The Agenda with Steve Paikin (Audio) - Family Planning For Queer & Trans Parents

Episode Date: January 17, 2025

What options are available to people who need fertility assistance in Ontario? And what barriers do queer and trans people face in their journeys to parenthood? Laine Halpern Zisman explains more in her new book "Conceivable: A Guide to Making 2SLGBTQ+ Family."See omnystudio.com/listener for privacy information.

I'm Matt Nethersole. And I'm Tiff Lam. From TVO Podcasts, this is Queries. This season, we're asking, when it comes to defending your beliefs, how far is too far? We follow one story from the boardroom to the courtroom. And seek to understand what happens when beliefs collide. Where does freedom of religion end and freedom from discrimination begin? That's this season on Queries in Good Faith,

a TVO original podcast. Follow and listen wherever you get your podcasts. Having a child is complicated and for the queer and trans community, fertility, conception, and family building present different kinds of challenges. Lane Halpern-Zisman offers guidance for hopeful parents in her new book, it's called Conceivable, a guide to making 2S LGBTQ plus family.

She is also an adjunct assistant professor at the University of Victoria in the School of Public Health and Social Policy and a certified fertility support practitioner at Birthmark. Oh, my God, what a title. We have no time for the interview. Your title went on forever there. Lane, it's great to meet you. Nice to have you here.

Thank you for having me. For people who cannot get pregnant on their own or who are having difficulty, what options are available here? That is a great question. There's a lot of options, and I think sometimes people imagine that there is only one way forward,

that there's a clear A to B, how to make a baby. And there is not. that there's a clear A to B how to make a baby. And there is not. There is not a clear A to B. There are a lot of different methods we can try, a lot of different protocols, and there's a lot of different steps that people can take. So for two SLGBTQ people, much of the time, they don't know where to start,

and that really is where the book comes in, to try to give people that little push of of here are some questions that you might ask, here are some different strategies you might try, and here are some questions you might ask yourself as well. If you're queer or trans, and again, a lot of my questions today are going to seem hopelessly naive and ignorant, but we're all going to learn together through here. Is there a particular process you have to go through? Yeah. So every family is different.

There's no one way to make a family, and there's no right way to make a family. So different families have different configurations. Some of them, we know one thing for sure. To make a human, we need eggs, we need sperm, and we need a uterus. So depending on what combination of those things you have available will determine the steps that you might want to take. So for some families they might have all three of those things readily available and they couldn't try at home. For other people they might need to find a donor or a surrogate and people might do that at home as well. Or they might seek the help of a doctor and fertility clinic. need to find a donor or a surrogate. And people might do that at home as well.

Or they might seek the help of a doctor and fertility clinic. There's a lot of people on a team. So you need a doctor. You should probably consult a lawyer. And it needs some mental health support, too, to help you navigate this journey. This sounds complicated. Is it?

For most people, it is. Yeah. I think that we need a lot of support and we need a team. The process is made a lot easier by having those things available, by having people you can talk to, by having community, by having doctors you can ask questions to. That definitely makes it a little bit less complicated. The doctors that you will want to talk to, I presume if some of them are of a certain age, they will not necessarily have received a lot of training at med school in all of this. Is that a problem?

Yeah, I think probably one of the biggest challenges is that we don't have a core curriculum on supporting to us LGBTQ people in their family building journeys or in their medical journeys. There's been research to show that doctors don't have as much comfort providing care to transgender patients because they don't have that education. And I'll say from my own work, speaking with doctors and speaking with staff, their intentions are so good. There is such a desire to learn,

but they don't necessarily have that education. So I think we really do need to focus on having that core curriculum for health care providers and support staff to support to us LGBTQ people in their fertility and family building. Gotcha. Let's do an excerpt from the book here. Sheldon, bring this up if you would, and I will read along for those listening on podcast.

While access to equitable health care is a fundamental right that should be extended to all people in this country, implicit and explicit discrimination against 2S LGBTQ plus communities, both individually and systemically, often impacts the services and support they receive in Canada. The language used by staff and doctors, limitations of electronic medical records, and a lack of 2S LGBTQ plus training can all impact access to quality healthcare. Okay, let's talk about that. Give me some examples here of the kind of language that might be off putting.

Yeah, definitely. So one of the things is that oftentimes we're filling out forms, right? There's a lot of bureaucracy in forms that happen in any kind of medical setting. When you're filling out a form as an intended parent about your family, if that form says mother and father and that's not the structure of your family, that can feel like the system isn't made for you. That can make you feel really excluded. But it also can make some legal implications, right?

Like, you're not a father and a mother. You might be two mothers. You might be two fathers. So ensuring that those medical records actually do, and those legal documents actually do represent your family structure can feel very important. So instead of mother and father, what should it say?

Parent? Parent one, parent two. Yeah, exactly. And I'll say a lot of fertility clinics are doing that work now. People are starting to look at their forms and assess the inclusion and equity of those forms to make it more inclusive. Having someone's name on a document that's different from their legal name will also create a more inviting environment.

