Lesbians TTC – Will Medicare pay for it?

Trying to conceive with the help of a fertility clinic is an expensive process. Even if you happen to be one of the lucky few who conceive in the first cycle, you’re still looking at thousands of dollars. So when Jay and I first made an appointment to see our fertility specialist, one of our first questions was “but how much does it cost, and will Medicare help us?”

To be entitled to a Medicare benefit, that is able to make a Medicare claim, you will need to have incurred medical expenses in respect of a “professional service” (see section 10 of the Health Insurance Act). While you might have paid to see a doctor, whether you can make a Medicare claim depends on whether that appointment was for a professional service

Under section 3 of the Health Insurance Act a professional service means a service:

  • with a “Medicare Benefits Schedule” (MBS) item number;
  • provided by a medical practitioner; and
  • is “clinically relevant.

There is an MBS item number for both IUI and IVF (see items 13203, 13221 and 13200 in the Health Insurance (General Medical Services Table) Regulations), which in most cases will be provided by a medical practitioner; this means points one and two of the definition are sorted. The issue which might trip up lesbian couples, is whether the service is clinically relevant.

A clinically relevant service is a service that is generally accepted in the medical profession as being necessary for the appropriate treatment of the patient (see section 3 of the Health Insurance Act).  

The legislation doesn’t get much more specific than that unfortunately, so the payment of Medicare benefits for IUI or IVF largely depends on the medical practitioner’s decision that he or she is providing a clinically relevant service. This decision will vary between clinicians, and may be influenced by your background, medical history, age and other factors.

if you have no known cause of infertility, you can contact your fertility clinic to ask what their policy is regard same-sex couples and Medicare claiming. Anecdotally, many fertility specialists will regard a service as clinically relevant once the patient has paid for two IUIs out of pocket.

Another question for the fertility clinic I’m afraid – don’t forget to add it to your list!

What more information?

Visit the Department of Human Services’ website. Feel free to make a comment below, or visit me on Facebook for any other questions.

Separation and rainbow families: what happens when it ends?

In my last post, we looked at whether same-sex couples can have both mothers’ names listed on their child’s birth certificate. Just to recap, the legislation is slightly different in each state and territory, but in general two women can be listed on a birth certificate provided they are in a de-facto, or ‘marriage-like’ relationship and the child is conceived by artificial insemination with the consent of both parties.

But what happens if the couple separates? If both parties are listed on the birth certificate, do they have the same legal rights and responsibilities?

Parental responsibility

When a couple separates, the Family Law Act presumes that it is in the best interests of the child for both parents to have equal shared parental responsibility for the child (see section 61DA of the Act). This presumption applies to parents living all Australian states and territories. 

Parental responsibility means the duties, powers, responsibilities and authority which, by law, parents have in relation to their children. In practice, this involves decisions about what school your child goes to, where they will live, whether they will be brought up a particular faith.

Assuming both parents are the child’s ‘legal parents’, the presumption of equal parental responsibility is not affected by whether they are or are not biologically related to the child.

Parenting Orders

The presumption of equal parental responsibility does not relate to the amount of time the child spends with each of the parents. If the couple were unable to decide this matter between them, they can apply to the Family Court for a Parenting Order (see section 65D(1) of the Act).

In these matters, the Court’s paramount consideration is the best interests of the child. It will also consider whether the child spending equal time, or ‘substantial and significant time’, with each of the parents is reasonably practicable. The Court will have regard to matters such as:

  • how far apart the parties live from each other;
  • their capacity to communicate effectively; and
  • any other relevant matter.

Getting help

Separation is a stressful time for any family, and often involves complex legal issues. If you need legal assistance, you can get advice from:

The Family Court of Australia provides general information and referrals to the public, but cannot provide legal advice. It has also published a brochure containing information for people considering, or affected by separation or divorce.

Australian birth certificates: can my kid have two mums?

