If you choose to attempt conception with a known donor or co-parent, you have three options to begin with.
The options are:
- home insemination using fresh semen
- home insemination using screened, stored sperm, and
- clinic-based insemination using screened, stored sperm.
Home insemination with fresh sperm
One advantage of home insemination with fresh semen is that it is free, apart from the costs of health screening. Fresh semen has a higher sperm count and lasts longer (inside your body) than frozen. Using it often means you can attempt conception over a number of your fertile days during one cycle, further increasing your chances of conception. There is additional information about techniques for successful home insemination in the resources listed on the links and resources page; they can really make a difference, so find out everything you can before you begin, including from other women.
Your donor/co-parent should be tested for gonorrhoea, chlamydia, HIV, syphilis, Hepatitis B and Hepatitis C and CMV (cytomegalovirus), plus blood group and antibody tests. It is also worth him having his sperm tested before you begin, as problems are not uncommon. All of these tests can be arranged by his GP. If he has problems with his fertility, this does not necessarily mean he cannot be your donor/the biological co-parent, but you are unlikely to succeed with home insemination. A fertility specialist can tell you what are options are.
The prospective birth mother should also have the recommended pre-pregnancy checks, including a pap test and HIV, rubella, blood group and antibody tests. Talk to your GP for more information about these and other aspects of preparing for pregnancy, including understanding your cycle and the timing of ovulation. Find out as much as you can about other aspects of successful home insemination. See the resources suggested at the end of this information sheet. You can do much to support your chance of conception; for example, there is good evidence that specialist acupuncture can help.
Some women choose home insemination because it is less medical and more private. But if you use fresh semen, the logistics can be challenging, as semen should used within an hour of (but not straight after) ejaculation. Using fresh semen may also be less safe if your donor has had any risk of infection since his last screening test. It can be challenging to talk to your donor about repeating his screening tests if he or his partner have had any risk of infection, but it is critical that you do so, as there are implications for your own health and that of the baby. These issues, along with lack of availability of the donor/biological co-parent are the main reasons why people choose to use frozen sperm from their donor instead.
Home insemination with screened, stored sperm
Melbourne IVF Clinic also offers a service where your donor/co-parent can donate his sperm to you through the clinic, which then provides you with his screened, stored sperm for home insemination. The clinic will conduct all health checks, quarantine the sperm for six months (to cover the ‘window period’ for HIV testing), and provide frozen sperm for you to take home. You can still inseminate at home, but do not have to coordinate with your donor/co-parent, or ask him to update his screening tests. This option means becoming clients of a clinic – see above for procedures (including checks, counseling and consents) involved. It also costs (approximately $1000 per cycle at the time of writing), especially as Medicare does not cover fertility services not medically required. Contact the clinic for details.
Your donor/co-parent (and his partner, if he has one) will undergo clinic counseling both with, and separate from you. He will fill out questionnaires about his medical background, see a medical specialist, and give consent to the procedures involved. The law no longer requires the donor’s partner to give their consent as well, although some clinics may require this, because openness about the process with all members of the donor’s family is now widely recognised as important to a good outcome for them. Some counsellors will also take you through issues around your donor/co-parent’s (and his partner’s) potential role in your family life. See ‘Making an agreement’, below, for an outline of such issues.
Clinic-based insemination with screened, stored sperm
The third option is clinic-based insemination using your donor/co-parent’s sperm. Aside from the advantages related to health screening and not having to coordinate with your donor/co-parent, this option means the clinic will conduct some basic fertility tests, and help track your cycle. A clinic can also do ‘intra-uterine’ insemination, inserting sperm directly into your uterus, which increases your chance of conception (but is not safe to do at home). However, Medicare will not cover clinic-based insemination unless there is a medical reason (such as trouble with ovulation).
Note that Victorian clinics can screen and store your known donor/co-parent’s sperm even if he lives interstate or overseas. You may be able to get permission from VARTA (the Victorian Assisted Reproductive Treatment Authority) to ‘import’ his sperm into Victoria, if he cannot come here to donate. He is required to undergo counseling through your clinic, but some clinics are willing to do this over the phone.
When insemination isn’t working; dealing with infertility
If you have had around six unsuccessful, well-timed attempts at conception, talk to your GP (if you are home inseminating) or the clinic about investigating your fertility. Depending on your age, how long you have been trying, and any medical issues identified, further treatment may be recommended, such as drugs to support ovulation, intra-uterine insemination (if you are not already using it) or in-vitro fertilisation (IVF). The out-of-pocket costs of IVF are considerably higher than clinic insemination (between $1,000 and $3,000 per cycle at the time of writing) but if you are undergoing IVF due to medical infertility, you are eligible for Medicare rebate (50% up to the Medicare threshold and 80% thereafter). Contact the clinics for details.
If there are ongoing problems with conception, or with miscarriage, it is possible that you and your donor would be required to undergo genetic testing. The fertility clinic will provide information and counselling support to assist you if this is needed.
It will be important for you to talk about the possibility of fertility treatment such as IVF in your initial discussions with your prospective donor. It is not uncommon, even for women under 35, to require assistance to conceive. It might well be that you and your donor (and his partner) have no issues with IVF, but it is important to talk it over before you begin trying to conceive, as it might be devastating for you if you needed IVF to conceive, and he was unwilling to be your donor under those circumstances. Read Talking with your known donor for more on this issue.
Some women will not be able to conceive, even with fertility treatment. Find out as much as you can about ways to maximize your chances of conception with lifestyle changes and complementary treatment. There is now credible evidence about the efficacy of specialist acupuncture, for example, during IVF treatment.
What about the ‘natural way’?
Some women (and/or sometimes their prospective donor) might be interested in the idea of conception through sex between the donor and prospective birth mother. This is not advisable, partly because of the potential emotional complications for everyone involved, but also because of the legal ramifications. Victorian law, in the Status of Children Act, says that if your child is conceived through a ‘treatment procedure’, including home insemination, then you (whether you are single or a couple) are their legal parent/s, and the donor is not, although his role in the child/s life can be legally recognised and protected (see below). But if he ‘donates’ by having sexual intercourse with the prospective birth mother to conceive, this makes him the child’s legal parent, and not the non-birth mother, because children cannot have more than two legal parents. In one such case, a donor was successfully pursued for maintenance against the wishes of both the mothers and their donor.