Austin's Aspire Fertility Models Inclusive, Affirming Care for Queer Families

From the misty atmospherics of San Francisco Bay to the liberated vibe of a Provincetown summer's Family Week, queer couples define commitment and family with as much devotion as anybody else – and when it comes to family building through IVF and other reproductive health technologies, those couples deserve the same level of care and expert attention that any other family can expect to receive.

Deep in the heart of Texas, the award-winning Aspire Fertility in Austin – part of The Prelude Network, North America's largest and fastest-growing network of fertility clinics – lives up every day to a commitment of making sure that the principles of inclusion and affirmation are offered to all who walk through their doors.

Ensuring acceptance and equality is a full-staff commitment at the clinic, Dr. David Prokai, a reproductive health specialist at Aspire, says.

"It's a top-down effort, starting at my level, the physicians," Dr. Prokai emphasizes, "on down to the nurses, the embryology staff, medical assistants, and admin people – an approach of making sure that we have an inclusive environment to all families."

"At a corporate level too, there's a lot of messaging that very much affirms that all families, all colors are welcome. There is permanent artwork showing multi-faceted families, showing implicitly that we help families of all persuasions and all orientations and makeups that come to our door," Dr. Prokai adds.

It's a regrettable, but well-documented, fact that LGBTQ+ people seeking health care of any kind disproportionately encounter ignorance, prejudice, and even hostility from health care providers who are, in theory, there to help everybody. Aspire Fertility strives to make sure that their queer patients discover that, if anything, the very opposite is true of their experience at the clinic.

"It starts with the welcome in the door," Dr. Prokai notes, "the person who greets them in the waiting room with a friendly demeanor."

That's not simply a matter of Texas charm, but part of an intentional focus on respectful interaction with prospective parents looking to welcome children through IVF. That level of institutional commitment takes planning – and a meaningful investment of time and attentiveness.

"One of the things that we do is at least once a year, if not twice a year, is we have sort of a clinic," Dr. Prokai reveals. "We shut down for half a day for an educational [event]. There are always scientific things, but we always have somebody from the local LGBT healthcare clinic come to give us a refresher on exactly what you're asking patients, about pronouns, about interacting with LGBTQ population."

"And at each session," Dr. Prokai adds, "I always learn something new I can add to my toolkit of being to welcoming to patients."

That's important on an individual basis, the provider explains. "Establishing a very warm, open atmosphere and presenting yourself as knowledgeable about having worked with LGBTQ couples is really the first step, because the first relationship that a patient forms is that bond with that first provider that they meet. Laying that groundwork of, like, 'I know what I'm doing, I respect you and what we're trying to do, and I've done this before,' it really puts them at ease."

"But also, you know, with most patient interactions I have," Dr. Prokai goes on to say, "the first few minutes are just establishing rapport and getting to know the couple. When I switch over to the medical aspect, I say, 'What are your goals for today? What are we looking to achieve?' That goes to the point of how there are so many different sorts of people building their families. I'm saying, 'What is our ideal scenario that we're wanting to achieve?'"

The answers to that very personal question are as varied as the people themselves.

"In the case of, let's say, a same-sex lesbian couple, the answer might be, 'I have my eggs and I want my wife to carry,'" Dr. Prokai says as an example. "Or, if it's a same-sex male couple, it might be 'We want my partner's sister to be the egg source,' or, 'We want to use an anonymous donor.'" Whatever the family's specific goals and wishes, "I'm like, what is the scenario that we're exploring?" Dr. Prokai says. "And then let me see if I can make that medically possible."

Part of what it means to give prospective parents useful guidance is respecting reality – and respecting the patients by providing them with facts.

"I highlight how that's achievable," Dr. Prokai details of his response to a couple's parenting dreams. "But I also put caveats if that's warranted in the scenario we're looking to explore. If I do find something from a medical aspect that may need to be modified, I highlight what that might be: 'Some of the other couples that I've worked with that have similar situations to you have explored these scenarios...' And sometimes it's like, 'Oh, interesting, okay.' The light bulb goes on."

