Abstract
OBJECTIVE: To explore the decision-making of male same-sex couples when selecting sperm, donor eggs, and embryo(s) to transfer when using assisted reproductive technology (ART). DESIGN: Qualitative. SUBJECTS: Twenty participants: 8 successfully achieved pregnancy via ART, and 12 were actively pursuing pregnancy. Most participants were gay, White, cisgender men. EXPOSURE: Not applicable. MAIN OUTCOME MEASURES: Reflexive thematic analysis of interview transcripts. RESULTS: Four themes related to the decision-making processes of male same-sex couples using ART were conceptualized from the data and included desire for actual or perceived genetic relatedness, actual or perceived risk mitigation, desire for control, and financial cost. Many couples preferred using ART because both partners wanted to contribute sperm to fertilize donor eggs. Couples often preferred using the same egg donor if they wanted more than one child, and many couples wanted to achieve a blended family by using an egg donor who looked like one or both partners. Many couples made decisions, such as genetically testing embryos or transferring a single embryo into a gestational carrier, on the basis of increasing the chances of a healthy pregnancy. Some couples wanted more control during the process; thus, they made decisions regarding sex selection because they had the option to. The high financial cost of ART was the largest barrier for many couples, causing many to make sacrifices to mitigate cost. CONCLUSION: Decision-making of male same-sex couples pursuing ART is complex and unique to each couple. There are many stages throughout the process that require complicated decision-making; however, decisions are often shaped by the desire for genetic relatedness, risk reduction, control, and financial costs. Male same-sex couples often must make decisions without evidence-based medicine; thus, better clinical guidance is needed to allow reproductive experts to facilitate these delicate conversations and improve the experience of intended parents. The high cost makes the process more difficult for many couples, requiring many to make sacrifices and leaving many unable to pursue ART to build their families. Better insurance coverage needs to be made available to improve care for this marginalized patient population.