Introduction

Canada is rated one of the most LGBTQIA+ (lesbian, gay, bisexual, transgender, intersex, asexual, and other identities) friendly countries [1] in the world with increasing sexuality disclosure [2], creating a responsibility to address the needs and challenges of this rising community to promote a more equitable society. While increasing societal acceptance of sexual diversities has improved the visibility of fundamental human rights for the one million LGBTQIA+ residents of Canada, a shift in focus from basic rights to life satisfaction is required to usher in an era of LGBTQIA+ acceptance rather than tolerance. For many LGBTQIA+ people, having children is the next step in their family-building journey, leading to more same-sex couples desiring children and taking on parenthood since the 2005 legalization of same-sex marriage in Canada [3, 4]. However, the number of sexual minority men (SMM) raising children is not growing in proportion to the increasing population of LGBTQIA+ people in Canada [5]. Understanding what barriers confront SMM having children may improve parenthood accessibility for those who desire, but struggle to reach, parenthood through currently available routes. In this paper, the umbrella term SMM refers to cisgender men whose sexual identities deviate from heterosexuality [2], e.g., gay, asexual, bisexual, and pansexual.

Parenthood options for SMM can include raising children from previous heterosexual relationships, as well as having children through adoption, co-parenting, fostering, and assisted reproductive treatments (ART) using donor oocytes and gestational carriers [6]. With increasing societal acceptance of same-sex parenthood in countries protecting LGBTQIA+ rights, a shift has occurred from SMM fathering children born from their previous heterosexual relationships to building families by means of adoption or ART [7]. SMM who value genetic relatedness or want to experience parenthood from birth often use third-party reproduction to overcome their biological obstruction [4]. Unfortunately, the substantial costs associated with ART using third-party reproduction can be prohibitive to many intended parents including SMM. Adoption prevents an asymmetry of genetic relatedness in same-sex male couples; however, it can be inaccessible to these couples due to high fees, and restrictive legislation in some jurisdictions that prohibit their right to adoption and legal parentage [8, 9]. Adoption inequality also exists due to unconscious biases that agencies have against same-sex male couples’ parenthood capability to raise children, despite the lack of evidence showing that differences exist between same-sex and heterosexual parents [5, 10].

The societal stigma surrounding SMM having children, regardless of their chosen parenthood route, is still prevalent. This can manifest in health disparities and discrimination when accessing services, such as difficulty when applying for paternity leave and obtaining birth certificates. This discrimination may lead to unnecessary psychological distress stemming from their sexual orientation [11, 12], in addition to the financial burdens they have already sustained during the process of creating a family. Furthermore, research on same-sex parents found that social stigma was not only part of achieving parenthood, but also something they actively face and fear in their daily. These barriers can potentially manifest into daily parental challenges to affect parent-child relationships and reduce social support from family and friends [13, 14]. It is clear that the paths to parenthood for SMM carry many barriers and social challenges; thus, having the desire to become a parent does not always equate to an intention or likelihood to become one [6, 15]

Previous studies have found that a gap exists between parenthood desire and intent among LGBTQIA+ groups, in which sexual minority individuals tend to have lower parenthood desire or intent than their heterosexual counterparts [15, 16]. The gap is more profound in SMM, likely due to the substantial efforts involved in using donor eggs and gestational carriers, and the financial costs required to achieve genetic parenthood [17]. On the other hand, procreation involving lesbian women usually only requires donor sperm. This may have contributed to the relatively small number of SMM seeking ART since its rise [18]. Additionally, inadequate knowledge of fertility and the currently available ART could be a barrier for SMM accessing fertility care. A United States (U.S.) study found that same-sex male couples seeking ART at an in vitro fertilization (IVF) center had inadequate knowledge of the female reproductive system and required more fertility education compared to heterosexual couples in the same program [19]. This is not a surprise, since studies have confirmed childless men in general have far less fertility and assisted reproductive knowledge than childless women [20, 21]. Further research is needed to assess the baseline knowledge among SMM recruited from the public domain to better understand this growing, yet underserved population.

