Assisted conception for same-sex couples

Modern fertility treatment can help same-sex couples start or build their family. Although there are some unique biological challenges to overcome, it is now very common for same-sex couples to use assisted reproductive techniques (ART) to have a baby. In this article, we discuss the different fertility treatments available for lesbian and gay couples, how to access donor sperm and eggs, and options for egg sharing and surrogacy.

For lesbian couples

Your first step is to decide how you wish to access donor sperm. You will then need to select a method of bringing egg and sperm together, a process called insemination.

Donor sperm

There are two main ways of obtaining donor sperm: through a known donor or a clinic-recruited donor. Many fertility clinics maintain a sperm bank. For example, Newlife IVF has an on-site sperm bank with samples from local donors. We are also able to access donor sperm from an international sperm bank.

Using clinic-recruited sperm has several advantages. There are very clear-cut legal boundaries in place. The donor has no legal connection to the child, so they are ineligible for custody and do not pay child support. Additionally, the donor and the recipient do not know each other’s identity. However, details of the donor’s medical history, background and traits will be shared with you. Once your child turns 18, they can request information about the donor’s identity.

Another advantage of using a clinic-recruited donor is that the sperm undergoes a rigorous testing process before it is declared fit for use. Sperm samples are initially screened for quality, infectious diseases and genetic problems, before being frozen and quarantined. After three months, the donors are retested to ensure that the sample they provided is safe to use. The sperm is made available for use only after all of these checkpoints have been cleared.

The second alternative is to ask a friend or acquaintance to donate sperm. If you and your partner long for a child that is genetically related to you both, you may wish to approach a relative. Of course, the sperm donor cannot be related to the partner who will provide the egg and carry the baby.

A benefit of using a known donor is that you are aware of their background, appearance and other important traits. However, there is the potential for social and legal grey areas when using a known donor. For example, you and the donor might have conflicting expectations about their level of involvement in your child’s upbringing. It is important to set clear boundaries and discuss expectations with your donor before trying to conceive. You may wish to seek legal advice on the best way to do this.

If you do choose to use a known donor, we suggest involving a fertility clinic. We can check your donor’s sperm count and motility (movement) and recommend the most appropriate method of insemination with this in mind (discussed further below). Additionally, the sample can be thoroughly tested for safety in the same way we would test clinic-recruited sperm.

Insemination

The next consideration is how to introduce the sperm to your egg (or your partner’s egg). The most appropriate method will depend on several factors. These include the health and medical history of the partner who will carry the baby, the quality of the sperm sample you choose to use, and your specific circumstances and preferences.

The simplest method is home insemination, where sperm is injected into the vagina using a syringe at home. As this method is similar to natural fertilisation, it may be an appropriate option where sperm count and motility are normal. It is also the most cost-effective option. However, if the sperm donor or the partner who will carry the baby have fertility issues, other treatments are likely to be more appropriate.

Another option is intrauterine insemination (IUI). In IUI, the sperm sample is concentrated before it is used. This means that a very large number of sperm are introduced into the uterus directly after an egg is released, increasing the chance of fertilisation. In some cases, you may be advised to take medications to stimulate the release of an egg. This increases the chance of an egg being available at the time the sperm is introduced.

The final option is in vitro fertilisation (IVF). In IVF, several of your eggs (or your partner’s eggs) are introduced to sperm in laboratory dishes. Depending on your circumstances, intracytoplasmic sperm injection (ICSI) may also be recommended. In this procedure, the best sperm are selected and a single sperm is injected into each egg. ICSI is always used with clinic-recruited donors. However, if you are using a known donor with low sperm count and motility, ICSI may also be appropriate for you. Once the fertilised eggs have developed into embryos, one will be chosen for transfer into the uterus of the partner who will be carrying the baby. The remainder can be frozen and stored for future use, if required.

IVF is the most appropriate option for women with fertility issues. It may also be recommended if other insemination methods have been unsuccessful, or you’re in your late 30s, early 40s or beyond (when fertility naturally declines).

IVF also enables egg sharing, where an embryo resulting from one partner’s egg is transferred to the other partner’s uterus. This allows both partners to have a biological connection with their child – one partner conceives the child with their genetic material, the other partner carries and delivers the child. In this process, the partner donating the egg will take medications to help mature several of her eggs. These mature eggs will then be collected in the clinic. The partner who will receive the fertilised egg (embryo) takes the oral contraceptive pill to synchronise her cycle with her partner’s. She then takes medications to prepare her uterus for embryo transfer.

Before egg sharing can commence, both partners must undergo a health check and counselling. This may include blood tests and ultrasounds to check general health and fertility. It should be noted that egg sharing can involve a significant financial investment, as both partners require treatment.

For gay couples

To have a baby, you and your partner will need to find an egg donor and a surrogate. According to Victorian law, the surrogate and egg donor cannot be the same person.

Donor eggs

There are two options for obtaining donor eggs. You may choose to utilise a known donor, such as a friend or acquaintance, or a clinic-recruited donor. If both you and your partner want a genetic connection to your child, you may wish to approach a relative of the partner whose sperm is not being used.

In Australia, egg donation must be altruistic. That is, the egg donor cannot be financially compensated. Donor eggs and sperm will be introduced to each other using IVF (discussed earlier in this article) with one of the resulting embryos then transferred to your surrogate’s uterus.

Surrogacy

You may wish to ask a friend, acquaintance or family member to be a surrogate. Like egg donation, surrogacy must be altruistic. However, ‘reasonable’ medical costs can be paid by you. It is important to note that multiple medical consultations, counselling sessions and legal advice are required for both you and the surrogate prior to proceeding. You will also need to seek permission from the Patient Review Panel (this is a legal requirement in Victoria), and the sperm or embryos must be quarantined. This process can take several months.

Seeking a surrogate overseas may also be an option. However, according to Australian law, this is only legal if it is altruistic. Be aware that this is a very expensive route and you will need to plan to potentially be overseas for a few months after your baby is born to organise their entry into Australia.

For specific advice on finding a surrogate, you may wish to seek legal advice and see a fertility specialist. IVF clinics are not permitted to help you find a surrogate. However, our counsellors can connect you with the Victorian surrogacy community and provide support and information as you look for a surrogate.

Note that sperm mixing, where sperm samples from both partners are mixed together and introduced to an egg, is not legal in Australia when using a surrogate.

Take the next step

If you are ready to begin your fertility journey, book an initial consultation with one of our fertility specialists. At this appointment, we will discuss your preferences and expectations, take a detailed medical history from both of you, then advise you on the best way to proceed.

If you attended our recent webinar on fertility treatment options for lesbian couples, you are eligible for a bulk-billed initial fertility consultation with one of our specialists. This means you can explore your options with no out-of-pocket costs.

To book a consultation, call (03) 8080 8933 or book online.