Guide to conceiving when you and your partner both have ovaries

There are a lot of things to consider when it comes to conceiving, and a few extra as a same-sex couple.

As a same-sex couple there is no ‘let’s just stop trying not to get pregnant’ — conceiving takes careful consideration, a lot of research, time, money, and emotional commitment.

While we’re happy to say conception via fertility treatment is possible for same-sex couples all over Australia, it’s not all easy.

‍The history of same-sex conception in Australia

To say Australia’s history with what has been deemed ‘social’ infertility is long and varied is an understatement.

While Victoria’s legislation around same-sex couples and single women’s rights to access Assisted Reproductive Technology (ART) came through in 2007, South Australia was nearly 10 years behind, only amending the Family Relationships Act of 1975 in 2017 [1].

For years, Australian legislation ruled that access to ART treatments was only credible in the case of medical infertility, and therefore same-sex couples and single women were not eligible because their infertility was a “social choice”.

Similar discrimination was in place for adoption throughout the country until 2017, which is enough to make your blood boil.

Thankfully, we’ve finally overcome this discrimination and same-sex couples have almost been given equal rights when it comes to conceiving.

As of the 2016 Australian Census data, 15% of same-sex couples have children, which is up from 12% in 2011, and that number has likely continued to increase in recent years as the final legislations have been lifted and stigmas are lessening [2].

In the same report, 25% of female-identifying same-sex couples reported having children as opposed to only 4.5% of male-identifying couples. This compares to 55% of opposite-sex identifying couples.

It’s hard to say if these low percentages are by choice or circumstance, but as things continue to improve, we hope to see those numbers continue to rise for all families that would like to bring children into the world.

If you and your partner are on that list, but you both have ovaries, there are a range of options for you to bring your dream child into the world.

There are a few key things to consider before getting started. Probably most prominently, which of you will carry the child, what donors you’ll use, and what process you choose for conception.

Who will carry the baby?

There are a few factors at play here, including if one partner wants to carry the child and the other doesn’t, or if one partner’s reproductive health is stronger for carrying. Your decision could also be based on other things such as age or medical conditions.

Obviously, the act of physically developing a child is precious, and it is understandable that if both partners are healthy and able, there will be some things to consider and decide on who will be the one to conceive.

There are other options as well. If you’re both able to, you could choose to simultaneously conceive and carry, i.e. have 2 babies at the same time. Or perhaps take turns, choosing one partner to carry the first child and the second partner to carry a second child later in life, if another child is part of your plan.

The good news is that there is a way for your child to be linked to both of you.

Reciprocal IVF

Reciprocal IVF is the process of extracting eggs from one partner to be fertilised and then implanted into the other partner [3]. This means that one partner is the birth mother of the child, while the other is the biological mother, giving each a unique and personal linkage to the child.

It’s important to note that in Australia, the birth mother is the recognised legal guardian of the child [4].

Female co-parents (even biological ones) will need to apply for a parenting order from the Family Court of Australia. Also, if the birth father is someone you know and choose to have in the child’s life as a co-parent, they’ll be recognised as a legal guardian.

What donors will you use?

When it comes to donors, there are 4 possibilities to consider:

1. Egg donors

Unfortunately, just because both of you have ovaries, it doesn’t mean you’re both fertile.

There are things you can do to boost your fertility, like maintaining a healthy weight, taking a supplement like Kin's Prenatal Vitamin, exercising regularly, and minimising your alcohol and coffee consumption.

However, you may still choose to get an egg donor, not only in cases of medical infertility but also genetic disease or damage to the ovaries from chemotherapy or surgery.

Most of the time, women receive egg donations through a trusted friend or family member, although in some cases there may be the chance to use a de-identified donor [5].

A de-identified donor is unknown to the recipient at the time of the donation, but under the law in Australia, all tissue donors must be willing to release identifying information to donor-conceived children when they turn 18.

These donors may be recruited through clinic advertisements. In some cases, they may be imported from international clinics as long as they meet all of the standards of Australian and New Zealand donor programmes (i.e. consent to releasing information to the child if requested).

Egg donors are subject to the same requirements as sperm donors in terms of medical screening, and psychological screening and counselling [5].

