The journey to, and enjoyment of, parenthood can be one of the most fulfilling experiences in anyone’s life. For LGBTQIA+ couples in Victoria, the dream of having children is increasingly achievable thanks to evolving laws, inclusive fertility clinics, and a growing network of support services. As gynaecologists, we have had the privilege of working with many individuals and couples in the LGBTQIA+ community as they navigate this beautiful, yet often complex, path.

In this blog, we’ll outline the fertility options available to same-sex, transgender, and gender-diverse couples, along with essential legal considerations, emotional support resources, and tips for navigating the system in Victoria. Whether you’re just beginning to explore parenthood, or ready to start treatment, this guide will help you understand your choices and plan your journey with more confidence.

Fertility Options for LGBTQIA+ Couples: who needs what?

On a basic level, the key ingredients to make a baby physically include: sperm; eggs; and a uterus in which to grow the baby. Depending on you and your partner’s assigned gender at birth, you may or may not have those three key ingredients easily available to you. Whichever missing piece(s) of the puzzle are missing, will need to be sourced from friends, family, a known donor, or an unknown donor.

Some couples may need donor sperm or eggs; others may explore surrogacy or reciprocal IVF. What follows is a breakdown of the medical pathways that may be helpful to explore, based on your family’s structure.

Fertility Pathways for Same-Sex Female Couples and People Assigned Female at Birth

The key considerations for same-sex family couples include:

• Which member of the couple will provide an egg
• Which member of the couple will bear the child
• Whether sperm will be sourced from a known donor (eg. family member or friend), or an unknown donor (sourced through a fertility clinic)
• Whether intrauterine inseminsation (IUI) or in vitro fertilisation (IVF) is more appropriate

Sourcing sperm

In terms of finding a sperm donor, couples can choose between:

• Clinic-recruited donors: You can peruse the registry of sperm donors through your fertility clinic of choice, and choose one based on various parameters, such as: the donor’s physical attributes, profession, and their family’s medical history. Sperm donors are anonymous at the time of fertility treatment, but are legally required to be identifiable to the child when they turn 18.
• Known donors: A friend or family member can act as a sperm donor, but it’s crucial that they complete proper health screening, and to seek legal agreement to minimise the risk of future disputes. Using sperm from a known donor does mean considering the Family Law implications. You may need and / or want to include the sperm donor in your family life. For many parents, this is a wonderful option for building a wider family.

Legal parentage for same-sex female couples using donor sperm is usually straightforward when the couple is in a relationship and consents jointly to the procedure.

Donor Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is one of the simplest and most affordable assisted reproduction options. A sperm sample is put through a laboratory process called ‘washing’, in which the ‘best’ sperm are isolated, and damaged sperm and debris removed. In IUI, the ‘washed’ sperm are then injected directly into the uterus, around the time of ovulation, in the hope that fertilisation (joining of an egg with a sperm) occurs, and the resultant embryo implants and grows into a baby. IUI is best suited for couples with no underlying fertility issues.

In vitro fertilisation (IVF) and reciprocal IVF

In vitro fertilisation (IVF) is a fertility treatment where an egg is fertilised by a sperm outside the body (typically in a petri dish in a laboratory). A few days later, the embryo is then transferred into a woman’s uterus, in the hope that it implants and grows to become a baby. For same-sex female couples, IVF is sometimes recommended (for example, if IUI is unsuccessful, or not medically appropriate). IVF success rates vary by age and baseline fertility, but are generally higher than IUI.

One female partner receives hormonal stimulation medications to encourage ovulation, then her eggs are retrieved, fertilised with sperm in the laboratory, and transferred to a uterus (either hers, or her partner’s).

Reciprocal IVF can be especially meaningful for lesbian couples. This refers to when one partner undergoes the egg collection, and the other carries the pregnancy. This allows both partners to participate both biologically and emotionally in the process of bringing their baby into the world, in that one parent is the ‘genetic mother’, and the other the ‘birth mother’. For many couples, this is a beautiful process that allows both parents to have a unique connection to their child.

The best treatment path for you (IUI or IVF) will depend on your individual circumstances, and the quality of sperm. This will all be discussed with your fertility specialist, to determine what will give you the best chance of a taking home a happy, healthy baby.

Fertility Pathways for Same-Sex Male Couples and People Assigned Male at Birth

Most often, if you’re a same-sex male couple, you will require an egg donor and surrogate in order to help create your family. They may be one and same person (eg. if you undergo IUI).

Intrauterine insemination (IUI)

As outlined above, IUI involves the injection of sperm into a woman’s uterus in the middle of her menstrual cycle, when she is most likely to be ovulating and fertile. Same-sex male couples may act as sperm donors in this context with a female friend or family member as the bearer of the child. (Of course, if a family member, they cannot be related to the donor of the sperm.) This is undertaken on the legal understanding that the male couple will be the primary caregivers and legal parents of any resultant baby. If you are interested in exploring this option, it’s prudent to ensure that all your ducks are in a row, in terms of: relevant health screenings (for both parties); the appropriate legal paperwork has been completed; and counselling has been undertaken.

Surrogacy

Male couples require a surrogate and an egg donor to have a biologically-related child. Victoria permits altruistic surrogacy only, meaning that your surrogate cannot be paid over and above ‘reasonable expenses’.

The surrogacy process involves:

• Selecting an egg donor (either known to you, or recruited by your fertility clinic)
• Mixing the eggs with either one or both partners’ sperm
• Allowing the fertilised egg to grow in the laboratory for a few days
• Transferring the embryo into the uterus of the surrogate

There are some key legal hurdles that must be jumped throughout the surrogacy process, in that surrogacy arrangements must be pre-approved by Victoria’s ‘Patient Review Panel’. Both the surrogate and the intended (male) parents must receive appropriate counselling and legal advice. After birth, the intended (male) parents must apply through the court for legal parentage of the baby. While somewhat arduous, these processes are vital, for safeguarding everyone involved, including (most importantly!) the welfare of the child.