If you don't use your legal name, having that, having a support person use that name to refer to you can be quite jarring. It can feel not just exclusionary, but oppressive to have someone refer to you the wrong way. So really ensuring that we have clarity in how we refer to people, in the pronouns we're using to refer to them, and in the written documents that refer to them as well is really important to

create that equitable environment. This experience is so vulnerable for anyone not just for LGBTQ people but for anyone who's accessing a fertility clinic there's so much emotion there's so much vulnerability there's so much grief that it becomes even more important to create an environment That feels like it includes you and that feels like it speaks to you. So I think that little extra effort of amending forms speaking to people with the names that they use That that can make a huge difference in their everyday life

Can I just follow up on that the the notion of not using your legal name? Why wouldn't you? Yeah, so notion of not using your legal name. Why wouldn't you? Yeah, so some people might have a legal name that was from a gender that they don't identify as. Someone might use a different name. So their health card maybe hasn't been updated. There's so many steps that go into changing your name that sometimes our legal documents

don't represent who we are. And that can, again, just feel very discriminatory. Okay. Circling back to the first thing you said, which was there are rules in this province around surrogacy. You know, if you are unable to, for whatever reason, have kids yourself and you need to bring in a surrogate parent to help out, what are the rules around that in Ontario? Yeah, so you, surrogacy is legal in Canada. However, there are regulations around using a surrogate. So you are not allowed to pay a surrogate in Canada. You are allowed to reimburse them for expenses.

And you also are not allowed to pay someone to find you a surrogate. So it is complicated to find a surrogate in Canada and the process can take quite a long time. There are people who find a surrogate within six months, but there are other people who it takes two years to find a surrogate. Even though you can't pay a surrogate, reimbursing those expenses is quite a lot of money. This sounds like a nudge nudge, wink wink of arrangement you know. Okay we're not allowed to pay surrogates but you know well you had to drive to the hospital so I'm gonna reimburse you a hundred thousand dollars for your taxi fees right? I mean that's how you get around that presumably isn't it? No not

quite so everything has to be reimbursed with a receipt so we're not gonna say you are driving to from London Ontario to Toronto, so I'm going to give you this money for that drive. We're going to say, keep a receipt of, keep an indication of your mileage. We're going to, after the fact, pay you back for every cent that you expensed, but we cannot pay you for that in advance. What would be the objection to paying for surrogacy? Because you've got to admit, that is like the ultimate gift

you can give somebody, right? The gift of a life of a child. What's the objection to paying people for doing that? Yeah, there is definitely two sides to this argument. And I do not think it is a simple answer. So I think surrogacy is labor in many senses of the word and I do think that labor should be compensated. I 100% agree with that. I think the fear is that someone would become a surrogate because they have no other employment and

they're doing it kind of for what we might think is the wrong reason. At the same time everyone is an adult and can make consensual choices about their bodies. So I think that there is a lot of reason to question why we cannot pay a surrogate in this country. I do not think it's a simple answer. For myself, I think that we need to address bigger systemic issues around unemployment and poverty so that people are making the choice to be a surrogate because they want to be, not because they have to be. And in that case, I do believe that it would, it

should be legal to pay a surrogate. In the States you can, right? You can pay surrogate mothers in the States. Yes. So that's one reason why the border still exists, I guess. Not the same policy in Canada and the United States. Is, are any fertility services and or surrogacy services or part of that whole Not the same policy in Canada and the United States. Any fertility services and or surrogacy services or part of that whole thing covered by OHIP at all? So there is a fertility program. So the Ontario fertility program does cover some fertility treatments, but it is not considered

a necessary health treatment. So it's not covered by OHIP, it's covered by this fund. Recently, Ontario announced $150 million more would be put towards this. That has not come into effect yet, but it's $150 million over the next two years. Currently in Ontario, the funding allows each person to access one cycle of IVF that does not cover the price of

medications. Medications can cost $10,000 and so sometimes that one round of IVF is not enough. If it doesn't, if you need additional rounds of IVF then you might be paying out-of-pocket $20,000 depending on the clinic. Any idea what percentage of people are lucky enough to have it work on the first go-around? So it depends on a lot of factors. For IVF, depending on age and depending on diagnosis, you might be looking at a 30% success rate or a 50% success rate. I really try to avoid statistics in the book because it doesn't help the individual, right?

If you don't fall into that number, then it's not going to change the individual, right? If you don't fall into that number then it's not going to change the outcome, right? So I try to veer away from statistics and think instead about the individual and how can we centralize that individual's story, that individual's needs, and that individual's preferences in their own experience navigating fertility. So what you just said was the Ontario situation. Is it pretty much the same across the country? No, every province is different.

