Discovering your road to parenthood: celebrating inclusive fertility

Expert insights from Carole Gilling-Smith, of The Agora Clinic, Brighton.

Recognising that every human being is unique, and that every parenting journey is different, is at the root of everything we do at the Agora Fertility Clinic. Here we celebrate inclusivity and diversity every day of the year, not just during Pride month, and advocate equal access to fertility care for all, irrespective of gender, sexual orientation and relationship status. 

Sadly, many barriers still exist for those from the LGBTQIA+ community, but the good news is that Sussex is well served. Recent revisions to the Sussex Integrated Care Board’s Fertility Policy has produced some significant improvements around the funding of donor sperm treatments for those in same sex female relationships or those planning solo parenthood through donor sperm. Same sex male couples are not so well served as surrogacy is not for the time being funded. 

Our role as fertility providers is to first make sure you understand all of your options from the outset, including the pros and cons of each, so you make an informed choice. The next step is to take you down your chosen pathway with scientific expertise, professionalism and human compassion. We also have a duty, as does your GP, to also ensure that you are aware of your NHS funding eligibility. Leaving funding issues to one side, this article explores the treatment options available to those from the LGBTQIA+ community who are planning to start a family.

Donor sperm options

Insemination of donor sperm into the uterus (DI) is a good first line approach for those in same sex female relationships as well as those planning solo motherhood. Our approach is to minimise the disruption to your working life so that you can complete a cycle of treatment with a minimum of two or three clinic visits for monitoring and treatment. Prior to starting treatment, we advise a basic fertility assessment of egg reserve to ensure the treatment is appropriate and has a good chance of success. 

For those in a same sex relationship, it is wise to consider this assessment for both partners as sometimes the younger partner may have the lower egg reserve making it more sensible for her to consider treatment first. We work with several different donor sperm banks and can help you navigate the complexities of choosing a suitable sperm donor and ordering samples for your treatment. You can expect a success rate of around 15% chance of pregnancy per cycle of DI, although success rates drop progressively with age in women who are older than 36. 

In vitro fertilisation (IVF) of donor sperm is the best option for those couples who want to share motherhood. One partner provides the eggs and is the biological parent. She undergoes stimulation of her ovaries with fertility drugs and egg retrieval and donor sperm is used to fertilise her eggs. A single embryo is transferred into her partner’s uterus and any remaining embryos can be frozen. Her partner carries the pregnancy and gives birth. IVF is also a good option for those who want to create embryos whilst age, and hopefully good fertility, is on their side and for those in whom DI has not been successful or when a fertility issue necessitates IVF such as blocked tubes.

Egg donation and surrogacy

This is the chosen pathway for same sex male couples, single men or those from the trans community who have no ovaries or uterus. In gestational surrogacy, eggs from a known or anonymous donor are fertilised with the sperm from one of the intended parents and the resulting fertilised egg or embryo is then implanted into their surrogate carrier. In straight surrogacy, the surrogate provides the egg. At birth the surrogate is the legal parent of the child. If she is not married, the person providing the sperm can be the second legal parent. The surrogate remains the legal parent until the intended parents have obtained a Parental Order, a process which cannot start until the child is at least 6 weeks old. Surrogacy law is changing and a recent draft bill on surrogacy, if approved by parliament, would allow intended parents to be the child’s legal parents from birth. 

Surrogacy is complex and can be a long and costly process. It can take a while to find an egg donor, as well as a surrogate, and legislation around the screening of both sperm and egg providers must be completed within a precise time frame before the start of treatment. At the Agora we have a dedicated surrogacy team with medical, nursing, laboratory and administrative expertise who can guide you through the process from start to finish and ensure you receive the necessary counselling and legal advice as and when you need it.

Fertility preservation

For those diagnosed with gender dysphoria who plan to start cross hormone treatment, egg freezing or sperm freezing is normally offered before the hormone treatment starts. Eligibility for NHS funded trans fertility preservation no longer rests on the age-old prerequisite of having been seen at an NHS Gender Identity Clinic, where current waiting times to be initially assessed runs into years. In Sussex, a GP qualified in assessing those with gender dysphoria can now make the referral directly to the Agora. Some prefer to self-fund their treatment or may need to do so if they are not eligible.

Where can you find out more?

This brief overview of modern parenting options is just a taster of what can be achieved but the journey to get there can be difficult to navigate on your own. In celebration of Pride month, the Agora Clinic will be holding a free educational event at their Brighton Clinic on Saturday June 10th to help all those who need a bit of help conceiving, whatever their gender and sexual orientation, understand their treatment options. There will be talks by fertility experts, past patients and LGBTQIA+ advocates and plenty of time and opportunity to ask questions.

For more information please visit our website agoraclinic.co.uk or give us a call on 01273 229410.