Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites


      To assess geographical distribution and practice characteristics of fertility clinics inclusive of lesbian, gay, bisexual, and transgender (LGBT) patients.


      Cross-sectional analysis.


      Not applicable.





      Main Outcome Measure(s)

      Prevalence and geographical distribution of fertility clinic websites with LGBT-specific content, indicated by keywords and home page cues specific to the LGBT patient population. Assessment of relationship between LGBT-specific content and clinic characteristics, including U.S. region, clinic size, private versus academic setting, and state-mandated fertility insurance coverage.


      Of 379 websites analyzed, 201 (53%) contained LGBT content. Clinics with the highest proportion of LGBT website content were in the Northeast (59/82, 72%) and West (63/96, 66%), while the lowest proportion was in the Midwest (29/74, 39%) and South (50/127, 39%). Most frequently used terms included lesbian (72%), LGBT/LGBTQ (69%), and gay (68%), while less used terms included trans/transgender (32%) and bisexual (15%). Larger clinic size was associated with LGBT-specific website content (odds ratio, 4.42; 95% confidence interval, 2.07–9.67). Practice type and state-mandated fertility insurance coverage were not associated with a clinic website having LGBT content.


      Over half of Society for Assisted Reproductive Technology member fertility clinics included LGBT content on their websites, yet those in the Midwest and South were significantly less likely to do so. Predictive factors for having LGBT website content included location in northeastern and western regions and increasing clinic size. Further studies are needed to evaluate whether inclusion of LGBT content on clinic websites impacts use of reproductive services by the LGBT patient population.

      Key Words

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        • Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities
        The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding.
        National Academies Press, Washington, D.C2011
        • Gates G.
        LGBT demographics: comparisons among population-based surveys.
        Williams Institute, University of California Los Angeles School of Law, Los Angeles2014
        • Amato P.
        • Jacob M.
        Providing fertility services to lesbian couples: the lesbian baby boom.
        Sex Reprod Menopause. 2004; 2: 83-87
        • Gates G.
        Demographics of married and unmarried same-sex couples: analyses of the 2013 American Community Survey.
        Williams Institute, University of California Los Angeles School of Law, Los Angeles2015
        • Gates G.
        • Brown T.
        Marriage and same-sex couples after Obergefel.
        Williams Institute, University of California Los Angeles School of Law, Los Angeles2015
        • Ethics Committee of American Society for Reproductive Medicine
        Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion.
        Fertil Steril. 2013; 100: 1524-1527
        • Ethics Committee of the American Society for Reproductive Medicine
        Access to fertility services by transgender persons: an Ethics Committee opinion.
        Fertil Steril. 2015; 104: 1111-1115
        • Murphy T.F.
        Ethics and the prohibition of donor gametes in fertility medicine.
        Reprod Biomed Online. 2009; 18: 60-67
        • Serour G.I.
        Islamic perspectives in human reproduction.
        Reprod Biomed Online. 2008; 17: 34-38
        • Golombok S.
        New families, old values: considerations regarding the welfare of the child.
        Hum Reprod. 1998; 13: 2342-2347
        • Anderssen N.
        • Amlie C.
        • Ytteroy E.A.
        Outcomes for children with lesbian or gay parents. A review of studies from 1978 to 2000.
        Scand J Psychol. 2002; 43: 335-351
        • Gurmankin A.D.
        • Caplan A.L.
        • Braverman A.M.
        Screening practices and beliefs of assisted reproductive technology programs.
        Fertil Steril. 2005; 83: 61-67
        • Lawrence R.E.
        • Rasinski K.A.
        • Yoon J.D.
        • Curlin F.A.
        Obstetrician-gynecologists’ beliefs about assisted reproductive technologies.
        Obstet Gynecol. 2010; 116: 127-135
        • Huang J.
        • Al-Fozan H.
        • Tan S.
        • Tulandi T.
        Internet use by patients seeking infertility treatment.
        Int J Gynaecol Obstet. 2003; 83: 75-76
        • Berger M.
        • Wagner T.
        • Baker L.
        Internet use and stigmatized illness.
        Soc Sci Med. 2005; 61: 1821-1827
        • Weissman A.
        • Gotlieb L.
        • Ward S.
        • Greenblatt E.
        • Casper R.
        Use of the Internet by infertile couples.
        Fertil Steril. 2000; 73: 1179-1182
        • Haagen E.
        • Tuil W.
        • Hendriks J.
        • de Bruijn R.
        • Braat D.
        • Kremer J.
        Current Internet use and preferences of IVF and ICSI patients.
        Hum Reprod. 2003; 18: 2073-2078
        • Johnson K.
        Excluding lesbian and single women? An analysis of U.S. fertility clinic websites.
        Womens Stud Int Forum. 2012; 35: 394-402
        • Jin H.
        • Dasgupta S.
        Disparities between online assisted reproduction patient education for same-sex and heterosexual couples.
        Hum Reprod. 2016; 31: 2280-2284
        • Petroll A.E.
        • Mitchell J.W.
        Health insurance and disclosure of same-sex sexual behaviors among gay and bisexual men in same-sex relationships.
        LGBT Health. 2015; 2: 48-54
        • Eyler A.E.
        • Pang S.C.
        • Clark A.
        LGBT assisted reproduction: current practice and future possibilities.
        LGBT Health. 2014; 1: 151-156
      1. United States Census Bureau Geography Atlas—Regions. United States Department of Commerce, 2015. Available at: Accessed December 20, 2016.