Research conducted on SMM has historically focused on parenthood through adoption [22], fostering [23], or children from a previous heterosexual relationship [24]. Within the small body of research on SMM and couples pursuing or having children through ART, the focus was on their treatment experiences and outcomes [17, 19], and relationship issues following gestational carrier birth [8, 25]. Undoubtedly, the parenthood intent among SMM utilizing ART to have children was already present. When investigating same-sex male families formed through third party reproduction [8], no difference in parenthood desire was found between genetic and non-genetic fathers, and most fathers were satisfied with their gestational carrier journey. Additionally, an Israeli questionnaire found that same-sex parents who had used ART did not differ from their heterosexual counterparts in their desire for more children and their ideal number of children [26]. However, the current body of research on same-sex parenthood through ART is limited in generalizability, with the majority of studies centered on same-sex female couples having children through sperm donation [6, 27]. There is a need to understand better the reproductive desire of SMM recruited from the LGBTQIA+ community, outside of the subset of SMM in the fertility care network such as IVF clinics or gestational carrier agencies.

This exploratory study aimed to examine (1) the parenthood desire and preconditions to achieving parenthood among childless cisgender SMM living in Canada; (2) the socio-demographic characteristics associated with parenthood desire among SMM; (3) sexual identity and perceived stigma on SMM having children; and (4) factors associated with fertility and assisted reproductive knowledge among SMM recruited from the public. The findings of our study could be used to improve SMM’s assisted reproductive knowledge and accessibility of parenthood, therefore advancing the family-building equality of this population.

Methods

Study design

This study used an exploratory, cross-sectional survey design method to collect data from SMM with the following eligibility: (i) age 18+, (ii) cisgender male, (iii) self-identified as a sexual minority, (iv) no children, and (v) live in Canada. Institutional research ethics approval was obtained (Veritas #3014) prior to data collection using an online survey administered through SurveyMonkey™ from March to June 2023 (14 weeks). Multiple recruitment strategies through convenience and snowball sampling methods were used to recruit potential survey participants. Various channels were used, such as Facebook, Instagram, a project-specific webpage, word of mouth, and hand-delivered printed flyers to shops and restaurants located in LGBTQIA+ communities. The cover page of the online survey served as a consent form to describe the risks and benefits of survey participation. Participation in the study was voluntary and anonymous. Potential participants were required to check a mandatory box to confirm their eligibility before proceeding to the survey page. Participants were offered an option to participate in a lucky draw voluntarily for a chance to win one of the ten $50 gift cards.

Survey construction

A 78-item study-specific survey was developed based on the research team’s clinical experience and a comprehensive review of relevant research literature on the study topic (Supplementary Table 1). The survey had 72 close-ended questions and six open-ended questions grouped into four main sections: (i) socio-demographics (15 questions); (ii) parenthood desire, preconditions, and plans (24 questions); (iii) knowledge of fertility and ART (15 questions); and (iv) sexual identity and disclosure, and perception of social stigma (24 questions). Although all the questions were mandatory, a category “prefer not to answer” was included where possible, allowing participants an option not to respond in accordance with research ethics. The survey was reviewed by a team of diverse staff and health professionals with experience in ART and fertility education for content and face validity. Eight LGBTQIA+ individuals’ pilot-tested the survey to ensure all the questions were asked sensitively, the categories in the multiple-choice questions were inclusive, and the survey length was appropriate. The survey included the following three validated scales with established psychometric properties to measure sexual identity, LGBTQIA+ community connectedness, and vigilance of discrimination due to sexuality. The scales were adapted by replacing the words “LGB” with “LGBTQIA+” and “gender” with “sexuality.”

  1. i.

    Identity Centrality sub-scale (Lesbian, Gay, Bisexual Identity scale) is a 4-item 7-point Likert scale from 1—“totally disagree” to 7 “totally agree” (lowest to highest: 1–28). Higher scores mean higher importance of sexual identity and sexual orientation as a focal point of an individual’s life. Cronbach’s alpha was 0.69. [28].

  2. ii.

    Community Connectedness sub-scale (Gender Minority Stress and Resilience Measure) is a 5-item 5-point Likert scale from 1—“strongly disagree” to 5—“strongly agree” that measures individuals’ connectedness to the LGBTQIA+ community (lowest to highest: 1–25). Cronbach’s alpha was 0.76 [29].

  3. iii.

    Abbreviated Heightened Vigilance sub-scale (Everyday Discrimination Scale) is a 4-item 6-point Likert scale from 1—“less than once a year” to 4—“almost every day” (lowest to highest: 1–16). Higher scores mean a higher effort to protect oneself from discrimination. Cronbach’s alpha was 0.86 [30].