In the last few years there have been significant changes to laws relating to birth certificates and presumption of parentage.

Fortunately, all Australian states and territories now allow both women in a de facto relationship to be listed on their child’s birth certificate – if that child was conceived via artificial insemination or IVF.

However, the laws are slightly different from state to state making things a bit complicated; scroll down to your state and find out the key information as it applies to you:

Australian Capital Territory (ACT)

Under section 11 of the Parentage Acttwo woman in a domestic partnership are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner agreed to the procedure. 

Additionally, the child is presumed not to be the child of the sperm donor.

This presumption applies a procedure involving:

(a) artificial insemination; or
(b) the procedure of transferring into the uterus of a person an embryo derived from an ovum fertilised outside the person’s body; or
(c) any other way (whether medically assisted or not) by which a person can become pregnant other than by having sexual intercourse with a person.

Under section 14 of the Births, Deaths and Marriages Registration Act, both parents may be listed on the birth certificate, but a not a sperm donor.

New South Wales (NSW)

Under section 14 of the Status of Children Act two woman in a de facto relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the fertilisation procedure. 

Additionally, the child is presumed not to be the child of the sperm donor.

This presumption applies to children conceived by a ‘fertilisation procedure’, which means:

(a) the artificial insemination of a woman, or
(b)  the procedure of transferring to a woman’s body an ovum (whether or not produced by her) fertilised outside her body, or
(c)  the procedure of transferring to a woman’s body an ovum (whether or not produced by her) or both the ovum and sperm to enable fertilisation of the ovum to occur in her body

Both female parents may be listed on the birth certificate, but not the sperm donor.

A birth registration statement (a legal document given by the parents to register the child’s birth) may include a declaration that the child was conceived using donor sperm (see section 22A of the Births, Deaths and Marriages Registration Act).

Queensland (QLD)

Under sections 19C and 19D of the  Status of Children Act two woman in a de facto relationship or civil partnership are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor has no rights or liabilities relating to the child.

This presumption applies to children conceived by:

  • artificial insemination; or
  • implanting an embryo or ovum in a person’s womb.

Both female parents may be listed on the birth certificate.

Victoria (VIC)

Under section 13 of the  Status of Children Act two woman in a relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor is presumed not to be the father of the child.

This presumption applies to children conceived by:

assisted reproductive treatment; or
artificial insemination. 

Both female parents may be listed on the birth certificate, but not the sperm donor.

A birth registration statement (a legal document given by the parents to register the child’s birth) may include a declaration that the child was conceived using donor sperm (see section 17A of the Births, Deaths and Marriages Registration Act).

Tasmania (TAS)

Under section 10C of the  Status of Children Act two woman in a significant relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor is presumed not to be the father of the child.

This presumption applies to children conceived by a fertilization procedure, which means:

artificial insemination; or
the procedure of implanting in the uterus of a woman an embryo derived from an ovum fertilized outside the body (IVF).

Tasmanian legislation does not prevent two women from being listed on a birth certificate. However, unlike many other states and territories, the Births, Deaths and Marriages Registration Act uses the terms ‘mother’ and ‘father’. Tasmanian same-sex attracted couples may have more difficulty registering the birth of their child, than couples in other states and territories.

South Australia (SA)

Under section 10C of the Family Relationships Act two woman in a ‘marriage-like’ relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor is presumed not to be the father of the child.

This presumption applies to children conceived by a fertilisation procedure, which means:

assisted insemination; or
assisted reproductive treatment.

In South Australia, the birth registration statement (a legal document given by the parents to register the child’s birth) must include the details of the biological parents , which means the person who carried the child and the sperm donor (see section 14 of the Births, Deaths and Marriages Registration Act) . However, this requirement does not mean the sperm donor is legally recognised as a father, or will be listed on the birth certificate.

Northern Territory (NT)

Under section 5DA of the Status of Children Act two woman in a de facto relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor has no right or liabilities in respect of the child.