If you need a de-identified egg donor, your chosen fertility clinic will either be able to provide you one through their own recruitment programs, or they’ll be able to assist you in finding one.

2. Embryo donors

Another option is to conceive through the use of donor embryos.

Sometimes, when a couple has successfully conceived and completed their family through IVF treatment, they’ll have excess embryos available and they’ll be given the option to donate those to others who are struggling to conceive.

This option is beneficial if you’re both suffering from fertility issues and need both an egg donor and a sperm donor.

3. Sperm donors

Sperm donors can either be known or de-identified, which would be from a sperm bank.

De-identified donors are donors that are unknown to the recipient at the time of treatment, however, they’re not referred to as ‘unknown’ or ‘anonymous’ because, under law in Australia, all donor children are legally allowed to request donor information at the age of 18 [6].

If you choose a known donor, what will their involvement be in the baby’s life?

If you’re choosing a known donor, a trusted friend or a partner’s relative, there are a few variables to consider, like whether there is a family history of mental illness and disease. You will also want to set up and document a clear understanding of what the donor’s involvement will be in the child’s life.

It’s important to really get to the bottom of how you want the donor to appear in the child’s life and to set clear boundaries around that.

Sometimes, especially with family members or close friends, it can feel hard to stick to strict boundaries or feel weird to include legal contracts in your agreement.

However, if there are no legal contracts signed, there is the possibility that the donor could seek custody of the child down the line if something were to go wrong between you. These laws vary from state to state, so ensure you know your rights before starting the process.

Also, as previously mentioned, if you choose to co-parent with a known donor or have them in your life, they are considered by law as the legal father of the child and therefore have legal guardianship.

Perhaps this is the perfect scenario for you and could be exactly what you want, but if you don't want these kinds of arrangements, it’s important to consider what legal documents need to be in place to keep your family safe.

If you do go this route, clearly set out what their relationship to the child will be (if any), seek independent legal advice to help draw up any contracts needed, and ask them to undergo the necessary health screenings to ensure they aren’t carriers of any genetic diseases, which they can do through Sperm Donors Australia, who partners with City Fertility Clinic [7].

In some cases, women seek donor sperm from a loved family member to conceive with their partner’s egg. This gives both a genetic link to the baby and means you’ll already have a pretty clear understanding of the family's medical history.

4. De-identified donors

If you prefer to go this route, you’ll have the option to browse available donors from your chosen fertility clinic.

Donated sperm is subject to an extensive medical examination before being made available for use, and candidates are thoroughly screened on their medical history, as well as mental, personality, and more. Not to mention, donors of any kind are legally required to undergo counselling and fully understand all case scenarios of donation, including the legal rights of the child.

As is the case with any of these donation processes, there can be a large emotional impact, including the fact that the child is legally allowed to request donor information when they turn 18, and could essentially seek to contact their donor.

It’s important to understand the legislation around donation in your state, as some specifics and laws can vary.

Finally, simply so you have all of the information, we felt it good to include the fact that it is illegal in Australia to receive compensation for the donation of tissues, which includes sperm, eggs, and embryos.

What procedures are there?

Once you have decided who will carry your baby and whose eggs and sperm will make it, it’s time for the procedure itself.

There are 3 main ways for insemination to happen:

• Intracervical insemination (ICI)
• Intrauterine insemination (IUI)
• In vitro fertilisation (IVF)

Let's dive into each of these.

Intrauterine insemination (IUI)

During intrauterine insemination (IUI) your fertility specialist will insert sperm into the uterus. Having already overcome one barrier — getting past the cervix — the sperm has a slightly better chance of surviving, and reaching and fertilising the egg.

That said, there’s a bit more to it: the sperm still has a lot of work to do on its own. Without taking other factors into account, IUI is generally less successful than IVF overall.

Ovarian stimulation and IUI

IUI can be done in time with your body’s natural ovulation cycle, or through stimulated ovulation, using hormones to stimulate the ovaries and trigger ovulation.

If you don't naturally ovulate, then you’ll need to be prepared for this process.

You’ll be prescribed either an oral medication that encourages the body to produce more follicle-stimulating hormone (FSH) or you may simply take injections of the hormone itself. This will encourage your body to produce more eggs.

Even if your body ovulates normally on its own, you may choose, or be recommended, this process as it gives some control over the whole procedure.