"Other times, it's a matter of giving information and letting it sink in," Dr. Prokai adds, "because any medical visit is such a wall of information, and you digest it over time, read some handouts to let the gears start turning, and then do a followup visit. Hopefully, things have started to crystallize at that point and we can start making plans accordingly."

IVF is, after all, a fairly complex process. Standing for "in vitro fertilization," IVF is simple in principle: Sperm and ova are brought together under laboratory conditions to create embryos that can then either be implanted in the womb of either one of the patients looking to build their family through the clinic's services, or a gestational carrier.

Getting to that point, though, is a multi-step process that involves identifying donors (or sperm or eggs), finding a gestational carrier if one is needed, stimulating the production of multiple eggs for fertilization, and then, once one or more embryos have bene created, carrying out genetic testing before implantation.

"Let's say you have a single mother by choice, or a same-sex female couple, and you have somebody who's wanting to both supply the eggs and carry, then the only thing lacking in that case is sperm, and a donor can contribute that," Dr. Prokai explains. "That's a relatively straightforward process" in which, rather than IVF, a couple might opt for IUI – intrauterine insemination – which also involves stimulating the production of eggs, but which brings sperm and egg together in the carrier's womb rather than in a laboratory. In that case, no artificial implantation is needed, though one famous side effect is the possibility of multiple embryos in the same pregnancy: twins, triplets, or even more babies.

"But," Dr. Prokai contrasts, "if somebody is looking to explore reciprocal IVF, where a same-sex female couple uses one person's eggs and the other person carries the embryo, then by definition we have to do IVF. Or, let's say we have a same-sex male couple who are going to be using an egg donor and then a gestational carrier. That's a lot of moving parts. I review the science of egg harvesting, freezing of eggs, fertilization, and then the gestational carrier portion."

Modern medical science makes even more miracles possible, Dr. Prokai notes.

"When we have non-binary or transgender patients, that also involves a lot of technical aspects, often around hormone replacement therapy, or HRT," Dr. Prokai explains, "or gender affirming care that they're currently undergoing, and doing any modifications need to be made to that during the reproductive treatment that they're looking to explore. That can be hugely complicated."

No matter the specifics of the couple's plans and hopes, fine tuning the specifics of the process comes down to asking relevant questions, and then listening to the answers with an attentive, experienced, and knowledgeable ear.

But even before that first meeting with a provider like Dr. Prokai, patients at Aspire Fertility will find they are being respected and heard. It all starts with the initial intake forms every patient fills out.

The forms are "a work in progress," Dr. Prokai admits, "because when you have an electronic medical records system, it has a cisgender, heteronormative standard" in which the default options might revert to terms like "husband and wife, male and female. So, there are some bugs."

Even so, Aspire's welcoming attitude is "reorienting some of that," Dr. Prokai notes. "When we have patient intake, we specifically ask for pronouns to clue us in. When you open the chart it'll say, 'Jane Doe, they/them pronoun,' or 'he/him.' It'll give a little alert, so whoever's interfacing with that patient, whether it's on the phone or in person, has a clue what their preferred pronouns are."

"It's not perfect," Dr. Prokai notes, "but certainly we are moving very much in that direction."

More personally, "One of the keys to the success that I've had with many of my LGBTQ patients is that I treat them just like any other patient in the best way possible," Dr. Prokai reflects. "I give the same standard of care to everybody."

There's a point, Dr. Prokai says, where the personal and the professional intersect.

"It's an extension of the satisfaction that myself, or any of the clinic members who we work with, see when we ultimately achieve that success," Dr. Prokai says. "When we get Christmas cards with families on them, birth announcements, these sorts of things, it's quite gratifying."

Adds the dedicated provider: "What got me into this field was the combination of that social aspect of deeply emotional satisfaction, but tied to science and technology and how that all links back together. That keeps me engaged, and keeps me excited about what I'm doing."