Meet Brent Monseur, MD, ScM

Why OB/GYN?

I grew up as a nonbinary, gay individual in a conservative area in southwestern Virginia. A very common refrain from anyone who comes out, or from close friends or family, is remorse or sadness that that person won’t be able to have a family. There’s really been a sea change in terms of people’s understanding of the possibilities. It’s tied into more societal acceptance and permissive legislation, like the legalization of marriage.

Before I got into medicine I wondered, how do gay people have families? It’s something we’re not even talking about or thinking about. So, I did my own research into what kind of career would support those goals, and landed on reproductive endocrinology.

I am fortunate that I finally ended up at a place that not only understands my vision, but continues to support it.

What needs to be changed about the current approach to LGBTQ+ family building?

Almost all the reproductive medicine literature leaves out all LGBTQ subgroups. However, the group that’s most represented is lesbian women, because there’s a longer history of lesbian individuals using donor sperm. The first sperm banks to accept them as clients started right here in California.

Still, many doctors treat lesbian women as if they need reproductive assistance because they’re infertile (for example, by using fertility medications). These women are not always infertile. They just need doctors to put sperm in their uteruses at the right time of their cycles. Otherwise, you’re doing expensive, inappropriate interventions that might put families at more risk. These could include twins, triplets, and all the associated paternal, fetal, and neonatal complications.

Gay men are a group that is particularly and conspicuously absent. As a fertility doctor, you typically see heterosexual couples. So, you do see male partners, but the focus remains on the uterus and/or ovary bearing individual.

For a gay male couple, a gestational carrier is common if it is important to be genetically related to the children. But it’s exceptionally expensive, around $200,000. How do you handle a gay man who shows up to an ultrasound with their gestational carrier? What do you do with a gay male couple when their baby is born prematurely and they have to go to the NICU? The system is not designed in a way that allows for these arrangements.

Before OB/GYN came my interest in the idea of queer individuals building their families.

In the transgender community, there is increasing interest in pursuing fertility preservation. But there are still a lot of unknowns. If they’re doing hormonal treatment, should they freeze their eggs before treatments? Should you stop treatment, and if so, for how long? What is the impact on egg quality and future embryo development?

It’s not one size fits all. It’s medically, socially, and legally complex for each LGBTQ+ subgroup and each patient.