目的:与具有不同性伴侣或异性恋身份的同龄人相比,具有同性伴侣或女同性恋/双性恋身份的女性使用医学辅助生殖(MAR)是否存在差异?
结论:具有同性伴侣或女同性恋/双性恋身份的女性更有可能使用任何MAR,但不更有可能使用ART(即IVF,互惠试管婴儿,胚胎移植,未指定的艺术,ICSI,和配子或受精卵输卵管内移植)与非ARTMAR(即IUI,诱导排卵,和阴道内或宫颈内授精)比他们的不同性别伴侣和完全异性恋的同伴。
背景:性少数群体妇女(SMW)以多种方式组成家庭,包括通过培养,收养,遗传,和/或生物路线。新出现的证据表明,这些人口越来越希望形成遗传和/或生物家族,然而,对他们的家庭形成过程和受孕需求知之甚少。
方法:今日成长研究是一个基于美国的前瞻性队列(n=27.805)。参与者的年龄为9-17岁(1996年和2004年)。两年一次的后续行动正在进行中,收集到2021年的数据。
方法:符合以下标准的Cisgender女性被纳入该样本:认可曾经怀孕;在2019年或2021年尝试怀孕;并认可男性或女性性伴侣或在受孕窗口中回答有关其性别认同的问题。主要结果是任何MAR使用,包括ART(即涉及配子微操作的程序)和非ARTMAR(即配子非操作)。次要结果包括特定的MAR程序,受孕的时间,和时间上的趋势。我们使用加权修正的泊松广义估计方程评估了任何MAR使用的差异。
结果:在3519名参与者中,有6935例怀孕/怀孕尝试,19.4%涉及MAR。共有47例怀孕或尝试怀孕的人是同性伴侣参与者,双性恋参与者中有91人,女同性恋参与者中有37人。同性参与者,与不同性伴侣相比,使用MAR的可能性几乎是后者的5倍(风险比[95%CI]:4.78[4.06,5.61]).与完全异性恋的参与者相比,与没有使用MAR相比,女同性恋(4.00[3.10,5.16])和双性恋(2.22[1.60,3.07])参与者使用MAR的可能性更大;与非ARTMAR相比,大多数异性恋参与者也更有可能使用ART(1.42[1.11,1.82])。在使用MAR怀孕的第一次怀孕中,受孕途径因伙伴关系和性认同群体而异;IUI的差异最大,阴道内授精,定时性交和诱导排卵。从2002年到2021年,MAR的使用与总怀孕/怀孕尝试成比例增加;在以后的几年中,同性伴侣和女同性恋参与者使用ART越来越普遍。
结论:我们的结果受到SMW数量少的限制,大部分是白色的均匀样本,受过教育的参与者,在创建SMW特有的概念途径时,MAR使用的潜在错误分类,和问卷的跳过逻辑,将某些参与者排除在接收MAR问题之外。
结论:先前关于SMW家族形成的研究主要集中在ART程序的临床结局和受孕方法的围产期结局,几乎完全局限于欧洲,仅依赖合作伙伴数据的临床样本。尽管在一项不具代表性的研究中SMW的样本很小,这是我们所知的第一项研究,使用来自美国各地的顺性别女性的非临床样本来阐明通过伙伴关系和性别认同形成家庭的途径,包括SMW特有的途径。这是由于我们在一个大的,收集详细性取向数据的前瞻性数据集。具体来说,拉拉,双性恋,与异性恋和不同性别伴侣参与者相比,同性伴侣参与者以相似的频率使用ART和非ARTMAR。这可能表明由于结构性障碍,对受孕途径的获取存在差异,随着SMW中家庭形成的增加,新兴的概念趋势,以及需要专业提供者和生育诊所以外的受孕支持。
背景:本出版物中报道的研究得到了美国国立卫生研究院(NIH)国家少数民族健康与健康差异研究所的支持,在裁决号R01MD015256下。此外,KRSS由NCI资助T32CA009001,AKH由NCI资助T32CA057711,PC由NHLBIT32HL098048,BM由斯坦福妇幼健康研究所临床培训生支持资助和美国生殖医学研究所的多样性奖学金,BGE由NICHDR01HD091405和SM由ThomasO.Pyle奖学金通过哈佛朝圣者医疗保健基金会和哈佛大学,NHLBIT32HL098048、NIMHR01MH112384和威廉·T·格兰特基金会赠款编号187958。内容完全是作者的责任,不一定代表美国国立卫生研究院的官方观点。第一作者最近在非营利计划中发挥了领导作用,女同性恋健康基金,一个研究基金专注于改善LGBTQ+妇女和女孩的健康和福祉。该基金在这项研究中没有任何作用,作者与基金的关系也没有偏见这份手稿的发现。
背景:不适用。
OBJECTIVE: Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities?
CONCLUSIONS: Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers.
BACKGROUND: Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs.
METHODS: The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021.
METHODS: Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations.
RESULTS: Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants.
CONCLUSIONS: Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire\'s skip logic, which excluded certain participants from receiving MAR questions.
CONCLUSIONS: Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics.
BACKGROUND: The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author\'s relationship with the fund did not bias the findings of this manuscript.
BACKGROUND: N/A.