For women in same-sex relationships who are thinking about starting or growing their family, one of the biggest decisions can be: who will carry the baby?
There is no single answer that is right for every couple. Fertility health, age, personal preferences and how each partner would like to be involved can all play a part in deciding which pathway feels right.
I recently spoke with Women’s Agenda about the fertility options available to same-sex couples, including IUI, IVF, reciprocal IVF and donor sperm treatment, and why both partners should feel included in conversations about building their family.
Deciding who will carry the pregnancy
For some couples, deciding who will carry the pregnancy or provide the eggs can be an important part of planning their family.
One option is reciprocal IVF, also known as shared IVF. With reciprocal IVF, one partner provides the eggs and the other carries the pregnancy. This means one partner has a genetic connection to the embryo, while the other has a pregnancy and birth connection.
For some couples, this can feel particularly meaningful because both partners have a biological role in creating their family. For others, reciprocal IVF may not be medically necessary or they may prefer a more straightforward pathway to pregnancy.
There are also medical and fertility factors to consider. Age, ovarian reserve, medical history, sperm donor availability and any other fertility factors affecting either partner can all help inform an appropriate treatment plan.
Beyond fertility health, it is important to consider your emotional and relational needs, how much each partner would like to be involved in the physical process, how much time you have and how many children you would like to have.
IVF isn’t the only fertility treatment option
A common misconception is that IVF is the first or only fertility treatment available to women in same-sex relationships. This isn’t always the case.
For some women who have no fertility issues, are regularly ovulating and have open fallopian tubes, intrauterine insemination (IUI) may be an appropriate treatment to start with.
IUI involves placing donor sperm into the uterus so the egg and sperm can meet within the body.
IVF involves collecting eggs and inseminating them with sperm in the laboratory to create an embryo, which can then be transferred into the uterus.
IVF may be recommended for circumstances including age-related fertility issues, tubal factors or previous unsuccessful treatment cycles.
The appropriate pathway will depend on your individual circumstances, which is why speaking with a fertility specialist can help you understand your options and develop a treatment plan based on your needs.
Understanding your donor sperm options
Same-sex couples may also need to consider their options for donor sperm.
This could involve a known donor, such as a friend or someone within your social circle, or a clinic-recruited donor. If you are considering treatment in Victoria, you can learn more about donor sperm treatment in Victoria, including the different donor and treatment options available.
In Australia, there is no anonymous sperm donation in the traditional sense. Donor-conceived children can request identifying information about their donor once they become adults, regardless of whether the donor was previously known to their family.
This is why I generally refer to an “unknown donor” as a clinic-recruited donor.
Clinic-recruited donors are recruited through a sperm bank or fertility clinic and undergo infectious disease screening, genetic screening, counselling and consent processes within a regulated fertility practice setting.
A known donor is typically someone the couple already knows. For some couples, knowing the identity of their donor can be meaningful, including when thinking about the relationship their child may have with their donor as they grow up.
Known donor arrangements require careful counselling and consideration of the relevant legal framework. I recommend undertaking known donor sperm treatment through a formal fertility practice rather than DIY home insemination, so important legal, counselling and health considerations can be addressed before treatment.
There are also limits on the number of families that can be created using sperm from each donor in Australia. These requirements vary between states and can affect the donor options available.
You don’t need to have all the answers yet
Starting or growing your family can involve many decisions, and you do not need to have everything worked out before seeing a fertility specialist.
Your first appointment can simply be an opportunity to map out the options available to you.
Taking the time to consider your fertility health, your family goals and how each partner would like to be involved can help you make a decision that feels right for you.
Most importantly, both partners should have the opportunity to feel informed, heard and included throughout the process.
I spoke with Women’s Agenda about these decisions and the different pathways available to same-sex couples considering starting or growing their family.
This article provides general information only and does not constitute personalised medical or legal advice. Please speak with your fertility specialist about your individual circumstances.