IUI success rate

It’s important to note that the success rate of IUI is lower than that of IVF, but the Fertility Society of Australia reports that 60% of IUI patients will conceive within 6 cycles [8]. Just remember: there are a variety of factors that may influence success rate.

Intracervical insemination (ICI)

While technically this can be done at home (the turkey baster method, if you will) it’s not highly recommended as there are risks associated, including lack of control around donor sperm like knowing it’s been medically screened.

And while self-insemination is legal, it won’t be covered by laws governing in-clinic options [9].

For ICI, the embryologist in the lab will prepare the semen sample such that the best quality sperm is left behind, typically the most motile sperm. Once the pellet of sperm has been prepared, it is injected into the uterus. This procedure is very similar to having a pap smear.

The procedure itself is fairly non-invasive, so it shouldn’t create too much discomfort, other than some minor cramping. Sometimes, you will be prescribed progesterone to support the final stages of your cycle — but this does not always occur.

In vitro fertilisation (IVF)

IVF involves fertilising the egg and sperm outside of the body, in a specialised laboratory setting, and growing the fertilised egg (embryo) for an amount of time in a protected environment before transferring it to the woman’s uterus.

Generally speaking, IVF success rates are higher than IUI rates. This is accounting for the fact that the egg is already fertilised before entering the body, removing yet another barrier.

If IVF feels like the best option for you, here’s what you can expect throughout the duration of the procedure:

1. Hormone treatments

IVF coincides with your natural menstrual cycle, so on day one of your cycle, you’ll have your bloodwork done and then start hormone treatments 1-2 days after.

You’ll inject the follicle-stimulating hormone (FSH) yourself at home with an EpiPen-like device. Of course, your partner can do the honours if you prefer, giving you each an active role the whole way through.

These injections will stimulate your follicles, prompting them to produce multiple eggs (during your natural cycle, your body will usually only produce and release one egg per cycle). The injections will be administered daily for roughly 2 weeks, with your fertility specialist carefully monitoring the size of your eggs along the way.

When your eggs have reached maturity, you’ll be given what’s called a ‘trigger shot’, which is a hormone called Human Chorionic Gonadotropin, or hCG for short. This triggers your ovaries to mature and release the eggs.

2. Retrieval

Thirty-six hours later, your eggs are ready for retrieval.

The egg retrieval procedure is fairly simple, usually taking about 6-10 minutes [10]. You’ll be put under sedation and your fertility specialist will use ultrasound technology to very carefully guide a needle into each ovary.

Your eggs are really small and invisible to the human eye, so your specialist will use the needle to aspirate the fluid from follicles that look large enough to hold a mature egg.

Because your specialist team will have been carefully monitoring you throughout the hormone injection process, they’ll have a pretty good idea of how many eggs are ready to be extracted. The average number is about 8-15, but it depends on the individual situation. Once they’re finished, you’ll be transferred to recovery until you wake up from the anaesthesia. In most cases, another 30 minutes later, you’ll be ready to walk out of the clinic.

3. Insemination

Once your eggs have been successfully retrieved, they’ll be united with your chosen donor sperm and incubated overnight with hope that fertilisation will occur naturally.

In some cases, fertilisation may be done via intra cytoplasmic sperm injection (ICSI) when each sperm is injected manually into each egg. Some clinics have various guidelines on which insemination process is required based on the donor used.

4. Embryo transfer

The fertilised eggs are then incubated for several days, usually around 5, as this is deemed the most successful stage for the embryos to implant within the uterus [11]. That said, your timings and procedures may vary by a day or so depending on your clinic.

The final procedure is similar to a pap smear, so again, shouldn’t cause too much discomfort or need much recovery time.

Your surplus embryos will be frozen for use at a later time, or if needed in the next cycle of IVF.

One IVF "treatment" is the implantation procedure, while a full IVF cycle refers to the use of all fertilised eggs.

IVF success rates

IVF Australia reports a 34.9% success rate per embryo transfer leading to a live birth for women under the age of 30 [12].

This number gradually decreases through the age brackets falling to 31.3% for women aged 30-34, and 25.1% for women aged 35-40. However, for women aged over 40, that number is only 8.7%.