This presumption applies to children conceived by a fertilization procedure, which means:

artificial insemination; or
a procedure in which a fertilized ovum is transferred into the uterus (even if the ovum was produced by another woman).

Both female parents may be listed on the birth certificate, but not the sperm donor (see Births, Deaths and Marriages Registration Act)

Western Australia (WA)

Under section 6A of the Artificial Conception Act two woman in a de facto relationship are presumed to be the parents of a child conceived using donor sperm, if the non-carrying partner consented to the procedure. 

Additionally, the sperm donor is presumed not to be the father or have caused the pregnancy.

This presumption applies to children conceived by an artificial fertilisation procedure.

Both female parents may be listed on the birth certificate, but not the sperm donor (see Births, Deaths and Marriages Registration Act)

Final takeaways

This information is a handy fact-sheet, not legal advice. The law, especially family law, changes quite rapidly so please visit a lawyer to get detailed information relating to your circumstances.

 

What is ‘IUI’? intrauterine insemination explained

A year ago Jay and I wandered into our doctor’s office and nervously explained that we wanted a baby. Since that day there’s been several hours of counselling, blood tests for every disease imaginable, ultrasounds and a toe-curling procedure call a ‘hycosy’ (it involves saline being injected into the uterus and fallopian tubes). Finally the treatment begins!

IUI, Intrauterine Insemination or Assisted Insemination

Jay and I are starting out with a procedure called ‘Intrauterine Insemination’ (IUI).  IUI is

a form of assisted conception involving assisted insemination into the uterus. IUI can be carried out with a woman’s natural cycles or with ovarian stimulation (superovulation) using clomiphene or follicle stimulating hormone, with ovarian monitoring. This process is used for either donor insemination (DI) or with a partner/husband’s semen (AIH) (Genea).

Like IVF, IUI is provided by a fertility clinic (we’re with Genea) and a specialist doctor. Many of the medications are similar, but as the eggs aren’t removed from the woman’s body there’s no operations or hospital stays. It’s also a bit cheaper which is always a bonus.

Medicines

While IUI can be done using the woman’s natural cycle, our specialist prescribed three medications:

  • Puregon – it helps follicles to develop (those small round sacs containing egg-cells)
  • Pregnyl – ripens an egg cell in the ovaries and releases the egg (ovulation)
  • Oripro – prepares the uterus to receive and maintain a fertilized egg

The Purgeon and Pregnyl are self-administered injections which had me a little worried. I’m now a few days into it, and it hasn’t been that bad; more psychological than anything else. The needle is very small (much smaller than the needle the doctor uses to give you a flu shot), so you only feel a very small pinch. 

The Oripro is a progesterone pessary, which is inserted at night. It’s very messy, so wearing a pad might be a good idea.

Tests

The fertility clinic monitors how your follicles are developing and responding to the medicines by regular blood tests and ultrasounds. Genea has a ‘morning clinic’, so I didn’t need to take time out of work to have these procedures.

The blood tests monitor the amount of estradiol (estrogen) in the blood. I got my first blood test three days after beginning the Puregon injections, and they continued roughly every two days until insemination.

The ultrasounds monitor the size and growth of the follicles. Ultrasound scanning uses an ultrasound probe placed in the vagina. There’s no need to have a full bladder for this test. I had four to five ultrasounds per cycle, which started five days after beginning the Purgeon.

Insemination

The insemination involves placing the washed sperm directly into the uterus. It is very anti-climatic, and feels similar to a pap smear.

I arrived at the clinic 45 minutes before the insemination. During this time I filled out paperwork, and a nurse took my pulse and blood pressure.

The procedure itself takes about five minutes, but I was asked to ‘marinate’ for another 15 minutes afterwards to give the best chance of conception.

After the insemination, I went home and watched netflix with Jay. It was a nerve-wracking time, but physically I felt fine and able to get on with my usual activities.