Comparing family planning desires and barriers between gay and lesbian military service members

Abstract: Objective: To investigate family planning amongst military service members identifying as LGBTQ+. Materials and methods: We developed a survey using a modified Delphi technique to investigate the impact of military service on family plan- ning. Four experts in military medicine and infertility serially reviewed the survey. After IRB approval, we distributed the survey throughout our institu- tion’s obstetrics and gynecology (OB/GYN) clinic and posted it on multiple open and closed social media pages for LGBTQ+ service members. Re- sponses were collected between August and December 2023. We reported descriptive statistics and compared binary variables using the Fisher-exact test. Results: 69 respondents completed our survey and self-identified as either cis-male (n1⁄428), cis-female (n1⁄440), or nonbinary/nonconforming (n1⁄41). All respondents identified as LGBTQ+ (100%). Respondents included veterans and active duty service members in the U.S. Army, Air Force, Navy, Marines, and Public Health Service. Most respondents (67.9% cis-males, 92.5% cis-females) plan to build their family during their military commitment, however, approximately half (50.0% cis-male, 55.0% cis-female) reported lack of support in doing so. More cis-females planned to achieve parenting via a biological route (75.0%), compared cis-males (32.1%). Most cis-females reported a genetic link to their child is ‘‘very important’’ or ‘‘somewhat important,’’ compared to fewer cis-males (67.5% v. 46.4%). Most cis-males (92.9%) had not met with a healthcare professional to discuss family building, nor had they pursued fertility care in the past (89.3%). A similar trend was appreciated among cis-females, but not to the same magnitude. Most respondents were unaware of resources that would assist in the pursuit of donor oocyte, donor sperm, or surrogacy (78.6% cis- males, 50.0% cis-females). Few participants endorsed familiarity with finan- cial resources available for service members to build their families (17.9% cis-male, 15.0% cis-female). There was a statistical difference when comparing which groups have pursued fertility care in the past (p<0.001), whether a participant has met with a healthcare professional to discuss family building (p<0.001), knowledge of resources for pursue donor oocytes/sperm and surrogacy (p1⁄40.02), and whether a participant knows who to talk to in the military about infertility care (p1⁄40.001). Conclusion: Our results suggest significant barriers to LGBTQ+ ser- vice members seeking infertility care. Overall, LGBTQ+ service members did not feel supported by the military in building their families. Although the military has made efforts to expand access to infertility services, efforts to raise awareness and build support for LGBTQ+ service members are warranted.