Queer Intimacies and Structural Inequalities

Introduction

The technological offerings of fertility biomedicine include the use of “donated” eggs and sperm and the services of women as third and fourth parties serving as gestational surrogates. The technology of in vitro fertilization (IVF) coupled with the ability to retrieve and preserve human gametes has served as a key “technological platform” (Franklin, 2013) for what is today a big business of assisting human reproduction. Associated with an increase in generative possibilities for family formation are many ethical and justice concerns raised by these possibilities. Many women and men, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) people, are turning to fertility biomedicine in the hopes of meeting their family goals. While no official data records are maintained, the contours of their practices vary from local to global, from fairly low-tech to highly technologized, from reliance on social and community networks to reliance on multiple organizational entities, and within a continuum of insurance, payment, and voluntary participation. Despite the tremendous variety, these processes are all shaped by and within an era of fertility biomedicine marked by a global set of technoscientific practices and transnational flows. Assisted reproduction is part of the many emerging ethical and justice concerns regarding who will supply the labor and gametes needed to meet the growing reproductive marketplace, at what costs, and how to balance recipients’ and donor’s needs.

Many critics of the marketplace refer to the U.S. fertility industry as the “wild west” of assisted reproduction pointing to the “unregulated imperial expansion” (Dresser, 2000; Krolokke, Foss, & Pant, 2012; Spar, 2006) of U.S. biomedicine. Some groups, including feminist and women’s health scholars and activists, call for discussion, research, and regulation of what is a growing profit-oriented industry. Important concerns include power differentials and vulnerabilities of those hired for reproductive labor as well as the lack of health data collected and follow-up health care for women who undergo egg retrieval necessary for IVF, whether women “donate” eggs or use their own, and for women who are engaged as surrogates. Supporting organizations include Our Bodies Our Selves (OBOS), the Pro Choice Alliance for Responsible Research, and the Center for Genetics and Society.

We participate in this call for scrutiny, conversation, and research into the power relations, health and safety effects of egg donation, and contract surrogacy. We also seek to examine the ways queer practices, queer bodies, and queer lives are brought into both the fertility industry and the ethical and justice debates around its proliferation. We understand that without this marketplace many LGBTQ families formed with “bio-ties” to their children may not be possible. Fertility Inc. (Kolata, 2002), the for-profit system of assisting reproduction, and its technological offerings, while neither monolithic nor determining, has come to structure many people’s reproductive (and for some, economic) life. LGBTQ people turn to this industry, as do heterosexual people, to meet their fertility goals for various reasons including legal necessity. While millions of women and men became parents in the past 30 to 40 years through various technologies of assisted reproduction, the technoscientific expansions and global forms are provoking many in the reproductive health, rights, and justice movements (including ourselves) to examine these practices a new. For this article, we consider the ways by which the increased use of fertility biomedicine among LGBTQ people are caught up in and constitute the reproductive landscape and debates. We begin with the premise that LGBTQ participation is a rights and a justice issue that intersects with and takes shape within broader and multiple reproductive rights and justice issues.

Our goal in this article is to address and hold this surprisingly contentious premise steady—that LGBTQ reproduction is part of reproductive justice—while recognizing the profound health and safety issues and the race, class, and national inequities present in what has become a global marketplace. While it is heterosexual couples—supported in their endeavors and able to pay for the services—that constitute the vast majority of users of these technoscientific offerings, LGBTQ people are often implicated in the ethical and justice debates forming around the industry. Our analysis builds on one of the author’s research with lesbians in the 1990s and early 2000s, but extends this research to consider contemporary shifts in biomedicine and the fertility industry and the LGBTQ intimacies produced through participation in human reproduction. That is, while normativity is more often produced in the use of these services, LGBTQ people’s inclusion in biological reproduction can also queer reproduction and family forms.

We argue that expanded possibilities for queer intimacies including and beyond normative notions of the family are produced within a landscape of expanded structural inequalities marked by interlocking systems of power, privilege, and vulnerability. These macrostructural conditions, however, exist alongside local and interpersonal ones. Family formations produced through fertility biomedicine are enabled by both complicit acceptance and active negotiation of these structures. Informal social networks are places where some queer people do create families through human reproduction and, as discussed below, these appear to be strengthening with social media platforms. Many others choose adoption as a way of resisting Fertility Inc. LGBTQ users of fertility biomedicine are constituted within expanded biomedical fertility services in ways that as is the case for their heterosexual counterparts, reproduce more than humans: they reproduce consumer marketplaces, normativities, notions of belonging, and intensifying inequalities. Yet as they negotiate and, at times, reinforce these contours, they also participate in new kinship forms as they demand inclusion in one of the most durable and supported social practice: having children. These interpersonal and structural dynamics, if attended to simultaneously, are also part of a reproductive justice framework that demands intersectional and ecological perspectives.