Statistical analysis

Quantitative data were analyzed by SPSS v.28 (IBM Corp., Armonk, NY, USA). “Prefer not to answer” responses were treated as missing data and were excluded from statistical analyses. A knowledge total score was calculated by summing the total number of correct answers from a list of 13 questions testing participants’ knowledge of fertility and ART (lowest-highest possible score, 0–13). Some ordinal and nominal variables were collapsed when reporting the frequency distribution in tables. Sample characteristics were examined by descriptive statistics, reliability tests, Spearman’s rank-order correlation, cross-tabulations, and chi-square tests using collapsed scales. The 5-point parenthood desire by any means was assessed as a dependent variable by t-tests and one-way ANOVA with post hoc tests. Bivariate linear regression and hierarchical multivariate linear regression models were used for knowledge assessment, using the full scales of ordinal variables and collapsed nominal variables as predictors. Model assumptions were confirmed before proceeding with statistical interpretations. All statistical tests were two-sided, and a p<0.05 was considered statistically significant. During the study period, over 160 people clicked the survey hyperlink. After excluding ineligible participants and incomplete surveys that were aborted before submission, 112 fully completed surveys were used for analysis. Ninety-five free-text comments collected from the surveys were organized by the second author using Excel to extract codes surrounding perceived barriers to achieving parenthood. The codes were then reorganized into a group of mutually exclusive themes, using words from the illustrative quotes if feasible. The first three authors reviewed and discussed the extracted codes and themes until consensus was reached to finalize the data structure.

Results

Sample description

Tables 1 and 2 summarize the socio-demographics and levels of sexuality openness of the 112 SMM who completed the whole survey. The mean age of participants was 33.2±8.5 and the majority of them were within the age range of 30–39 (n=48, 42.9%). Most of them were white (n=65, 58.6%), identified as gay (n=77, 68.8%), university-educated (n=79, 71.1%), or had a cisgender male partner (n=68, 61.8%). While the majority lived in Canada from birth (n=65, 58.0%), less than half (n=50, 45%) came from a family whose parents were both born in Canada. Almost two-thirds were “quite”/“very much” open about their sexuality in daily life (n=70, 64.2%), with full disclosure to the entire family (n=72, 64.9%). Two-thirds (n=72, 66.1%) indicated family acceptance (“quite”/“very much”) of their sexual orientation.

Table 1 Participants’ socio-demographics and parenthood desire (N = 112)
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Table 2 Participants’ sexuality openness and perceived parenthood stigma (N = 112)
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Parenthood desire, preconditions, and preferable paths

As shown in Table 1, having children by any means was “quite”/“very much” important to more than a third of participants (n=39, 34.8%) or their parents (n=47, 42.0%). Another 27.7% (n=31) indicated it was “quite”/“very much” important to have a child genetically linked to themselves or their partner. Forty-four percent (n=48) indicated it was “likely” for them to achieve parenthood in the future, and 39.6% (n=44) felt ready to have children in the age range of 30–39. Among a list of seven parenthood preconditions (Fig. 1), financial readiness (85.7%) and relationship stability (81.9%) were the two most “important” considerations. The most “likely” parenthood paths chosen by participants were with a cisgender male partner (n=62, 59.6%), either through adoption (n=54, 50.0%) or egg donation/gestational carrier (n=50, 49.0%) (Fig. 2).

Fig. 1
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Participants’ rating of parenthood pre-conditions (N = 112)

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Fig. 2
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Participants’ rating of preferable parenthood paths (N = 112)

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Bivariate analyses were conducted using all the socio-demographic variables in Table 1 to examine what characteristics were associated with parenthood desire. The means of parenthood desire were significantly higher among participants who were under age 30, compared to the age 30–39 and age 40+ groups (3.2±1.3 vs. 2.9±1.4 and 2.1±1.2, p=0.008), non-white compared to white (3.2±1.3 vs. 2.6±1.4, p=0.017), or no sibling compared to had siblings (3.4±1.3 vs. 2.7±1.4, p=0.024). A higher proportion of white participants ranked parenthood desire as “not at all”/“not quite” important (55.4% vs. 23.9%, p=0.004) and were more “unlikely” to pursue parenthood (68.3% vs. 37.8%, p=0.002), compared to non-white participants.

