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Chloe He Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
Research Team, Sapphic Bison, London, United Kingdom

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Nour Al-Ma’ani Research Team, Sapphic Bison, London, United Kingdom

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Mei Francis Department of Philosophy, University of Warwick, Coventry, United Kingdom

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Jules Sales Product Team, Apricity, Paris, France

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Isabella Marson Acquisition Team, Apricity, London, United Kingdom

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Neringa Karpaviciute Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom

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Rishabh Hariharan Research Team, Apricity, London, United Kingdom

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Ranya Derrick Wonersh Surgery, NHS, Guildford, United Kingdom

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Sotirios Saravelos Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom

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Luca Sabatini Centre for Reproductive Medicine, Barts Health NHS Trust, London, United Kingdom

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Sofia Tzouganatou Embryology, Centre for Reproductive and Genetic Health, London, United Kingdom

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Devika Nair Embryology, Centre for Reproductive and Genetic Health, London, United Kingdom

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Danielle Ellis Care Team, Apricity, London, United Kingdom

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Céline Jacques Research Team, Apricity, Paris, France

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Timothy Ferrand Research Team, Apricity, Paris, France

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Tash Oakes-Monger Trans Learning Partnership, Spectra, London, United Kingdom

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Teodora Popa EGA Institute for Women’s Health, University College London, London, United Kingdom

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Francisco Vasconcelos Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom

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Cristina Hickman Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom

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In brief

We describe a first-of-its-kind audit of LGBTQ+ inclusivity in fertility care providers across the United Kingdom. Despite efforts being made to improve LGBTQ+ inclusion in fertility care, our results paint a picture of widespread gaps in clinical and cultural expertise alongside significant barriers to LGBTQ+ inclusion.

Abstract

LGBTQ+ patients comprise one of the fastest-growing user demographics in fertility care, yet they remain under-represented in fertility research, practice, and discourse. Existing studies have revealed significant systemic barriers, including cisheteronormativity, discrimination, and gaps in clinical expertise. In this article, we present a checklist of measures that clinics can take to improve LGBTQ+ inclusion in fertility care, co-created with members of the LGBTQ+ community. This checklist focuses on three key areas: cultural competence, clinical considerations, and online presence. The cultural competence criteria encompass inclusive communication practices, a broad understanding of LGBTQ+ healthcare needs, and knowledge of treatment options suitable for LGBTQ+ individuals. Clinical considerations include awareness of alternative examination and gamete collection techniques for transgender and gender diverse patients, the existence of specific clinical pathways for LGBTQ+ patients, and sensitivity to the psychological aspects of fertility care unique to this demographic. The online presence criteria evaluate provider websites for the use of inclusive language and the availability of LGBTQ+-relevant information. The checklist was used as the foundation for an audit of fertility care providers across the UK in early 2024. Our audit identified a widespread lack of LGBTQ+ inclusion, particularly for transgender and gender diverse patients, highlighting deficiencies in clinical knowledge and cultural competence. Our work calls attention to the need for further efforts to understand the barriers to inclusive and competent LGBTQ+ fertility care from both healthcare provider and patient perspectives.

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