The Biomedicalization and Stratification of (In)Fertility

Fertility services exemplify processes of “biomedicalization”: they are marked by large-scale technoscientific transformation, increasing commodification of services, and placing responsibility on people as consumers for their own health and treatment (Clarke, Shim, Mamo, Fosket, & Fishman, 2003; Clarke, Shim, Mamo, Fosket, & Fishman, 2010; Mamo, 2010). Fertility biomedicine, previously called infertility medicine, in the United States includes a technological trajectory of moving up a ladder of biomedical solutions to “infertility” from assisting sperm vaginally or directly into a uterus to IVF outside a woman’s body. Unlike many countries, the United States relies on professional, voluntary guidelines to circumscribe its boundaries. Fertility services do not hold stable practice boundaries. Over time, a growing constellation of technological offerings, professional actors, and sources of biomaterials have been incorporated. The expansion includes new actors, such as third and fourth parties, brought into reproduction to provide biomaterials or bodily services; new technological practices such as Preimplantation Genetic Diagnostics, offered by a growing menu of possible procedures; new health care guidelines for fertility preservation and storage; and new entrepreneurial organizational actors including egg brokers, surrogate services, and fertility specialists (Mamo, 2010).

Stratifications punctuate these transformations structurally, as political-economic institutions shape the flows of resources in ways that map onto usual stratifications in national, economic, and other lines of power and vulnerability, and in microinteractions, as small-scale organization–consumer and patient–provider interactions unfold in ways that generate disparities in health care (Shim, 2010). Stratified reproduction, originally coined by Shellee Colen (1995), applies to activities related to having or not having children, referring explicitly to “power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered . . . [and] arrangements by which some reproductive futures are valued while others are despised” (Ginsburg & Rapp, 1995, p. 3).

In the landmark edited volume by Ginsburg and Rapp (1995), the sites of reproduction considered ranged from abortion in Romania to assisted reproductive technologies in the United Kingdom, to contraceptive technologies in Brazil, and to prenatal diagnostic screening technologies in southern California. Today’s biomedical expansions, in contrast, include activities that do not result in women having or not having children themselves (egg donation and surrogacy), or having children at that moment (creation and storage of eggs or embryos for future use), or reproducing at all (e.g., egg donation for stem cell research). Today’s technological platforms—leaps in kind, forms, and numbers—reveal that the notion of a reproductive right to “decide freely and responsibly the number, spacing and timing” of children, “and to have the information and means to do so” (U.N. Population Division, Department of Economic and Social Affairs, 1994), is insufficient in addressing today’s contours. Furthermore, as women and gender studies scholar Rajani Bhatia (2012) argues, the association of particular technologies with nationally or culturally bound sites no longer captures analytically the contours of understanding assisted reproduction technologies (ARTs) within a framework of stratified reproduction. Situated activities, she argues, maintains the focus on power and inequality, but undoes what she regards as a local/global context binary accounting for the ways technologies, clinics, and users are webbed together in circuits of travel that include multiple nodes of power.

Reproductive situated activities—or reproductive situations—include “transnational inequalities on which reproductive practices, policies, and politics increasingly depend” (Ginsburg & Rapp, 1995, p. 1) and involve the buying and selling of ova, surrogacy services of women, often from low resources and high gender unequal regions, and other cross-border uses ARTs. The traveling electronic communications, services, biomaterials, clinicians, brokers, technologies, recipients, donors together constitute a global form of assisted reproduction (Ong & Collier, 2005).

The provision of women’s eggs is both a biomedical service and a commercial good (Ikemoto, 2009). Yet procedural differences punctuate these practices. While sperm donation is a simple procedure, requiring no drugs or surgical interventions to retrieve a biomaterial that is hardly scarce, egg retrieval is not biologically straightforward. Unlike sperm, female gametes are neither in excess nor easily available, requiring drug-induced stimulation of egg production and techniques to “harvest” or withdraw eggs. Whether eggs are retrieved for storage and assumed future use, for donation, or for one’s IVF, the procedures also come with some health and safety risks (Almeling, 2007).

The first pregnancies resulting from retrieved eggs came in the mid-1980s when physicians began to use the technology of IVF and soon realized that the eggs could be provided by a third party “donor.” At the same time, as public funding for infertility research subsided, much of the activities of assisting reproduction moved into the private sphere where industry innovation and expansion were valued (Cooper & Waldby, 2014). By the late 1980s and early 1990s, surrogacy brokers, egg brokers, IVF clinics, and other reproductive agencies had expanded exponentially and began to compete for both recipients of their services and for women who would provide eggs and surrogacy services. Recruitment began to focus on what Cooper and Waldby (2014) term “class and educational prowess,” characteristics deemed desirable by clients seeking donated eggs (p. 49). As interest in and access to IVF expanded, the number of reported “donor oocyte cycles” significantly increased, from 10,801 to 18,306 (Kawwass et al., 2013). IVF has a complex “pregnancy success rate” of 6% to 50% depending on factors such as age, use of fresh or frozen eggs, donor or recipient eggs, and health conditions (Centers for Disease Control and Prevention, 2012).

