This is a how-to guide for any queer person pursuing assisted reproduction. Author Kristin Liam Kali, who describes themselves as “a white, queer, nonbinary transmasculine empty nester parent of four grown children,” writes in this book that “Because new parenthood is inherently vulnerable, I want you to start with the most solid foundation possible.” Kali brings a wealth of both personal and professional experience to bear in order to help give readers that foundation. They are a licensed midwife and owner of Seattle-based MAIA Midwifery & Fertility Services, which since 1991 has supported thousands of LGBTQ+ parents from preconception through conception, pregnancy, and early parenthood. Queer Conception focuses on these same areas.
The book begins with a chapter on deciding to become a parent and thinking about the best timeline, given that fertility declines with age for both bodies with eggs and those with sperm. It looks at carrying a pregnancy as a solo parent, deciding which partner will carry if you have that choice, and the pros and cons of simultaneous pregnancies. Dedicated sections cover pregnancy as a transmasculine or nonbinary person, using one’s gametes to create a pregnancy as a trans woman or nonbinary person, parenting and conception decisions in poly families, and intentionally co-parenting with non-romantic partners.
Subsequent chapters cover fertility health “for every body”; preconception health and testing; the various methods of assisted reproduction, including gamete donation, in vitro fertilization (IVF), and surrogacy; insemination methods; complications, troubleshooting, and cycle attempts; miscarriage; and early pregnancy, including lactation induction.
Detailed sections first explore how food, exercise, and sleep can impact the endocrine system and fertility (but also noting that while body compositions “with greater-than-average fat tissue” can lower sperm production, so can restrictive diets). Kali offers suggestions for how people can start to support their fertility up to a year ahead of time.
Kali then delves into the details of what preconception testing looks for in both people with eggs and those with sperm. The information is scientific enough to feel informative and substantial, but doesn’t require a degree in science to understand.
There is information on donor selection, pros and cons of known versus unknown donors, the partner dynamics involved in choosing a donor, asking someone to be a donor, and talking with kids about being donor conceived. Other sections cover IVF and surrogacy.
Kali also gets into the nitty gritty of ovulation cycles and insemination timing, and explains how to use the MAIA Cycle Chart (included) to track everything. They also explain what an IUI (intrauterine insemination) procedure will be like, and offer a “Trauma-Informed IUI Guide” for both patients and care providers, in order to make sure that those who have not had positive experiences with pelvic exams will have an IUI that is as comfortable as possible.
Kali also covers various reasons for infertility and what possible treatments could entail, finding funding for assisted reproduction, managing the stress of conception, especially if it involves multiple attempts, and going through miscarriage and pregnancy loss (for both the gestational and nongestational parent).
The book moves on to the bodily changes and symptoms of early pregnancy, caring for your body during pregnancy, choosing a prenatal care provider and a birthing location, and more. They acknowledge that trans and BIPOC people may “find the lack of inclusivity heartbreaking” in both cis/het and queer spaces, and offer some suggested ways the rest of us can do better to help change this.
The section on lactation is thoroughly detailed but clearly written. Some of this is what any nursing parent needs to know, such as getting an infant to latch on to a nipple, but it also contains a section on for nongestational partners on inducing lactation, should they wish to do so (including feeding after chest masculinization surgery).
Throughout, Kali is fully inclusive of pregnant people of all genders and sexualities, and those who are single, coupled, or in poly relationships. There is information on navigating cis/het clinic environments, being the nongestational parent, and other queer-specific concerns. Some sections are aimed at both trans men and trans women who may be going off hormone therapies in order to start their families (noting, importantly, that studies so far show that “transgender hormone therapy does not affect egg health or pregnancy rates”).
Kali writes that one of the reasons this book exists is to give people enough information to be confident asking questions of their providers. In that, they are likely to have succeeded. Providers, too, can benefit from this book, and special sections address them directly.
As important as the extensive factual information in the book is, the support and affirmation it provides to queer prospective parents is just as vital. Kali writes, “Stepping into your truth, nurturing your capacity for resilience, and intentionally choosing life, love, and joy are what queerness is all about. We have so many tools as queer and trans people that serve us as parents.” Consider this book a user’s manual, at least for the beginning of the journey.
