Abstract

Assisted reproductive technologies (ART) make possible a range of alternative family structures (i.e., families with single, unmarried or LGBTQ+ parents). However, some practices still decline provision of ART to single and diverse sexuality and gender (DSG) individuals. Fertility clinics across the United States vary in terms of the options they provide to these patients (Wu et al., Fertil Steril 108(1):183–191, 2017). Those clinics who appropriately favor equal access to fertility services, regardless of marital status, sexual orientation, or gender identity, emphasize that single and DSG individuals often desire biologically related children and have the autonomy to seek out fertility care to support those interests. They emphasize justice (i.e., that different treatment is only justified when there is a morally relevant difference between cases) and the “right to reproduce” (De Wert et al., Hum Reprod Oxf Engl 29(9):1859–1865, 2014). Clinics who do not support equal access to fertility treatment question the welfare of children born into alternative family structures, despite clear evidence to undermine this concern, and inappropriately prioritize professional autonomy (APA, Published online 2004; van Rijn-van Gelderen, J Adolesc 40:65–73, 2015; Farr, Dev Psychol 53(2):252–264, 2017; Goldberg et al., J Fam Psychol 27(3):431–442, 2013). Marital status, sexual orientation and gender identity do not impact parenting ability and thus physicians have an ethical duty to treat unmarried and DSG individuals in the same manner as heterosexual married couples when determining which services to provide (ASRM Ethics Committee, Fertil Steril 116(2):326–330, 2021).