Transnational and commercial expansions of sperm, eggs, and gestational labor have sparked a gestational “surrogate baby boom” (Twine, 2011). Women in India and other newly industrialized countries “rent out” their wombs to Americans and other women, creating the ability to easily export reproductive services across the globe (Goodwin, 2010). Reproductive tourism or transnational reproduction began as an option for those seeking fertility treatments or surrogacy and who wanted to evade country or state regulations. The rhetoric of choice and liberty, often used to promote services to recipients, has become common practice for both heterosexual and queer families to engage in cross-border reproductive practices. Today, a large portion of those who engage in transnational reproduction are affluent people who have decided to forego adoption in the hopes of maintaining genetic ties to one parent. These shifts have invigorated power imbalances as well as criticism and advocacy, especially for the ways women and our bodies and biomaterials are called on to fill what is a consumer-driven demand.

Queering Reproduction, Biomedicalizing Kinship

Queering Reproduction (Mamo, 2007) centered on the perspectives and actions of lesbian “users” as they navigated institutions of biomedicine, as well as legal structures and gender and sexuality norms en route to their pregnancy goals. Working within and yet moving beyond identitarian politics, the book considered the ways practices might queer as well as reinforce existing structures and forms of power and intimacy. Drawing on feminist scholarship of the 1990s and early 2000s, Mamo argued that biomedical fertility services were reproducing not only humans but also a consumer marketplace that stratified users by who can pay; heteronormativity that supports pronatalism as well as heterosexual definitions of infertility, and a sentimentalism of belonging achieved through family formation (Mamo 2007; Thompson 2005). Lesbians, as they negotiated fertility biomedicine, did so in ways that imagined and created kinship ties based on the affinities offered by the technoscientific offerings.

The practices of getting pregnant were highly biomedicalized as what was once a do-it-yourself lay social practice had transformed into a highly biomedical one that included increasingly technological interventions, multiple specialists and specialties, and by the late 1990s, transnational flows. LGBTQ social movements in the United States were dominated by challenges to marriage exclusions as well as pressure on legal, medical, and other institutions to overturn barriers to LGBTQ inclusion. While discrimination and institutional barriers were uneven and often prohibited LGBTQ inclusion in biomedical fertility, ability to pay had emerged as the most salient stratification for access to Fertility Inc. in the United States. Lesbians and single women frequently found ways to access needed services.

Shifts in information technology that allowed people to engage in commerce, networks, and communications over the World Wide Web in ways previously unimagined, allowed many lesbians, perhaps also invigorated by social inclusions, to click their way to the selection of what sociologist Lisa Moore (1997) first described as “best donor for the job.” Clicking one’s way to a donor produced possibilities to imagine social relatedness based not on biology or social connection but a hybridization of multiple characteristics (Hertz & Mattes, 2011; Mamo, 2007; Moore & Grady, 2014).

The lesbian baby boom was enabled partly from the growth of a fertility industry with sperm banks willing to include and even center lesbians in their services (Agigian, 2004; Mamo, 2007), partly from greater inclusion of LGBTQ people, and partly from technological expansion. By the late 1990s, gay men were gradually launching a baby boom of their own. In 2005, The Washington Post described the rise of “the two-father family” produced through egg donation, surrogacy, and adoption as the most visible new social form of the last decades of the 20th century (Boodman, 2005). More recent attention has been made to transgender reproduction and these emergent family forms. For example, Patrick Califia, a queer cultural icon and scholar, wrote about his new family in “Family Values: Two Dads With a Difference, Neither of Us Were Born Male,” published in the New York City, Village Voice. In this article, Patrick explains that his boyfriend is his baby’s mother, referring to his partner Matt Rice who became pregnant with a friend’s sperm and insemination (Califia, 2000). By the 2010s, many organizations were placing reproductive justice and T(ransgender) and Q(ueer) rights on their agendas (Nixon, 2013).

Disrupting the opposite sex, two-parent family represents one form of queering reproduction as LGBTQ people forge ties and create meaning on their own terms and in ways that do not necessarily map neatly onto embedded logics of who and what makes a family. In addition, expansions in the biomaterials and bodies contributing to human reproduction similarly disrupt and produce the meaning and social arrangement of who and what makes a family. Each and together, these disruptions to constructed yet embedded forms of relatedness queer kinship as well as the interpersonal experiences of intimate family forms.

