Know all the available routes to family building, Dr. McNicholas said—from assisted reproductive technologies, such as in vitro fertilization and surrogacy, to the many forms of adoption—and the limitations of each.
As a case in point, she cited a 40-year-old lesbian patient who was already having irregular periods yet was seeking intravaginal insemination because of its relatively low cost.
“We had to have a real conversation about the time it would take for her to conceive potentially via this route,” she said. “My recommendation was that she needed to get to a reproductive endocrinologist sooner rather than later if [she and her wife] really wanted a good chance at a successful conception.”
Thinking beyond the pregnancy test
There are many models of prenatal care, and many physicians are moving to group practices where patients can see a variety of providers. Establishing trust is crucial, Dr. McNicholas said, so patients can embrace being cared for by a team.
“Understanding the complexities of the health care system as it pertains to this population is also really important,” Dr. McNicholas said. “Depending on the state you live in or the conservativeness of the hospital in which patients might be delivering, it’s important to consider what the policies of the hospital are.” Policies can encompass areas such as who can be in the delivery room and who can make decisions for the newborn or the pregnant woman if a complication arises.
She also noted the need to be aware of postpartum issues that may arise. Know who, if anyone in the relationship will be breastfeeding, provide screening for postpartum depression, and have LGBTQ-friendly pediatricians available for referral.
The 90-minute webinar features presentations by five other LGBTQ health experts, including two other LGBTQ physician parents, and a reproductive endocrinology and infertility specialist.
At the 2016 AMA Interim Meeting, the House of Delegates adopted policy saying that if health insurers cover fertility treatments, they should offer such benefits regardless of their beneficiaries’ marital status or sexual orientation. The Association will support local and state efforts to promote such an approach to reproductive health insurance coverage.
The AMA provides resources for creating an LGBTQ-friendly practice, including links to prominent LGBTQ practice and facility directories. The AMA Journal of Ethics offers a collection of articles on the ethics of caring for transgender patients in its November 2016 issue. Learn more about the AMA's Advisory Committee on LGBTQ Issues.
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- Treating LGBT patients: Creating a medical practice that offers inclusive care