Perceived parenthood stigma

As shown in Table 2, over half of the participants perceived parenthood stigma (“quite a lot”/“very much so”) existed in Canada against same-sex male couples (n=57, 51.3%) and non-heterosexual single men (n=63, 56.7%), respectively. Table 3 summarizes the key themes of free-text comments related to participants’ parenthood desire and perceived barriers to achieving parenthood. Although parenthood desire had existed for some participants since childhood and persisted as a factor in major life decisions, many commented that it was difficult for SMM to pursue parenthood. Barriers, such as financial costs, increased age, lack of a partner, lack of fertility knowledge, social and religious stigma towards same-sex male parenthood, and SMM in non-monogamous relationships, all played a factor.

Table 3 Participants’ free-text comments of parenthood desire and perceived barriers to achieving parenthood
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Sexual identity centrality, community connectedness, and vigilance of discrimination

The mean total scores of the Identity Centrality, Community Connectedness, and Abbreviated Heightened Vigilance subscales were 18.4±5.0, 17.4±4.0, and 10.9±4.3, respectively, and all three means were within the moderate range of the corresponding subscales (see Supplementary Table 2). The correlation matrix in Table 4 shows that these three standardized subscales correlated significantly with participants’ levels of sexuality openness in daily life: the Identity Centrality subscale (rs(107)=0.242, p<0.05), the Community Connectedness subscale (rs(106)=0.358, p<0.001), and the Abbreviated Heightened Vigilance subscale (rs(106)=−0.38, p<0.001). Furthermore, perceived parenthood stigma on same-sex male couples correlated positively with perceived parenthood stigma on non-heterosexual single men (rs(111)=0.629, p<0.001), the Identity Centrality subscale (rs(109)=0.227, p<0.05), and the Abbreviated Heightened Vigilance subscale (rs(108)=0.228, p<0.05). Perceived parenthood stigma on non-heterosexual single men correlated positively with the Abbreviated Heightened Vigilance subscale (rs(108)=0.197, p<0.05).

Table 4 Correlation matrix of perceived stigma, sexuality openness, identity centrality, community connectedness, and vigilance of discrimination (N = 112)
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Fertility and assisted reproductive knowledge

Fig. 3 shows participants’ responses to a list of 13 questions assessing their fertility and assisted reproductive knowledge. The mean total knowledge score was 6.05 ± 2.2 (range: 1–12). Fifty-seven percent (n=64) answered less than half of the questions correctly and no one answered all questions correctly. Despite that, over a third (n=38.4, 43.0%) self-appraised their knowledge level was “above basic” (Fig. 4). Participants’ most popular sources of receiving “above basic” knowledge (Fig. 5) were the internet and social media (n=54, 48.2%) and friends (n=45, 40.2%).

Fig. 3
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Percentages of responses to a list of 13 questions assessing participants’ fertility and assisted reproductive knowledge (N = 112)

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Fig. 4
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Participant’s self-appraisal of fertility and assisted reproductive knowledge (N = 112)

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Fig. 5
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Participant’s sources of acquiring fertility and assisted reproductive knowledge (N = 112)

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A hierarchical linear regression model (Table 5) was used to identify significant factors predicting fertility and assisted reproductive knowledge. Univariate linear regression was conducted first using all the variables in Tables 1 and 2. The 12 variables that were found to be significant at p<0.05 cut-off (see last column) were then grouped in a clinically meaningful way for the block-entry hierarchical linear regression model to examine the isolated effects of socio-demographics (block 1), sexuality (block 2), and SMM having children (block 3). The final hierarchical regression model explained 43% of the variance in the knowledge scores (R2adj =0.353), with 24.7% variance contributed by the socio-demographics variables in block 1, 7% by the sexuality variables in block 2, and 11.2% by the SMM having children variables in block 3. Significant predictors in the final model included the levels of (i) education (β=0.37, p<0.001), (ii) family acceptance of sexual orientation (β=0.39, p=0.004), and (iii) parenthood desire by any means (β=0.27, p=0.002).

Table 5 Hierarchical linear regression model of fertility and assisted reproductive knowledge (N = 112)
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Discussion

This study provides novel empirical findings of the parenthood desire, parenthood preconditions, and knowledge of fertility and ART among childless cisgender SMM recruited from the LGBTQIA+ community outside the fertility care circle. Our findings fill some of the research gaps regarding this growing, yet understudied population, and shed insights into the barriers confronting SMM in achieving parenthood.