The “new kinship,” proposed by legal scholar Naomi Cahn (2013), captures the ways biological ties alone no longer bond who and what constitutes a family and instead, a constellation of bio and social connections form the basis of kinship. These new kinship forms emerge as children born from donor offspring, Cahn argues, search for and form family ties among those whose relationships, both social and biological, are connected to the biodonor. Yet these are not simple arrangements between “donors” and “recipients.” What comes to be defined as family, as constellations of relatedness and intimacies, is constituted by complex arrangements and organizations. Fertility biomedicine, understood as including transnational circuits of travel, includes biomedicalization processes marked by for-profit, professionally regulated and individualized systems of health care such as the United States, and different nodes of power circumscribed by national, economic biopolitics.

When you look from the perspectives of users and the meanings they bring to the situation, even if aware of these normative structures being reproduced, people engage in their own negotiations. Charis Thompson (2005) theorized this best when she wrote about the choreography of objectification and subjectification. It is in these negotiations, often of structural inequalities and traditional definitions of family, that queering reproduction takes place. Mamo termed the disruption of the binary between biological and social ties forged in assisted reproduction as “affinity ties.” Affinity ties captured the ways lesbians in selecting donors, donor sperm, and imagining futures of relatedness conjoined social and biological ties representing a new way of conceiving kinship based on choice and biology (Mamo, 2007).

The donation of biomaterials and its allowance of “secrecy” or not disclosing to others, including children, the source of the biomaterial, has long been a narrative in ARTs. Naming a man might assume infidelity and place shame and stigma on one’s social father and mother. Yet such disclosures have never been part of lesbian or LGBTQ reproduction. Knowing the men who donated sperm for reproduction or who contributed sperm to co-create families has long been a part of achieving pregnancy for lesbians. As sperm banks came to dominate the practice with “anonymous” donors, secrecy of the use of a donor was never part of the narrative of conception. Children were told of their “donors.” In the 1990s, “willing-to-be-known” donors emerged as significant for LGBTQ people using sperm banks demonstrating that secrecy was neither desirable nor possible.

Queering Reproductive Justice

Reproductive justice was coined in the United States by women of color with the conceptual objective of linking reproductive health and rights activities with social justice frameworks. A goal was to shift the rhetoric and actions of feminist organizations from reproductive “choice” and individual liberty to include a focus on the political, social, economic inequalities that constrain women’s lives, especially, those most marginalized and vulnerable (e.g., incarcerated people, poor people, women of color, and disenfranchised people) to not only control their reproduction, but to do so in conditions supportive to having and raising children (e.g., free from coercion, economic hardship, and discrimination). Reproductive justice is not just access to and “choice” of health care procedures (abortion services and contraceptives), or protection of legal rights to individual autonomy but also addressing structural inequalities that affect women’s health and lives that become the focus and activities of reproductive justice frameworks (Asian Communities for Reproductive Justice, 2005).

The expansion of fertility biomedicine and the conditions of reproduction that expansion highlights have generated a great number of social, legal, medical, and ethical issues that reproductive rights, health, and justice communities are only beginning to address. Technoscience and its medical and scientific practitioners are constituted by capital and their work is as much embedded with values and power as any other. What many term, “outsourcing” intimate life, referring to consumers purchasing surrogate services and surrogate providers of gestational labor by the world’s most vulnerable often filling this need, has come under intense social and academic scrutiny. Films such as “Eggsploitation” and “Made in India” depict firsthand accounts of egg donors harmed medically and the collective harm of a gendered economy in which a growing number of women work as surrogates in India. Critical analyses of these practices are widespread among academics as well. For example, the emergence and rapid growth of “surrogacy hubs” for international clientele since legalizing commercial surrogacy in 2002 is the object of research by France Winndance Twine (2011) and the emergence of “baby markets” as families are created through private market dynamics is the focus of Michelle Goodwin’s (2010) legal scholarship. Media, film, and academic analyses speak to the escalation and complexities of practices that include cross-border travel to seek reproductive services or price points that are not available in one’s home country. Questions arise: Who will provide the eggs and the wombs necessary to enable these family forms? From what towns, communities, and countries will the biomaterials be drawn? Will these services follow capitalism to secure the bodies and labor necessary to fulfil our American dreams? How can we be accountable to the collaborative reproducers who provide biomaterials necessary to fulfil these demands?

In the U.S. context, Susan Markens analyzes the politics surrounding legislative responses to surrogacy revealing with careful analysis the ways various groups—feminist, conservative, legal, and others—declare surrogacy as “baby-selling” or as infertility regulation. In comparing two legislative debates in California and New York and situating these within a decade of state, national, and international conversations, she demonstrates that surprising agreement exists among disparate group including an unwillingness to challenge, or even engage in discussions regarding individual rights to procreation (Markens, 2007). Similar to Bhatia’s argument, analyzing human reproduction through a dichotomous lens of either exploitation or reproductive right, while a comfortable framework is insufficient to move conversations and actions that account for both reproductive rights and reproductive justice forward. Such an either/or framework has also been unable to capture and hold the tensions inherent in attending to queer practices, queer bodies, and queer lives in the fertility marketplace.

