Once you have talked it all over and made your agreement, there are three options for beginning to attempt conception (provided there are not already known fertility issues).
The three options are: home insemination using fresh semen; home insemination using screened, stored sperm; and clinic-based insemination using screened, stored sperm. We explore each in some detail below. It is important to remember that although some people conceive the first time they try (be warned, it certainly does happen!), for others the process might be much longer and more complex than they first envisaged.
Checking and supporting your fertility
Consider having a sperm test early in the process, as problems are not uncommon. If you are a gay couple, and the intending donor has fertility issues, then the other man may consider taking this role. If this is not possible, you might still be able to donate, although probably not through home insemination; if they are open to it, the prospective mother/s can find out about other options from a fertility specialist. There are also diet and other lifestyle changes that both you and the prospective birth mother can make support your chances of conception.
Health screening and safer sex
However you plan to attempt conception, you will need to be screened for a number of sexually transmissible infections. Donor insemination carries many of the same risks of infection as unprotected sex. If you are planning to home inseminate using fresh semen, you will need to ask your GP to arrange these tests, which should include gonorrhoea, chlamydia, HIV, syphilis, Hepatitis B and Hepatitis C and CMV (cytomegalovirus), plus blood group and antibody tests.
If you or your partner are subsequently exposed to any risk of infection, you will need to test again, to ensure you do not put the prospective birth mother, her partner or the baby at risk. It is more important than ever that you have safer sex throughout the period you are attempting conception. Talk openly with your partner/s about your sexual practices, together and (if relevant) with other people, and minimize your risk of infection through safer sex and avoiding other risks (such as through injecting drug use).
Another option is to make a ‘directed donation’ to the mother/s through a fertility clinic. The clinic will arrange all the screening tests, and after a quarantine period (to allow for the HIV testing window), will provide the mother/s with your frozen, screened sperm for home insemination, clinic-based insemination or IVF. You will not need to re-test unless more sperm is required.
Options for attempting conception
Home insemination with fresh semen
One advantage of home insemination with fresh semen is that it is free, apart from the costs of health screening (see above). The prospective birth mother should also have the recommended pre-pregnancy checks, including a pap test and HIV, rubella, blood group and antibody tests. She should talk to her GP for more information about preparing for pregnancy, including understanding her cycle and the timing of ovulation.
Some people choose home insemination because it is less medical and more private. Other advantages are that fresh semen has a much higher sperm count than frozen. You can also increase the chance of conception by making more attempts each cycle, because women are fertile for a number of days, and fresh sperm is viable for longer (inside a woman’s body) than frozen. However, the logistics can be challenging, as semen should used within an hour of (but not straight after) ejaculation. You will also need to ensure that you get the entire ejaculate into the clean, dry glass container you are using to transport it, as there is more sperm in the first part of the ejaculate. Find out more about maximizing the chance of conception through home insemination in resources listed in Information for prospective lesbian parents.
Home insemination with screened, stored sperm
Melbourne IVF Clinic also offers a service, mentioned above, where you can give a ‘directed donation’ to the mother/s through the clinic. After a ‘quarantine period’ (to cover the window period for HIV testing), the clinic provides the mother/s with your screened, stored sperm for home insemination. This means that the mother/s will need to become clients of the clinic, which involves a number of complex procedures and legal checks (see Information for prospective lesbian parents). It also costs (approximately $1000 per cycle at the time of writing), especially as Medicare does not cover fertility services not medically required.
If the mother/s need to become clients of a clinic, as their donor you will undergo clinic counseling both with, and separate from them. Many clinics also require your partner to attend counselling and give his or her consent to the donation. The mother/s will also have to undergo police and child protection checks. You will fill out questionnaires about your medical background, see a medical specialist, and give consent to the procedures involved. Some counsellors will also take you through issues around your (and your partner’s) potential role in the family’s life. See ‘Thinking about it and making agreements’, for an outline of such issues.
Clinic-based insemination with screened, stored sperm
The third option is clinic-based insemination using your sperm. The advantage of this method is that the clinic will conduct some basic fertility tests, and help track the prospective birth mother’s cycle, maximizing her chances of conception. A fertility clinic can also do ‘intra-uterine’ insemination, inserting the sperm directly into her uterus, which increases her 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 sperm even if you live interstate or overseas. The prospective mother/s may be able to get permission from VARTA (the Victorian Assisted Reproductive Treatment Authority) to ‘import’ your sperm into Victoria, if you cannot come here to donate. You will be required to undergo counseling and give consents through the Victorian clinic, but some are willing to do this over the phone and by mail.
What about the ‘natural way’?
Some prospective sperm donors (and/or sometimes the prospective mother/s) 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. The law says that if you are the sperm donor for a child conceived through a ‘treatment procedure’, including home insemination, you are not their legal parent. That is, you are not responsible for them, financially or otherwise. Your role in their lives can be legally recognised and protected, as we explain below. But you cannot be pursued for child maintenance, and they have no claim on your estate, insurance or superannuation (except in very limited circumstances).
But if you ‘donate’ by having sex to conceive, this makes you the child’s legal parent. In one such case, a donor was successfully pursued for maintenance, against the wishes of both the mothers and donor.
When insemination isn’t working
If the mother/s have had around six unsuccessful, well-timed attempts at conception, she/they will need to talk to their GP (if home inseminating) or a clinic about investigating their fertility. Depending on the prospective birth mother’s age, how long they have been trying, and medical issues identified, further treatment may be recommended, such as drugs to support ovulation, intra-uterine insemination (if they 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 they are eligible for Medicare rebate (50% up to the Medicare threshold and 80% thereafter).
If there are ongoing problems with conception, or with miscarriage, it is possible that you and the prospective birth mother would be required to undergo genetic testing. The fertility clinic will provide information and counselling support to assist you if this is needed.
It is important that you discuss the possibility of fertility treatment such as IVF in your initial discussions with the prospective mother/s. It is not uncommon, even for women under 35, to require assistance to conceive. You might well have no issues with IVF, but it is important to think it over before you decide to donate. See Thinking about it and making agreements, for more on this.