        • Hasenbush A.
        • Flores A.
        • Kastanis A.
        • Sears B.
        • Gates G.
        The LGBT divide: a data portrait of LGBT people in the Midwestern, Mountain, and Southern States.
        Williams Institute, University of California Los Angeles School of Law, Los Angeles2014
        • Gates G.
        Comparing LGBT rankings by metro area: 1990 to 2014.
        Williams Institute, University of California Los Angeles School of Law, Los AngelesMarch 2015
        • Flores A.
        • Herman J.
        • Gates G.
        • Brown T.
        How many adults identify as transgender in the United States.
        Williams Institute, University of California Los Angeles School of Law, Los AngelesJune 2016
        • White Hughto J.M.
        • Reisner S.L.
        • Pachankis J.E.
        Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions.
        Soc Sci Med. 2015; 147: 222-231
        • Herman J.
        • Mallory C.
        • Wilson B.
        Estimates of transgender populations in states with legislation impacting transgender people.
        Williams Institute, University of California Los Angeles School of Law, Los AngelesMarch 2016
      2. Transgender health and the law: identifying and fighting health care discrimination. Transgender Law Center, Oakland, CAJuly 2004
        • White Hughto J.M.
        • Murchison G.R.
        • Clark K.
        • Pachankis J.E.
        • Reisner S.L.
        Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis.
        LGBT Health. 2016; 3: 424-433
        • Reisner S.L.
        • Hughto J.M.
        • Dunham E.E.
        • Heflin K.J.
        • Begenyi J.B.
        • Coffey-Esquivel J.
        • et al.
        Legal protections in public accommodations settings: a critical public health issue for transgender and gender-nonconforming people.
        Milbank Q. 2015; 93: 484-515
        • Macapagal K.
        • Bhatia R.
        • Greene G.J.
        Differences in healthcare access, use, and experiences within a community sample of racially diverse lesbian, gay, bisexual, transgender, and questioning emerging adults.
        LGBT Health. 2016; 3: 434-442
        • Roberts T.
        • Horne S.
        • Hoyt W.
        Between a gay and a straight place: bisexual individuals’ experiences with monosexism.
        J Bisexuality. 2015; 15: 554-569
        • Dodge B.
        • Herbenick D.
        • Friedman M.R.
        • Schick V.
        • Fu T.J.
        • Bostwick W.
        • et al.
        Attitudes toward bisexual men and women among a nationally representative probability sample of adults in the United States.
        PLoS One. 2016; 11: e0164430
        • Friedman M.R.
        • Dodge B.
        • Schick V.
        • Herbenick D.
        • Hubach R.
        • Bowling J.
        • et al.
        From bias to bisexual health disparities: attitudes toward bisexual men and women in the United States.
        LGBT Health. 2014; 1: 309-318
        • Herek G.M.
        • McLemore K.A.
        Sexual prejudice.
        Annu Rev Psychol. 2013; 64: 309-333
      3. State infertility insurance laws. Birmingham, AL: American Society for Reproductive Medicine. Available at: Accessed December 20, 2016.

      4. Frequently asked questions about infertility. Birmingham, AL: American Society for Reproductive Medicine. Available at: Accessed December 20, 2016.

      5. The costs of infertility treatment. McLean, VA: Resolve, the National Infertility Association. Available at: Accessed December 20, 2016.