Queer bodies and lives and the structural conditions of those lives are an important intersection of power and in/equality in the reproductive justice framework: They participate in the global form of reproduction in ways that enhance and limit power imbalances. Do any Google search for gay parenting and you will find commercial surrogacy agencies catering to gay men. In a recent search of our own, Google yielded 83,000 hits including from Singapore, Mumbai, Las Vegas, and San Francisco. These resources join the myriad lesbian-friendly sperm donor clinics, both nonprofit and for-profit, that continue to serve lesbian women and couples and seem to be thriving. The same Google search will also land you on films such as the 2010 documentary Google Baby (Frank, 2009), about a gay Israeli man who helps other gay men in Israel locate White U.S. women to provide eggs to Indian surrogates. The media along with reproductive rights and justice organizations have taken note examining the “fatherhood” by a new formula. This and other media implicate LGBTQ people in outsourcing demands signaling the rise of the two-father family forms via surrogacy as well as the particular practice of locating egg donors within the United States and surrogates from those who live outside U.S. borders.

The ethical, social, and justice issues constituted by an ever-expanding fertility landscape coexist with or without the participation of LGBTQ individuals. An optic into the structural and the intimate, what public health scholar Sonja Mackenzie (2013) calls, the “structural intimacies,” is needed to allow the tensions inherent in LGBTQ reproductive practices. Structural intimacies account for the simultaneity and coproduction of interpersonal lives and social structural patterns of health and illness and focus on the agencies of actors as they negotiate power and vulnerability. Examining the case of the U.S. Black AIDS epidemic, Mackenzie reveals the ways “risk” of HIV/AIDS is inseparable from the structural inequities of race, class, and sexuality.

The concept, for us, provides entry into understanding, and perhaps allowing, the tension of the stratifications and inequalities produced in fertility biomedicine as well as the generative possibilities for queering kinship and relatedness. We point to Savannah Shange’s (2014) response to the 2014 lawsuit brought by a White lesbian couple against a sperm bank for inseminating the “wrong” sperm from a Black not White man. Shange (2014), a scholar and recent parent of a child conceived with donor sperm, responds by discussing the structural shaping of her own fears of being mistakenly inseminated with a White man’s sperm. She states, as a “child of chattel slavery, the threads of consent, race, and childbearing are all wound together in this womb of mine.” Skeptical about the influence of genetics on their child anyway, what mattered most to Shange and her partner was not passing on a behavior or specific facial features, but rather a heritage and cultural legacy. Shange continues that faced with the reality of the lack of protections for both Black and queer families in the law, paired with the “already perilous work of raising a Black baby in America,” she and her partner decided against using a known donor (Shange, 2014). Turning to the sperm bank with the largest pool of open donors (i.e., donors that could be known later) left them with a selection of just five Black donors and the one selected for their inseminations. The “choices” here demonstrate the ways very different, yet specific, historical and legal social policies of injustice perpetrated against African Americans and queer people intersect in shaping this reproductive situation. In addition, she reveals that the practice of “matching” or selecting sperm donors from similar racial/ethnic backgrounds is not always a means to communicate relatedness and bypass social questioning nor is it a “preference” for looking like one’s children, but can be a political form of resisting power and building the relations and relatedness that matter interpersonally and structurally.

LGBTQ participation in the global form of Fertility Inc. often includes the negotiation of local structural inequalities, as is the case in ensuring legal protection under the U.S. family law. Even as things “progress” for LGBTQ parents, such progress is neither uniform nor evenly distributed and, even in the context of U.S. legal inclusions, uncertainties remain. A recent New York legal ruling, for example, argued that second-parent adoption, a procedure recommended and routinely undertaken by same-sex couples (with children at financial cost, legal scrutiny, and intrusion into their homes), is no longer necessary under “marriage equality.” Same-sex couples, like heterosexual ones, once married receive legal recognition as a couple and are automatically considered legal parents to any child born to them, regardless of how and by whom the children are conceived and birthed. But questions remain about parental treatment of both parents in states and places where LGBTQ rights are less secure (Dodge, 2014). States such as Arizona and Mississippi have recently witnessed legislative attempts to allow businesses, including health care services to deny services to LGBTQ people. Such stratification of access also denies LGBTQ people the same possibilities for family formation offered to heterosexuals and implements a “don’t ask, don’t tell” health care policy.

These stratifications reveal the structural intimacies present in local and global politics around assisted reproduction, today queer people are not evenly brought into biomedical offerings nor are fertility practices queered by their presence. However, some LGBTQ bodies will be included in Fertility Inc., perhaps due to their Whiteness, money, insurance status, or otherwise, and some of these will rely on third and fourth party donors, friends, and extended family to achieve their goals. Furthermore, many other LGBTQ people will not ask for, nor welcome, fertility biomedicine—or human reproduction in any form—into their lives challenging these normativities through other forms of interpersonal intimacies.

