title: Trans people's experiences with assisted reproduction services: a qualitative study.
abstract: OBJECTIVE
  What are the experiences of trans persons (i.e. those whose gender identity does not match the gender assigned to them at birth) who sought or accessed assisted reproduction (AR) services in Ontario, Canada, between 2007 and 2010?
  
  
  CONCLUSIONS
  The majority of trans persons report negative experiences with AR service providers.
  
  
  BACKGROUND
  Apart from research examining desire to have children among trans people, most of the literature on this topic has debated the ethics of assisting trans persons to become parents. To-date, all of the published research concerning trans persons' experiences with AR services is solely from the perspective of service providers; no studies have examined the experiences of trans people themselves.
  
  
  METHODS
  Secondary qualitative research study of data from nine trans-identified people and their partners (total n = 11) collected as part of a community-based study of access to AR services for sexual and gender minority people between 2010 and 2012.
  
  
  METHODS
  Trans-identified volunteers (and their partners, when applicable) who had used or attempted to access AR services since 2007 from across Ontario, Canada, participated in a 60-90 minute, semi-structured qualitative interview. Qualitative analysis was performed using a descriptive phenomenological approach. Emerging themes were continually checked against the data as part of an iterative process.
  
  
  RESULTS
  The data highlight barriers to accessing AR services for trans people. Participant recommendations for improving AR service provision to better meet the needs of this population are presented. These recommendations address the following areas: (i) AR service provider education and training; (ii) service provider and clinic practices and (iii) clinic environment.
  
  
  CONCLUSIONS
  The majority of study participants were trans people who identified as men and who resided in major urban areas; those living in smaller communities may have different experiences that were not adequately captured in this analysis.
  
  
  CONCLUSIONS
  While existing literature debates the ethics of assisting trans people to become parents through the use of AR, our study demonstrates that they are already accessing or attempting to access these services. This reality necessitates a shift toward exploring the ways in which AR services can be improved to better meet the needs of this population, from the perspectives of both service users and service providers.
  
  
  BACKGROUND
  This project was supported by the Canadian Institutes of Health Research-Institute of Gender and Health, in partnership with the Assisted Human Reproduction Canada: Catalyst Grant: Psychosocial Issues Associated with Assisted Human Reproduction (FRN-103595). S.M. was supported by a Canada Graduate Scholarship from the Social Science and Humanities Research Council, as well as research funding from Osgoode Hall Law School, York University. S.J.-A. was supported by an Ontario Graduate Scholarship funded by the Province of Ontario and the University of Toronto.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Child, Youth and Family Program, Lakeridge Health, Oshawa, ON L1G 2B9, Canada.
authors.forename: S
authors.initials: S
authors.lastname: James-Abra
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON M5S 2G8, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Tarasoff
authors.affiliation: Canadian Media Guild, Toronto, ON M5V 3B5, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Green
authors.affiliation: LGBTQ Parenting Network, Sherbourne Health Centre, Toronto, ON M5A 2S5, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Epstein
authors.affiliation: CATIE, Toronto, ON M5V 3B1, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Osgoode Hall Law School, York University, Toronto, ON M3J 1P3, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Marvel
authors.affiliation: Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON M5B 1W8, Canada.
authors.forename: L S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON M5S 2G8, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada l.ross@utoronto.ca.
authors.forename: L E
authors.initials: LE
authors.lastname: Ross
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D005783:Gender Identity; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D027724:Reproductive Techniques, Assisted / Q000941:ethics*; D063106:Transgender Persons / Q000523:psychology*
keywords: assisted reproduction; gender identity; qualitative research; sexual orientation; transgendered persons