Stratified medicalization rerouted: Lesbian women's turn to IVF as pragmatic overmedicalization amid stratified reproduction.

Lesbian women's growing use of assisted reproductive technologies (ARTs) to pursue parenthood and their frequent marginalization compared to heterosexual couples in the process exemplify stratified medicalization. In China, where access to ARTs and sperm banks is restricted to married heterosexual couples, intended lesbian mothers have to rely on underground or overseas ART markets and face ongoing challenges in parenting, reflecting broader patterns of stratified reproduction. This paper examines the puzzling and underexplored prevalence of in vitro fertilization (IVF) among Chinese lesbian women compared to less costly, less physically demanding procedures such as intrauterine insemination (IUI), complicating existing understandings of stratified medicalization. Drawing on ethnographic research and qualitative interviews with 32 lesbian mothers and mothers-to-be, I show how regulatory and sociocultural barriers to lesbian motherhood paradoxically reroute many women toward IVF without medical indications, presenting a form of pragmatic overmedicalization. Three dynamics shape this process: constrained choices in circumventive markets; the optimization of reproductive possibilities through IVF in response to gendered expectations and heteronormativity; and the pressures of a "queer biological clock" shaped by delayed reproduction and fertility anxiety. This case contributes to theories of stratified medicalization by showing how individuals may engage in intensive clinical protocols as a negotiated response to structural inequalities.