Yet the concept also reveals, however painful, the presence of inequities and their ethical dilemmas, as well as possibilities for expanding, if not also queering, kinship. Structural intimacies of human reproduction, demands, we think, that we not limit or disparage the inclusion from the margins or conjecture that such inclusions require exclusions, but allow the tensions to coexist as we find a way to be accountable to both the reproductive laborers and those seeking inclusion in the market. Doing so cannot rely on false celebration of inclusion, but can attend to complexities of recognition and belonging and the ways intimacies and inequities are coproductive, psychosocial, and structural.

Queer Intimacies and Social Relatedness in Web 2.0

Today, from all across the world, those who can pay—gay or straight, gender conforming or gender queer, parents-in-waiting—buy eggs, locate surrogates, and surf their way to meet their reproductive demands. The addition of social media has not only delivered a new way for commercial reproductive spaces to market themselves and compete with one another but has also created new pathways to consumers (Moore & Grady, 2014). In their 2014 cyberethnography of commercial reproductive spaces, Moore and Grady highlight how these social networking practices have also shifted modern understandings of reproduction, kinship, and masculinity. It is in these spaces that core ideas from queer studies of kinship—the emphasis in the ability to create and choose family—and emerging understandings of gender, enter into conversation with foundational arguments of biology.

As Rachel Epstein (2002) notes, new possibilities have emerged for butch women, through their experiences of pregnancy, birth, and mothering. We argue that these same possibilities exist for gender queer and trans parents-in-waiting who expand what Epstein (2002) refers to as the “linking of queer masculinity and sexuality to the attachment of the female body” (p. 55). These reconfigurations of “motherhood” create opportunities for families and individuals whose identities exist outside the confines of cisgender heteronormativity to participate in the world of ART (Epstein, 2002). Our own recent search yielded sites not known to Mamo a decade before. “Boy and Baby: Adventures in Queer Parenting,” “Baby Cakes, Gender Queer Pregnancy and Birth,” “Transpregnancy” at Queereka.com, and many others. This fertility industry intersects with queer lives as many join in on one of the most enduring social identities and human practices, that of parenting and kinship formation.

ARTs and Web 2.0 have also expanded social relations by connecting parents-in-waiting to anonymous, identity release, and known donors. It is through the communications of social media platforms that parents-in-waiting let their fingers take them to real and imagined social possibilities. Connections are made and imagined, bricks and mortar fertility services are identified, and reproductive practices allow previously obfuscated intimate social possibilities to join visible ones. Virtual “self-help spaces”—be they personal blogs, organizational websites, or interactive chat rooms—participate in the production of parent-in-waiting identities, new family forms, and queer communities. Furthermore, these spaces allow their users to feel more freedom in how, and with whom, they decide to create their families.

In recent years, the addition of sites aimed at connecting parents-in-waiting and donors who wish to circumvent traditional private or “directed” sperm, egg, and embryo donation have also changed the landscape. These peer-to-peer donation sites describe donor–recipient relationships as “intimate,” and as such, believe they should be exempt from Food and Drug Administration regulations (Vogel, 2012). For example, the Known Donor Registry (KDR), developed in the United Kingdom by Beth Gardner in 2010, was created not only with the intention of bringing people together to create new families but also in ways that allowed both parents-in-waiting, including potential co-parents who have not yet met, and sperm and egg donors to feel more connected to each other and to the process. Unlike for-profit donor sites, users on KDR are not seen as “customers” trying to locate a “product,” rather using a traditional online dating approach, KDR allows parents-in-waiting and donors to create profiles and find what they refer to as a “parenting match”. With over 17,000 registered members, KDR describes itself as an “alternative family resource,” a “community,” and a place to expand one’s network and meet new people (http://knowndonorregistry.com). Other sites such as modamily.com, pollentree.com, and familybydesign.com offer meeting opportunities for potential co-parents.

In the United States, a “Donor Sibling Registry” (DSR; 2014) allows parents and their kids, once conceived by donated sperm, eggs, and surrogates, to find themselves part of “donor families” with “donor siblings” they may have previously had little idea existed; some people are creating these “families” from their earliest intention of becoming parents. The DSR, developed in 2000 by Wendy Kramer and her son, Ryan, is a web-based connection portal for parents and children initially founded for those who used donor sperm to locate and meet biological kin. The DSR represents a central example of new social forms, “donor families” as recipients, children, and reproductive collaborators meet in cyberspace. The DSR website (https://www.donorsiblingregistry.com) states that DSR was designed to provide a means “to assist individuals conceived as a result of sperm, egg or embryo donation who are seeking to make mutually desired contact with others with whom they share genetic ties.” A core value of the DSR is the “conviction that people have the fundamental right to information about their biological origins and identities” and “to acknowledge the humanity and rights of the donor-conceived.” As a result, this online community formed around the offspring, children conceived and born with the gametes from a reproductive collaborator (someone who sold or donated their sperm or eggs for a third party’s reproduction) and not the parents-in-waiting.

