in the past, now occupies a distant fourth place.

“Expectations around family building in the LGBT community are changing rapidly,” FEC’s CEO the Rev. Stan J. Sloan wrote in the report, “particularly in the wake of the 2015 Obergefell marriage equality ruling that legalized same-sex marriage nationwide.”

With LGBT family building on the rise, and with assisted reproduction being a primary method of conception for this community, the spotlight is being shone on fertility practices and their level of preparedness for a new wave of patients.

Not only do these patients require being seen by experienced, professional doctors who understand their medical, cultural, and emotional needs, but also by a staff and practice that offers sensitive, inclusive, and respectful care where lesbian, gay, trans, and non-binary patients can feel welcomed, supported, understood, and empowered.

Dr. Dan Kaser. at RMANJ
Dr. Dan Kaser. leads RMANJ’s LGBTQ
and donor program

But where does this type of care exist? Check for the ‘Open Door.’

To help LGBT patients navigate the fertility world and find a clinic respectful of their needs, the FEC has created the Open Door program that provides LGBT training to family-building professionals. These including fertility and surrogacy clinics, family law practitioners, pharmacists, pediatricians, social workers, midwives, doulas, and holistic health care providers like acupuncturists and chiropractors.

The training consists of courses like ‘Beyond Diversity: LGBTQ 101,’ ‘Creating an Inclusive Practice,’ ‘Supporting Our Community in the Postpartum Period,’ and ‘Trans Fertility Considerations.’ Health care and wellness providers who complete the training receive the Open Door designation, allowing LGBT people to find an Open Door provider and have faith in the type of care they’re signing up for.

RMANJ, the clinic to which Tanya and Danielle turned to start their family, recently became an Open Door provider, solidifying their longtime mission to help individuals and couples from all walks of life achieve their dreams of family.

“Think of Open Door like The Good Housekeeping Seal of Approval,” said Dr. Dan Kaser, who leads RMANJ’s well-established LGBTQ and donor program. “Any clinic with the designation is deemed a safe space where members of the LGBTQ community can get the professional care they deserve in a welcoming, compassionate environment.”

What kind of insights does the Open Door training give clinics like RMANJ?

In two words: respect and inclusion. In more words? Well, there’s training on pronouns, the importance of not using gendered language, having gender-neutral bathrooms, advice on how to navigate the trickiness of legal name changes and other good practices like having inclusive paperwork, a strong non-discrimination policy and conducting annual inclusivity training with staff.

“Fertility treatment can be challenging for anyone, and our job is to make all our patients feel validated, heard and seen as they embark on one of the most important journeys of their lives,” said Dr. Kaser.

For Tanya and Danielle, who are celebrating their tenth wedding anniversary in September, the journey continues. Raising their children is their life’s work—and they wouldn’t have it any other way.

“I see now how much less fulfilling life would have been without our children,” Danielle says. “I’m so proud to be their mama, and I love our family.”