Date of Award

June 2017

Degree Type


Degree Name

Doctor of Philosophy (PhD)




Janet Wilmoth


Assisted conception, Assisted reproduction, Assisted Reproductive Technologies, Conception Disclosure, Fertility treatment, Sexuality

Subject Categories

Social and Behavioral Sciences


This dissertation uses data from an original online survey including a diverse sample of individuals across different sexual and gender identities, who have given birth to at least one child successfully conceived using ART (N=114). I use a mix of qualitative and quantitative techniques to examine parents’ experience undergoing fertility treatment as well as conception disclosure. My research has two overall research objectives: first, to explore and analyze variations in the experience of fertility treatment process based on sexual identity; second, to examine differences in attitudes towards conception disclosure as well as disclosure importance and behaviors based on sexual identity. I engage mostly a conflict, feminist and medical consumerism frameworks to discuss individual experience and behavior within the medical encounter for fertility treatment. I also use symbolic interactionism and communication privacy management theory frameworks to gain insight on conception disclosure processes.

My findings highlight that some individuals felt the process of ART was depersonalized, regimented, and homogenized, which left them feeling disempowered and disaffected. These participants responded in multiple ways by empowering themselves through research about different options, approaches, and techniques; they questioned physician expertise; demanded inclusion in determining treatment plans; and at times, decided to discontinue their service relationships. The discontinuation of service is an important form of resistance for fertility patients who felt marginalized during the process or minimized to their biological and reproductive capacity. In this way, my research shows that fertility treatment is not exempt from medical consumerist behaviors. Individuals are agentic medical consumers who act as medical associates during the process of fertility treatment. Participants’ retelling of their experiences provides counter narratives to the patient-as-passive-recipient model of healthcare and responds to some feminist concerns. The overall experience during the treatment process did not differ based on sexual identity, however sexual minority persons had some unique experiences stemming from heteronormative structures.

My data also show that parents were more inclined to disclose to family, close friends and physicians but practiced more restraint when sharing with other persons. When it comes to conception disclosure to the child, among other reasons, parents felt it was important to demonstrate to the child they were wanted and to transfer aspects of the child medical history. They also thought disclosure was necessary to fight shame. In this dissertation, I argue that individuals make decisions about conception disclosure in response to social norms. More specifically, I make the claim that parents are engaged in subversive disclosure to disrupt dominant opinions about assisted reproduction as unnatural and children conceived through ART as “synthetic” or different. Thus, my research recognizes that individuals are embedded in social systems that ultimately influence their decisions concerning disclosure. I observed nuanced differences based on sexual identity; which lead me to argue that heterosexual identified persons were more likely to restrict conception disclosure in comparison to sexual minority persons.

Based on conception disclosure timing strategies I categorize persons as intentional early initiators or opportunistic seguers. I also grouped participates into two categories based on their conversational approach to disclosure: those who are straight talkers and those engaged in creative dialogue. Still conception disclosure can be overwhelming, leading some parents to create their own patchwork, hybrid approach. Sexual minority parents’ disclosure practice differed from heterosexual identified persons in one key way; specifically, sexual minority persons constructed the content to emphasize different family structures and the way families are created.


Open Access