Parenthood desire

Over a third (36%) of our surveyed SMM ranked it as important for them to have a child by any means and 44% indicated their likelihood to pursue parenthood. These findings align with two large-scale U.S. studies that show 54-56% of childless gay and lesbian adults expressed parenthood desire [15, 16] and 30% expressed both parenthood desire and intent [15]. Our study also found that SMM with certain demographics, including being non-white, under age 35, or growing up without siblings, had a significantly higher parenthood desire compared to the others without these characteristics. Existing LGBTQIA+ research [15, 16] has identified the associations of parenthood desire, age, and ethnicity, in which younger individuals with ascribed racial identities had higher parenthood desire compared to others. It is plausible that younger sexual minorities are not only coming out earlier, but they are more likely to include parenthood in their life plan than previous generations [10]. Furthermore, our sample consisted of SMM with diverse ethnicity and cultural orientations, as evidenced by a mixture of SMM being non-white (41%), identifying their ethnicity as non-mainstream (51%), did not live in Canada since birth (42%), or had one or both parents born outside of Canada (55%). Studies exploring the impact of sociocultural contexts on parenting aspirations within the LGBTQIA+ communities [31, 32] have found sexual minority groups from familistic and pronatalist countries, such as Portugal and Israel, exhibited higher levels of parenthood desire and intent compared to those who were from more individualistic societies like the UK [31]. Notably, white SMM participants in our study had a significantly lower parenthood desire and were significantly less likely to pursue parenthood than non-white groups, potentially reflecting the individualistic nature of Canada as a country.

Relationship factors as parenthood preconditions

Previous studies have shown that self-imposed preconditions for parenthood may cause a delay in, or failure to reach family-building goals for both heterosexual and same-sex couples [19, 20]. Furthermore, sexual minority individuals tended to have less harmonious relationships with their parents than heterosexual counterparts contributed by conflictual views on sexuality, making it difficult for SMM to benefit from the emotional support and practical childcare assistance that families can offer when taking on parenthood [33]. Commonly reported parenthood preconditions for SMM are achieving financial stability prior to family-building [10, 34], finding a committed partner to raise children with, and having supportive families who accept their sexual orientation [17, 19]. Similar findings were shown in our study that relationship stability (82%) was the second most important parenthood precondition following financial readiness (86%).

Financial barrier to achieving parenthood

In this study, the most preferable paths for SMM to achieve parenthood were through third-party reproduction (49%), adoption (50%), and/or with a cisgender male partner (60%). However, 56% of our participants indicated that it was unlikely for them to achieve parenthood, with free-text comments including social stigma and financial obstacles associated with adoption, ART, and third-party reproduction. While finances are a known precondition for parenthood considerations applying to all prospective parents [34, 35], the additional financial burdens of adoption or ART can have a pronounced impact on SMM that may lead to a substantial parenthood delay or a failure to achieve parenthood—despite the desire to do so at a younger age. Studies conducted within the fertility network have found most same-sex male couples pursuing ART came from financially privileged households who could afford the costs of third-party reproduction [17, 36]. This may explain the reason why SMM (2.1%) were eight times less likely to live with young children compared to heterosexual men (17.7%) reported in the latest Canadian census [2]. Furthermore, the Canadian Census also shows that 7.8% of lesbian women, in contrast to 2.1% of SMM, lived with young children in Canada [10], highlighting that SMM were less likely to be parents. This is likely due to the additional costs incurred when using donor eggs and gestational carriers, whereas lesbian women require only donor sperm and oftentimes gestate and birth their own children. Since finances act as both precondition and barriers to achieving parenthood as we have shown, reducing financial burdens for SMM through government financial subsidies and/or sponsorship programs could improve their parenthood accessibility and promote family-building equality for this population.

Perceived stigma on SMM having children

Stigma against SMM having children exists in heteronormative assumed societies, manifesting in biases held by adoption agencies, denial of same-sex paternity leave, and legal obstacles in obtaining birth certificates [10,11,12]. Studies on same-sex couples forming families through ART have revealed that social stigma is not only a barrier to achieving parenthood but also a daily challenge for same-sex parents [37, 38]. Interestingly, our findings show a significant correlation between perceived stigma on parenthood among same-sex male couples and non-heterosexual single men (see Table 4), suggesting that the stigma experienced by SMM is closely linked to sexuality rather than same-sex male couple appearance. Additionally, our data showed that perceived social stigma against same-sex male couples having children correlated significantly with how alert SMM men were to discrimination, the perceived centrality of being an SMM to their identity, and their perception of parenthood stigma against non-heterosexual single men having children. It is plausible that individuals who strongly associate their sexuality with their identity may perceive themselves as targets for discrimination, potentially resulting in heightened vigilance and subsequently, a decreased desire for parenthood due to fear of social backlash.

