Starting a family as a same-sex couple

Thanks to advances in fertility treatment and recent legislative changes, it’s very feasible for same-sex couples to have a family. But with the unique fertility challenges that same-sex couples face, what is an incredibly exciting time can also be a bit daunting. Rest assured that there are fertility specialists out there, like myself, who are experienced at providing fertility treatment for gay or lesbian couples and can give you the special level of guidance and support that you need.

I have been fortunate to help a number of same-sex couples have a baby, and the journey for every couple is different. For a gay or lesbian couple, I draw on the same fertility treatments that I use for heterosexual couples or single women, such as IVF, intrauterine insemination (IUI) and donor sperm. To help you understand the process it could take for you and your partner to have a baby, I’ll describe a few different scenarios that I have used for my patients to achieve their dream of starting a family.

There are various fertility treatments for same-sex couples

A lesbian couple wants to have a baby and they have a friend who has agreed to be their sperm donor. What are their options?

There are a few different fertility treatments that could be used to help this couple become pregnant. Firstly, I’ll make the point that women in same-sex couples face the same fertility issues as all other women – that is, the amount and quality of a woman’s eggs declines with age and women with certain conditions (e.g. PCOS or endometriosis) may have difficulty getting pregnant. I generally recommend doing some initial tests to assess each partner’s chances of becoming pregnant and whether any additional treatments are required.

The couple then needs to decide whose egg will be used and whether the same woman will carry the baby during the pregnancy. This decision dictates the type of procedure we will use. ‘Assisted conception’ can be used when the same woman whose egg is used will also carry the pregnancy. There are a few different assisted conception techniques. Essentially, these all involve a fertility specialist performing a procedure to place the donor sperm inside the woman’s body to facilitate fertilisation.

The other scenario, where both mums play a role in the pregnancy, requires assisted reproductive technology (ART). ART is where fertilisation occurs outside the body in a lab setting – the best-known type of ART is IVF (see below).

Let’s say in this instance the couple has decided to go with assisted conception. Both mums, and the donor, need to go through counselling and provide consent before we can initiate any treatment. This is so that everyone involved in the process understands the implications of the situation. For example, even though the donor is ‘known’, they still need to understand that their information will be accessible to the child from age 18.

The couple can choose to have screening performed to test whether the donor sperm carries medical and/or genetic diseases that could be passed on to the child. Provided the results of screening are negative, we’ll then proceed with treatment.

The most common assisted conception procedure I perform is intrauterine insemination (IUI), which takes about as long and feels similar to a pap smear. This fertility treatment is available to couples where the woman is 40 or younger. During the insemination procedure, a very fine tube (about 1mm in diameter) delivers the prepared sperm through your cervix and directly into your uterus. The procedure will be timed to coincide with ovulation and you may need to take some hormones to increase your chances of becoming pregnant.

As an alternative, the couple could choose to perform ‘home insemination’, rather than coming into the clinic for IUI. This involves you tracking the timing of your ovulation and inserting the fresh donor sperm using a small syringe. Home insemination has the advantage of being economical and convenient but lacks the protection against infectious diseases that IUI can provide.

How can a fertility specialist help a lesbian couple who want to share the pregnancy and require donor sperm?

When both mums are physically involved in conceiving the baby, it’s known as ‘partner IVF’ – one mum will undergo ovary stimulation and egg retrieval (steps 1 and 2 of the IVF process), the egg and donor sperm will then be fertilised in a lab and the embryos are grown (steps 3 and 4) before being transferred into the womb of the other mum (step 5). The woman who is carrying the pregnancy will take hormones in the lead-up to the transfer of the embryo to prepare her body for pregnancy.

When a couple requires donor sperm, I can help them through the process of finding and choosing a donor. All ‘clinic-recruited’ donor sperm (i.e. unknown to the recipient) is rigorously tested and quarantined for several months before use. Upon donating sperm, the donor consents to identifying information being accessible by the child at age 18.

Counselling is also an important part of the process – it ensures that the couple has had a chance to fully understand the implications of using donor sperm and what it means for their future child.

How can a fertility specialist assist a gay couple who want to have a baby?

Helping a gay couple have a baby is more complex because it requires surrogacy, but it is possible. While surrogacy is becoming more accessible in Australia, it is still difficult for a few reasons:

• The couple must find a surrogate themselves – unfortunately, this is not something a fertility specialist can help with. The Victorian Assisted Reproductive Treatment Authority (VARTA) provides advice on finding a surrogate.
• By law in Victoria, the same woman cannot donate her eggs and be the surrogate. Therefore, couples must find a separate egg donor and surrogate.
• In Australia, surrogacy must be altruistic – a person cannot be paid to carry a pregnancy for you.
• The surrogacy process requires extensive counselling, psychological assessment, a consenting process, independent legal advice and health screenings.
• In Victoria, surrogacy cases need to be approved by a surrogacy ethics committee and a patient review panel.

As mentioned above, in addition to finding a surrogate, gay couples also need an egg donor. This can be someone you know or – unlike surrogacy – you can seek help from a fertility specialist to find one. For example, I can help my patients source a donor from the world egg bank
Once a couple has both an egg donor and a surrogate, they then need to decide whose sperm will be used to fertilise the egg. I recommend undertaking some fertility tests to check sperm quality before commencing treatment.

The fertility treatment used in this situation is IVF (from step 3 onwards). The dad’s sperm is used to fertilise the donor egg, and then the fertilised embryo is implanted into the surrogate’s womb to start the pregnancy.

Talk to a fertility specialist who understands your unique situation

These are just a few examples of ways that same-sex couples can achieve a pregnancy – the procedure that’s right for you as a couple will depend on your age, health, preferences and whether you have known donors or require assistance finding a donor.

My role as a fertility specialist is to not only perform the procedures that allow you to start your family, but also to help you understand your options and the expected success rates, and answer any questions you may have. I’ll also ensure that you feel adequately counselled before consenting to go through with any fertility treatment to help you have a baby.

Perhaps the most important message is that it’s never to soon to speak to a fertility specialist and find out what your options are. So if you feel ready to make an appointment and take the first step towards starting your family, call my rooms on (03) 9418 8299 or book online.