In their research based on an online survey sent to members of the Single Mothers by Choice Organization, Hertz and Mattes (2011) also note that sperm banks would have never imagined their users connecting in the ways that they do today via the Internet. However, in recent years, the popularity of the DSR has pushed the major U.S. sperm banks to establish their own donor sibling registries. Rather than a disconnected network of biogenetically related children, there is actually an increasing number of donor families who have begun to form “durable clans” (Hertz & Mattes, 2011). As a result, many parents-in-waiting begin their process today with knowledge of the potential for connecting with donor-shared siblings in the future.

Beyond the DSR, donor families utilize social media to form relationships and negotiate varying levels of involvement. In particular, sites like Facebook that allow families to exchange photos, send messages, and interact on a regular basis are the site of many donor family connections (Moore & Grady, 2014). While initial contact is usually made via the sperm bank’s Facebook page, users frequently co-opt the technology to create kinship relationships with other donor families (Hertz & Mattes, 2011). Facebook creates a controlled way for families to forge a bond. It is often through viewing a photo of a donor sibling that parents begin to feel attached to “the other half” of their child and become open to creating social ties with their fellow donor families (Hertz & Mattes, 2011). Such queering may not be specific to LGBTQ lives, but these intimacies produced through Web 2.0 and Fertility Inc. reveal possibilities for expanded notions of kinship.

Biomedical Fertility as Obligatory Passage Point for LGBTQ People

Queering Reproduction asserted that as advanced, high-tech biomedical options were becoming routine, standard practices, these options were constructed as not only the “best” option but as the only valid approach (Becker, 2000) with a new grounding assumption, “If you can achieve pregnancy, you must procreate” (Mamo 2007, p. 228). Family formation, including having children, had gradually become a cultural expectation for many LGBTQ people. Yet full legal, social, and biomedical inclusion remained constrained by social–legal policies, economic and cultural capital. Many who work in queer studies describe this emergent cultural expectation and especially the practices of LGBTQ people to “conform” as a homonormativity (Duggan, 2002). Queer intimacies and queer normativity were recognized if and when LGBTQ people engaged in human reproduction. Sarah Franklin (2013), in her book on IVF, has brilliantly added: “it’s not having children but trying to have them that is the new normativity and provides a sense of belonging” (p. 238). As this article goes to press, we cannot help wonder if corporate America is flexing its full participation in this new normativity as companies like Facebook and Apple provide “benefits” to their female employees to freeze their eggs. Such a practice of “trying” to have a child could secure these women into the politics of belonging whether or not their lives take them to pregnancies.

Similar issues of inclusion in normativity via biomedical services are now presented to transgender men and women, who The New York Times has declared as the next frontier of fertility biomedicine (Richards, 2014). For example, recent guidelines of the World Professional Association for Transgender Health (WPATH) includes its first section on “Reproductive Health” not only acknowledging that “many transgender transsexual, and gender nonconforming people will want to have children, but recommending appropriate health care practices and consumer information” (WPATH, 2011, p. 50). Part of the biomedical guideline of transitioning by WPATH recommends early decisions about reproduction in light of fertility-limiting effects of feminizing/masculinizing hormone therapy (Darney, 2008; Zhang, Gu, Wang, Cui, & Bremner, 1999). As a result, transmen and transwomen are also included into fertility biomedicine and made to be parents-in-waiting as fertility becomes an obligatory passage point on their route to the men and women they know they are (Mamo, 2013). As egg freezing enters the marketplace, corporate young women along with transmen, depending on whether they can afford to pay, are provided more options, but questions must be asked: What’s on the menu and at what cost?

Beyond heterosexual couples and single women and lesbians, gay men and transmen and women are joining the generative possibilities offered by Fertility Inc. Not wanting to be excluded from biological reproduction is precisely what Mamo found among the respondents of her research a decade ago. Demands for inclusion and recognition in normativity continue today among LGBTQ people. This sentimentality of belonging can be found in the idea that somehow biological reproduction includes one in more than the practice of reproduction, extending to belonging to society more generally. Mamo found that the social intimacies formed among respondents in her research were nuanced and varied: parents-in-waiting were couples, singles, and four parents. They were mostly, but not all born female, they self-identified as butches, femmes, leather dykes, gender queers, and other positions—familiar and less so—in the gender and sexual order. As they selected people, sperm, and eggs on route to pregnancy they imagined future families and future relationships built on a new sense of belonging. They described their families in ways that aligned with and diverged from normative heterosexuality, but they collectively emphasized the deeply personal and social desire to be included in the identities and experiences of parents.

