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.

Donor Sperm

Congratulations! You and your partner have hired a u-haul, successful raised a happy fur-baby, and now you’ve decided to take the plunge and get knocked up.

One problem – sperm.

As a lesbian couple, the first challenge is to get your hands on some sperm (I know, I know – the thought grossed me out too).

Unknown sperm donor

One way to get sperm is to use a sperm bank. Many Australian fertility clinics use Fairfax Cyrobank,  which is based in the United States.

You can select your donor based on their height, occupation, blood type and even get copies of their baby photos (I’m not sure whether I think this is cute or creepy).

The main draw back with this option is cost; at a minimum you are looking at $1000. It could be much higher depending on: the number of children you plan to have; which clinic you go with; and the quality of the sperm (how many sperm per vial).

Children conceived by ‘unknown’ sperm donors still have the option of finding out their donor’s identity when they turn 18. In all Australian states and territories, fertility clinics must be accredited with the Reproductive Technology Accreditation Committee and comply with the National Health and Medical Research Council ethical guidelines.  Under these guidelines,  clinics must not use sperm (including sperm from persons overseas) if the donor’s identity cannot be established.

Known sperm donor

Your second option is to approach a close friend or relative to donate sperm. If you are thinking of using a known sperm donor, there are a couple of limitations:

  1. A ‘minor’ cannot be a sperm donor (hope that goes without saying!);
  2. Embryos (i.e. children) must not be created from close genetic relatives;
  3. Family members can donate sperm (e.g. a brother in-law, cousin etc), but the nature of the relationship means it requires special consideration; and
  4. Older donors create additional risks which you should carefully consider.

If you go with a DIY method, it is relatively inexpensive to conceive via known donor sperm. In fact, it is illegal to pay someone to donate sperm in Australia under each state and territory’s Human Tissue Act. However, donors can be reimbursed for any out-of-pocket expenses, such transport costs, taking time of work, and any medical expenses associated with the donation.

If you decide to go through a fertility clinic (like we did), your costs will add up quite a bit.  You’ll need to pay for:

  • blood tests (SO MANY BLOOD TESTS);
  • andrology tests;
  • freezing sperm;
  • counselling sessions (yes, you need to get counselling to use donor sperm); and
  • specialist doctor appointments.

These costs are not covered by medicare, and in total you’re looking at just shy of a $1000. The main benefit (in terms of cost) of a known donor, is that you can get much larger quantities than if you purchased it from a sperm bank.