Some provinces have funding for fertility care and some provinces have none. What's also interesting is that some provinces have multiple fertility clinics and some provinces have one or none. So it changes the options that are available to you. Here in Ontario, there's quite a few fertility clinics relatively speaking to other provinces. So people might be able to kind of shop around and find the fertility clinic

that works best for them. But in other provinces they might only have one fertility clinic and then it becomes a little bit more difficult to access your needs or to find things that meet your choices or preferences. And forgive my ignorance again on this, but how many rounds of fertility can you go before you kind of realize it's not going to happen? Yeah, again, that's something that's up to a doctor to speak with their patients about. Everyone is different and everyone has a different kind of threshold. For some people, one round of IVF is all they have in them emotionally, financially, physically. For other people, they might do five, six more rounds of IVF.

You could do that many? Yes. Really? Yeah. Anecdotally speaking, what's the most you've ever heard anybody do? Quite a few. Yeah, I would say probably like six or seven, but there are people who definitely do more than that. When we're talking about a round of IVF,

I'm talking about people doing egg retrieval. So IVF is a process of stimulating egg growth, retrieving those eggs, trying to develop embryos, and then transferring them back into the uterus. So that I'm referring to as one round, that is what's covered through Ontario's fertility program with any transfers of embryos that come out of that retrieval.

Okay, I don't normally ask people personal questions on this program, so we checked ahead of time and apparently I have the green light to ask you some stuff about your own situation. Is that right? Sure, yes. Okay, I like to get on the record because you know, sometimes if I do this, people are gonna ask me after,

how dare you ask her that kind of question? I wanna let you know, it's Kosher, she gave me the green light here. Okay, did you go through all this? Yeah, me and my partner did, we did. When we started our process of trying to build our family, there was no information easily accessible. Our doctor, our GP had referred us to a clinic that actually didn't fit the needs that we

were looking for at the time. We had to kind of go through the process of learning what options were available to us, learning the steps in the process. I thought to myself, this is not okay. I then became certified as a full spectrum doula and fertility support practitioner so that I could help people on their journeys of trying to navigate this system and identify what their preferences and their choices were.

So now do you and your wife have kids now? We do, we have two. You have two kids. We do. And again, if it's not too intrusive, how'd you do it? Yeah, great question. So I am both a gestational parent, meaning that I carried our first child, and a non-gestational parent.

So my wife carried our second child. So we each had one. We did, yeah. Now that's true teamwork. It is amazing. We're very lucky. Yeah, so we went through the process of trying with IUIs, with intrauterine dissemination, and with IVF.

We experienced some hardships along the way, as well as a chemical pregnancy, which is an early loss. And yeah, we have been very lucky in our experiences to come out of this with two children. I need help translating. So, IUIs. Miscarriages along the way, Is that what you're trying to say? Yes, we had one miscarriage along the way.

One miscarriage along the way. Yeah. Okay, and how many months in? It was early. Early, okay. And you have two kids now. We do. And the kids are how old?

Three and seven months. Oh wow, who had the seven month old? My wife. Your wife did, so this is three years in the rear view mirror for you. Right. And the kids are okay? They're wonderful.

Which end? We have a girl and a boy. You got a girl and a boy. Well, you've covered all the bases. You're OK here. All right. OK. This, you call it a journey, is it something

that you would recommend for others who find themselves in similar circumstances? Because I could understand how it might not be for the faint of heart right? Yeah I think what I would recommend is building your community. Find people to talk to, find support people, find community resources. Having that team to help you figure out what's best for you, what options you might be interested in pursuing is so essential. I think that team is what makes you feel supported, what helps you to advocate for yourself, and provides you with the education to learn

about what you might choose to do. Do the sperm donors know about this? Do they know about? The fact that their sperm helped create two children. Mmm. So there's different options for donors available to people. People could choose to have a known donor. They can choose to use a bank and use an entirely anonymous donor, or they can choose to use an open ID donor.

An open ID donor is someone whose identity will be revealed only if the donor conceived people choose to when they turn 18 years old. And what did you do? That's a personal question. Okay, well, you know, you've opened the door a little bit, so I just want to know. Okay, so leave that one alone. Okay, I got you.

See, I pick up on this pretty quickly. It's good, yeah, it's good. Okay, fine. Last question here. What do you think needs to be done in this country immediately to make this whole scene that we're talking about more reasonable, more doable, more equitable, all that stuff? Yeah, so I think that we need more transparency in our protocols, more transparency in what options are available, more transparency in the financial costs and in the funding that's available. I also think we definitely need more healthcare provider education. And again, I think that our healthcare providers are invested in that and are interested in that. And I think we're starting to see change.

Well, congratulations to you and your wonderful family. Are you done? Not yet. You're going to have more kids, hey? You're going to have more kids. I mean, we'll see, but I hope so. Okay. And do you know who's going to have them? Like, do you arm wrestle to decide who's going to have them? We might? You're gonna have more kids. I mean, we'll see, but I hope so. Okay, and do you know who's gonna have them? Like, do you arm wrestle to decide who's gonna have them? We might, yeah, I'm not sure.

It's on. Lane Halpern-Zisman has been our guest. The book is called Conceivable, a guide to making 2S LGBTQ plus family. Thanks a lot for coming in tonight. Thank you for having me.