The intimacies realized were shaped by the very market forces that can be exploitative and commodifying of bodies and lives and can enact barriers to entry-based professional choice, legal issues, and payment structures. Yet people do and will continue to take on biomedical interventions for their own pragmatic purposes as queer users avail themselves of the large-scale consumer markets. This, in many ways, is what fellow sociologist Joshua Gamson (2014) asserts as he recounts and interprets his own experience of “conceiving and creating” his family. He states, “Although I was constantly aware of and wary of the role of the market elements of the process, I was also aware that without those transactions I would remain excluded from biological reproduction” (p. 123). Gamson continues to state that “[t]hese experiences are much more complex and nuanced than the critical concerns about the commodification and outsourcing of personal life might suggest” (p. 134).

Carla Pfeffer (in press) argues in her forthcoming book (an award winning qualitative research) on women who partner with transgender and transsexual men, that the social forms of these families and relationships do not fit neatly within dominant structures of same-sex or opposite-sex constellations. Instead, social contradictions, paradoxes, and transformative potentiality emerge in these lived experiences (Pfeffer, 2012). It is here, and in the empirical research that is needed on contemporary LGBTQ family formation, that we are hopeful, that our goal of moving away from identitarian politics and toward queering reproduction may be realized. Furthermore, the tensions inherent in the reproductive situations of LGBTQ lives must be held but not disregarded as we confront the many challenges and possibilities posed by assisting human reproduction.

Conclusions: A Research Agenda for LGBTQ Reproduction and Family

As fertility biomedicine captures additional queer users, implications reverberate in multiple directions. It is neither a simple celebration of expanded rights and justice realized nor a further exploitation of global inequality and injustice. Questions must be asked and steps taken to address stratifications and inequities as well as agencies and possibilities produced by Fertility Inc. in specific reproductive situations (see, e.g., Amrita Pande’s [2014] ethnographic research on women and surrogacy in India). For academics, justice can be both a research object of study and a sought after goal or outcomes of one’s research (Mamo & Fishman, 2013). It is not the coexistence of generative possibilities and global inequalities that we address here, but the ways LGBTQ practices of reproduction are often deployed as somehow “proof” of widespread structural inequities and, thus, as reasons for intervention into ARTs. The stratifications imbedded in practices of biomedicine are intensifying in political economies that do not include a right to health, but a right to buy health care and enhance one’s own health. Biomedical stratifications bring forward certain users and uses along familiar lines of economic, social, and cultural advantages. As the most fortunate have their rights expanded, the least fortunate are often called on to support those rights. But power and privilege are not so unidimensional or straightforward and we find ourselves somehow back in identitarian politics, advocating, at least partially, for the support of LGBTQ people to be included in an unequal system of ARTs. Such rights-based claims are not our singular agenda; instead, we advocate for multidimensional, intersectional logics of the workings of power and inequality in health and health care. It seems to us that we may also “discover” agencies as Mamo (2007) did a decade ago among lesbians seeking pregnancy and as Thompson (2005) did among women undergoing IVF. Research is needed that analyzes agencies and constraints negotiated among recipients, donors—be they known, directed, or willing to be known—“donor-sibling” children and their families. As these people challenge themselves and others to rethink family and belonging, they are queering kinship. Research is needed that explores these social relationships. When we look at people’s practices, we see negotiations, not only of consumption and market forces but also of one’s own agencies, desires, and comforts. We see decisions in selecting donors that are not simple reproductions of privilege, but complex historically situated intentions that account for the past as much as they do plans for the future. And we find many people willing to challenge themselves and others to forge relations that once may not have been possible.

As fertility biomedicine expands, as we suspect it will, research is also needed into the many justice issues facing third and fourth parties in ARTs that are often effaced and enacted. Scholars working at the intersections of law and society, science and society, and women’s health and reproduction are particularly needed to examine possible ways to address intensifying stratifications in the marketplace. Medical health and safety researchers might demand data on the health impacts of egg retrieval and fertility drugs as well as long-term follow-up on those undergoing egg retrievals for their own or another’s reproductive rights (or for the growing research industry not addressed in this article). More research is needed into freezing eggs and pregnancy success rates. Research is also needed into reproductive health, rights, and justice issues for transmen and transwomen and gender queer people as they enter fertility clinics and/or find ways to subvert and challenge what may be an obligatory passage point for inclusion. In what ways are clinical encounters from insurance claims to doctor–patient interactions addressing the clinical needs of transgender and gender queer clients? What structural conditions shape the lives of LGBTQ people to forge reproductive situations that include not having children? Research into LGBTQ lives might study the coproduction of racism, heterosexism, and transphobia in the expanded marketplace. And qualitative work might study the meaning of family formation in the LGBTQ community given these shifting contexts. The many ethical, legal, medical, and justice issues require our attention, and as proponents of women’s health, we are deeply committed to research into these areas. At the same time, we believe in “LGBTQ” health equity and that reproductive justice includes supporting people to reproduce and raise families. Theorizing relationships among intimate life and market forces in ways that account for situated nodes of power and the structural intimacies that make up our lives is needed and welcome.