Australian Doctor Australian Doctor 3rd November 2017 | Page 25

Therapy Update
Rainbow families
REPRODUCTIVE HEALTH
How do you tackle the topic of pregnancy and
parenting with your LGBTI patients?
DR BRONWYN DEVINE
R
AISING
chil-
dren together is
a desirable and
fundamentally
important goal for many
couples. In addition, many
single people, regardless of
gender or sexual identity,
are seeking to create a fam-
ily through donor or surro-
gacy arrangements.
During the highly politi-
cised marriage equality
campaign, the parenting
rights and abilities of LGBTI
people have been held up to
public scrutiny and ques-
tioned.
It is worthwhile remem-
bering that most laws pre-
venting access to assisted
reproductive
technology
(ART) services for LGBTI
people were removed in
Australia in 2015.
At that time, the Federal
Government assured the
UN Human Rights Com-
mittee that it would comply
with
anti-discrimination
laws and lift state-specific

exemptions that allowed
certain states to restrict pro-
vision of fertility treatments
to people of diverse sexual-
ity and gender and singles.
To date, some of these
exemptions still stand. It
is still not possible for gay
men in WA and single peo-
ple in WA, SA and ACT to
undertake surrogacy.
In Queensland it is cur-
rently legal for ART provid-
ers to withhold treatment
on the basis of sexuality and
relationship status. How-
ever, in 2012, the Queens-
land Attorney-General was
unsuccessful in his attempt
to criminalise gay men,
lesbians and single people
from seeking surrogacy.
and financial hurdles exist
for anyone seeking to cre-
ate a family through donor
or surrogacy. Patients may
be overawed by the multi-
ple mandatory requirements
and processes that must
be followed if treatment is
undertaken through a clinic.
Lesbian couples and
single women
Lesbian women commonly
access ART services in Aus-
tralia but many choose to
attempt conception at home
with a known sperm donor. 1
This may be a person
known to the woman or cou-
FOR THE MAJORITY OF LGBTI PEOPLE
HOPING TO CREATE FAMILIES,
THE PROCESS WILL NOT BE AS
STRAIGHTFORWARD AS FOR FERTILE
COUPLES IN TYPICAL HETEROSEXUAL
RELATIONSHIPS.
Reproductive hurdles
For the majority of LGBTI
people hoping to create
families, the process will not
be as straightforward as for
fertile couples in typical het-
erosexual relationships.
In addition, social, legal
That said, many of these
steps serve to protect all par-
ties involved from potential
risks, including transmis-
sion of blood-borne infec-
tions and legal challenges to
parenting rights.
ple, but it may also be some-
one who was chosen from
a website or donor commu-
nity.
In situations such as this,
there may be minimal or no
infectious disease screening
www.australiandoctor.com.au
and no fertility potential test-
ing of sperm.
The popularity of this
method, however, rests on
its relative “ease of use” —
usually by insemination of
freshly ejaculated semen into
the vagina via a syringe —
and its low cost.
Attending a fertility clinic
for treatment is safe and
effective. Medicare rebates
for treatment cycles will not
apply initially, unless there is
a medical cause for subfertil-
ity.
However,
once
three
insemination cycles have
been attempted without
pregnancy success, women
then become eligible for
Medicare rebates.
Those opting to use donor
sperm and conceive with the
assistance of a fertility clinic
often state a preference for
intrauterine
insemination
(IUI) or in-vitro fertilisation
(IVF).
More often than not, the
decision to start with IUI is
based on a desire to avoid
‘over-medicalisation’ as there
is a perception that IVF is
more invasive and costly.
Many also believe that
without a medical diagnosis
of infertility, IVF is unneces-
sary.
Certainly, for individuals
with a healthy reproductive
tract and patent fallopian
tubes, IUI can be a valid
place to start.
However, overall (single)
cycle live birth rates with IUI
(around 12%) are generally
lower than for IVF (around
32%). 2,3 Once the patient is
eligible for Medicare rebates,
these are proportionately
higher for IVF cycles, mak-
ing the out-of-pocket cost
difference between IUI and
IVF quite minimal.
If the patient prefers IVF,
this may be used as the first-
line approach. A frank and
detailed discussion, includ-
ing an analysis of the results
of relevant investigations,
cont’d next page
3 November 2017 | Australian Doctor |
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