        • James S.
        • Chilvers R.
        • Havemann D.
        • Phelps J.Y.
        Avoiding legal pitfalls in surrogacy arrangements.
        Reprod Biomed Online. 2010; 21: 862-867
        • Benardo S.
        • Benardo K.
        Egg donation and surrogacy arrangements in law and practice.
        Bloomberg Corporate Law J. 2007; 2: 406-413
      6. Financial considerations for gay male couples. Lexington, MA: Gay IVF LGBT services at IVF New England. Available at: Accessed December 20, 2016.

        • Blake V.
        It’s an ART not a science: state-mandated insurance coverage of assisted reproductive technologies and legal implications for gay and unmarried persons.
        Minn J Law Sci Technol. 2011; 12: 651-715
        • Maragh-Bass A.C.
        • Torain M.
        • Adler R.
        • Ranjit A.
        • Schneider E.
        • Shields R.
        • et al.
        Is it okay to ask: transgender patient perspectives on sexual orientation and gender identity collection in healthcare.
        Acad Emerg Med. 2017;
        • Cahill S.
        • Makadon H.J.
        Sexual orientation and gender identity data collection update: U.S. government takes steps to promote sexual orientation and gender identity data collection through meaningful use guidelines.
        LGBT Health. 2014; 1: 157-160
        • Maragh-Bass A.C.
        • Torain M.
        • Adler R.
        • Schneider E.
        • Ranjit A.
        • Kodadek L.M.
        • et al.
        Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: a multi-method analysis of patient and provider perspectives.
        LGBT Health. 2017; 4: 141-152
        • Haider A.H.
        • Ranjit A.
        • Vail L.
        • Scott V.
        • Kodadek L.M.
        • Shield R.Y.
        • et al.
        Emergency department query for patient-centered approaches to sexual orientation and gender identity (EQUALITY): a mixed methods study.
        JAMA Intern Med. 2017; 177: 819-828
        • German D.
        • Kodadek L.
        • Shields R.
        • Peterson S.
        • Snyder C.
        • Schneider E.
        • et al.
        Implementing sexual orientation and gender identity data collection in emergency departments: patient and staff perspectives.
        LGBT Health. 2016; 3: 416-423
        • McNamara M.C.
        • Ng H.
        Best practices in LGBT care: a guide for primary care physicians.
        Cleve Clin J Med. 2016; 83: 531-541
        • Walker K.
        • Arbour M.
        • Waryold J.
        Educational strategies to help students provide respectful sexual and reproductive health care for lesbian, gay, bisexual, and transgender persons.
        J Midwifery Womens Health. 2016; 61: 737-743
        • Amato P.
        • Morton D.
        Lesbian health education: a survey of obstetrics and gynecology residency training programs.
        J Gay Lesbian Med Assoc. 2002; 6: 47-51
        • Obedin-Maliver J.
        • Goldsmith E.S.
        • Stewart L.
        • White W.
        • Tran E.
        • Brenman S.
        • et al.
        Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education.
        JAMA. 2011; 306: 971-977
        • Feldman J.
        • Brown G.R.
        • Deutsch M.B.
        • Hembree W.
        • Meyer W.
        • Meyer-Bahlburg H.F.
        • et al.
        Priorities for transgender medical and healthcare research.
        Curr Opin Endocrinol Diabetes Obes. 2016; 23: 180-187
        • Unger C.A.
        Care of the transgender patient: a survey of gynecologists’ current knowledge and practice.
        J Womens Health (Larchmt). 2015; 24: 114-118
        • Makadon H.
        • Potter J.
        • Mayer K.
        • Goldhammer H.
        The Fenway guide to lesbian, gay, bisexual and transgender health.
        2nd ed. American College of Physicians Press, 2015
      7. LGBT resources. Chicago: American Medical Association. Available at: Accessed December 20, 2016

        • Coleman E.
        • Bockting W.
        • Botzer M.
        • Cohen-Kettenis P.
        • Decuypere G.
        • Feldman J.
        • et al.
        Standards of care for the health of transsexual, transgender, and gender-nonconforming people.
        Int J Transgend. 2011; 13: 165-232
        • Ross L.E.
        • Steele L.S.
        • Epstein R.
        Lesbian and bisexual women's recommendations for improving the provision of assisted reproductive technology services.
        Fertil Steril. 2006; 86: 735-738
        • Ross L.E.
        • Tarasoff L.A.
        • Anderson S.
        • Green D.
        • Epstein R.
        • Marvel S.
        • et al.
        Sexual and gender minority peoples’ recommendations for assisted human reproduction services.
        J Obstet Gynaecol Can. 2014; 36: 146-153