Each clinic will have its own success rates calculated using its patient data, but generally speaking, Dr Karin Hammarberg, Senior Researcher at Monash University and the Victorian Assisted Reproductive Authority (VARTA), reports that IVF has a success rate of about 20% for women under 35, and only about 10% for women over 40 [13].

It’s also important to note this specific data accounts for ‘fresh’ embryo transfer only, meaning the first treatment of the IVF cycle, and success rates are slightly higher for subsequent treatment cycles.

How much do these treatments cost?

The cost of your treatment will depend on your chosen clinic, but generally speaking, an IVF cycle will cost around $10,000 and a cycle of IUI costs just over $2,000.

Medicare and private health cover is available to you, as well as SuperCare, but unfortunately there are some barriers still in place for those deemed ‘socially’ infertile.

Medicare and private cover

While our country seems to finally be catching up on simply being a bit more accepting and open-minded, not everything is moving as quickly as we’d like.

This means that if someone is deemed ‘socially’ infertile, i.e. they aren’t able to get pregnant naturally due to their sexual preference, they can’t access Medicare benefits until after their first round of unsuccessful treatment [14].

As ridiculous as it is, unfortunately, it’s still the case as of now. So it’s something to keep in mind as you start your journey towards conception.

SuperCare

Most IVF clinics also offer SuperCare as a payment option, giving you early access to your superannuation as a means to pay for your treatments.

However, in the case of same-sex couples, there are a few parameters in place that will need to be overcome to prove the couple needs access to their super fund [15]. Essentially, you’ll need referrals from 2 medical doctors stating that being unable to conceive naturally has negatively impacted your mental well-being.

Another option offered by a few clinics would be either their own payment plan or credit option or something like Zip Money, which offers support for fertility treatments.

Talking to your child about your family dynamic

There is a shocking amount of literature out there attempting to prove that children of same-sex parents (or single parents) are ‘worse off’.

Not only are they not ‘worse off’ than children with heterosexual parents, but some research shows that children of same-sex female couples experience higher quality parenting [16]. Their sons display greater gender flexibility and emotional capacity, and both sons and daughters display more open-mindedness toward sexual, gender, and family diversity.

As with many other areas of life, there is always the chance that a child may face social stigmatisation for having a ‘different’ family structure than their classmates.

But bullying could occur over anything, and as with any other bullying scenario, ensuring your home is a safe and honest place to discuss their feelings and what’s going on for them will help them to feel protected and better able to deal with this type of adversity.

In terms of donor conception, if the donor is not known to your child, again, openness and honesty about how they were conceived are the most effective routes.

Of course, the discussion of your family dynamic is completely personal, but as above, feeling they have a safe, trustworthy environment to discuss their feelings and perceptions will ensure your child feels comfortable and likely open-minded.

Understanding your own story and level of comfort with how you and your partner discuss it amongst yourselves, with others, and with your children will help give your children the support they need to do the same.

Other resources

We’ve included a list of valuable resources which cover everything from your rights as a same-sex couple, to IUI and IVF success rates, costs, and more:

• Rainbow Fertility - Australian fertility clinic with a focus on same-sex couples, including a lot of resources and support information.
• Lesbians & the Law - Legal advice and support for same-sex female couples and singles wanting to conceive.
• VARTA - Victoria Assisted Reproductive Therapy Authority, extensive useful information and resources for those looking to conceive using ART.
• IVF Australia - In-depth look at all ART options, prices, and more for the IVF Australia clinic - please note there are multiple reputable fertility clinics throughout Australia. It’s important to do the research and find the clinic that’s right for you.  
• Monash IVF Clinic - In-depth, user-friendly resource with explanations, prices, and more. It’s important to note there are multiple reputable fertility clinics in Australia. It’s important to do the research and choose the clinic that’s right for you.
• Fertility Society Australia - Information and webinars about fertility and ART options in Australia.
• Sperm Donors Australia - Information about the ins and outs of sperm donation in Australia.
• SuperCare - Information about your options when it comes to covering the costs of your treatments.
• Medicare - Information about what’s covered under Medicare.
• Health Law Central - A resource for ART access state-by-state.
• Talking Turkey - A legal guide for lesbian, gay, bisexual, transgender, intersex and queer parents and donors in New South Wales.