Knowledge of fertility and ART

Health literacy is instrumental in optimizing health outcomes, in which poor health literacy contributes to health disparities and limited access to healthcare [20, 39]. Participants in this study were SMM recruited from the LGBTQIA+ community in the public domain outside the fertility care circle. With 57% answering less than half of the questions correctly and no one answering all questions correctly, our findings show that many SMM had inadequate knowledge of fertility and ART. Additionally, our hierarchical regression model found that education level was one of the three significant predictors associated with SMM’s fertility and assisted reproductive knowledge, thereby confirming that SMM with a lower education level had a greater knowledge deficit. More concerningly, 56% of participants responded “False” or “I don’t know” when asked whether SMM have legal rights to ART (see Fig. 3). While lack of knowledge on available paths to parenthood may impact SMM’s accessibility to assisted reproductive care and their ability to make informed family-building plans, thinking fertility care is not legally available to SMM transcends a gap in knowledge by solidifying the misconception that parenthood is impossible due to legal restrictions. This sentiment echoes comments from same-sex male couples participating in a gestational carrier study who thought it was simply not possible to have children as SMM, and until learning it was feasible, they did not consider possible options of using ART to achieve parenthood [40]. Furthermore, two of the three significant predictors of SMM’s fertility and assisted reproductive knowledge were related to viewing parenthood as a possibility: (i) family acceptance of sexual orientation and (ii) parenthood desire by any means. Family acceptance of sexual orientation may directly influence the perception of parenthood as something attainable through having support and fewer social barriers. When parenthood seems unachievable, parenthood desire may decrease leading to less motivation to improve assisted reproductive knowledge regarding available options for SMM.

Strengths and limitations

A key strength of this study was that the survey participants were recruited in the LGBTQIA+ community across Canada outside the fertility network. Additionally, our sample comprised a mixture of socio-demographically diverse groups of SMM from a racial, ethnic, relationship status, and immigration history. However, this cross-sectional online survey-based study has several limitations that could impact the generalizability of the findings. Firstly, response bias is possible due to voluntary survey participation. SMM who chose to complete the survey in response to recruitment flyers may have had more personal interest in fertility and family-building matters than non-respondents, although a direct comparison was not possible due to the lack of a control group. Secondly, there might have been a subjective aspect to the participants’ descriptions, but further clarification was not possible due to anonymous participation. Thirdly, eligibility of participation was self-confirmed by participants without in-person evaluation of participants’ identity. Finally, a cross-sectional design has limitations in establishing the causality of variables in statistical analyses, which may have limited our data interpretation regarding contributing factors of race, culture, sexuality, and perceived social stigma in influencing parenthood desire. Nonetheless, this study contributes important data to the paucity of research on the family-building needs of SMM and, to our knowledge, is the first study assessing the knowledge base of fertility and ART among childless SMM recruited from the public domain.

Conclusions

Although childless cisgender SMM in this study expressed a desire for children, factors such as financial and relationship stability, perceived social stigma, and knowledge base of fertility and ART caused a gap in parenthood desire and intent which impeded the actualization of parenthood in this population. Inadequate fertility knowledge and misconceptions surrounding SMM’s legal rights to access ART create health disparities among SMM, thereby hindering their realization of parenthood goals. In addition, the perceived social stigma associated with same-sex male couples having children in predominantly heteronormative societies may deter some SMM from pursuing parenthood to avoid being a target for discrimination. With an increasing number of SMM desiring children, it is vital to advance family-building equality through improving their assisted reproductive knowledge, removing barriers to accessing adoption and ART, and abolishing stigma against same-sex parenthood in society. Programs geared to the needs of SMM are much needed to improve their knowledge of ART and family-building options. Normalizing SMM parenthood through public education along with providing community resources to sexual minority groups throughout parenthood before and after having children could encourage more SMM to pursue parenthood, thus augmenting their parenthood representation in society.