Surrogacy Australia provides excellent resources, for couples who are interested to find out more: click on this link to find out more.

Fertility Options for Trans and Gender-Diverse Couples

If you are preparing to gender transition, one of the many important considerations prior to starting hormonal therapy is if you would like to have a family now, or in the future. Hormone therapy can reduce or eliminate fertility potential; surgical interventions like hysterectomy (surgical removal of the uterus), oophorectomy (surgical removal of the ovaries), or orchidectomy (surgical removal of the testicles) may significantly limit your parenting options thereafter, from a biological point-of-view.

So, if you’re thinking you may transition medically and/or surgically in future, please discuss this with your treating team. Some people may choose to start a family (either through natural conception, or IUI / IVF) prior to transitioning. If you’re not ready to start a family now, but would like to keep your options open in future, your fertility specialist may recommend collection and storage of your gametes (eggs / sperm), or embryos, for later use.

Fertility Preservation

Fertility preservation options include:

• Egg freezing: Requires hormone stimulation to encourage ovulation, followed by egg retrieval, freezing, and storage.
• Sperm freezing: Simple and non-invasive, this simply requires a sperm donation at an appropriate pathology laboratory. The semen sample is then frozen and stored.
• Embryo freezing: If you already have a partner (who was assigned the opposite gender at birth), or want to use donor material (egg or sperm). This would involve going through the IVF process, then freezing and storing any resultant embryos, for potential use in future.

Should you undergo egg or sperm freezing and storage, you will have the option in future of having these thawed, and using either your partner’s egg or sperm, or those of a donor, through IUI or IVF process: whichever combination is most appropriate to you, and most likely to be successful. Depending on your circumstances, a surrogate may be needed to carry the baby.

People of all gender identities should be offered the opportunity to become biological parents. In Victoria, inclusive fertility services are expanding, and expert clinicians such as Maven Centre’s Dr Melissa Cameron welcome transgender and non-binary individuals with sensitivity and respect.

Legal Considerations: protecting your family

In Victoria, the legal parentage of children conceived through assisted reproductive treatment is primarily governed by the Assisted Reproductive Treatment Act of 2008.

For Same-Sex Female Couples

If both partners consent to treatment, they are both recognised as the child’s legal parents, regardless of biological relation. Both names can be listed on the child’s birth certificate.

For Male Couples Using Surrogacy

Legal parentage is not automatic. After the birth, intended parents must apply to the County Court to transfer parentage from the surrogate to themselves. The surrogate is initially considered the legal mother, even if she has no genetic link to the child (ie. if the baby she bore was conceived with a donor egg, rather than her own).

For Known Donors

If you use a known sperm or egg donor (such as a friend or family member), it’s vital to have a formal legal agreement in place. A donor without such an agreement may later attempt to assert legal parenting rights, which can lead to complex disputes.

It is always strongly recommended that you consult a family lawyer with experience in LGBTQIA+ fertility and surrogacy law. Most well-respected fertility clinics will require you to do so before starting fertility treatment.

Emotional and Psychological Support

The fertility journey can be filled with anticipation, joy, stress, and grief — often all at the same time. LGBTQIA+ couples often face additional emotional layers such as:

• Navigating healthcare systems that may not feel entirely inclusive
• Facing judgment or misunderstanding from family or wider society
• Managing internalised stigma or past trauma

There are a range of supports available, including:

• Rainbow Families offers peer support groups, parenting resources, and community events.
• Specialised counsellors from fertility clinics such as Melbourne IVF provide support before, during, and after treatment.
• Psychologists specialising in LGBTQIA+ health can help you navigate the emotional complexities of parenthood planning.

Cost Considerations and Financial Assistance

Fertility treatment costs vary widely depending on the type of treatment and clinic. As a rough guide:

• IUI: $1,500 – $3,000 per cycle
• IVF: $7,000 – $12,000 per cycle (before rebates)
• Egg / sperm donation and surrogacy: Significantly more, especially if legal and interstate / international travel expenses are included

Financial supports include:

• Medicare rebates
• Private health insurance: may cover anaesthesia, hospital fees, and medications — check your policy.
• Payment plans or bulk billing clinics (for eligible patients).

Victoria’s public fertility services (for example through the Royal Women’s Hospital) offer subsidised treatment options.

Choosing the Right Fertility Clinic

It can be incredibly nerve-wracking to approach a fertility specialist for the first time. Things can suddenly seem very real! You will be asked to discuss some incredibly personal details about yourself, your partner, and your life. That is why it’s essential to find a team that understands the unique fertility requirements and their implications for LGBTQ+ people. Unfortunately, not all clinics are equally inclusive or experienced with LGBTQIA+ families. Look for clinics that:

• Explicitly state their LGBTQIA+ inclusivity
• Offer a variety of donor and surrogacy programs
• Employ staff trained in cultural competency
• Provide legal and psychological support services
• Have positive reviews from other rainbow families

Established clinics like Melbourne IVF have dedicated LGBTQIA+ programs and can help guide you through every step: from testing and counselling to conception and post-birth legalities.

Conclusion: creating families, creating joy

The fertility journey may not always be easy, but it is incredibly worthwhile. In Victoria, LGBTQIA+ people now have more tools and support than ever before to create the families they’ve dreamed of.

If you’re just beginning, start by speaking to your GP or getting a referral to a fertility clinic. Take time to research, connect with community organisations, and prepare emotionally and financially. You deserve not just access to parenthood, but support, understanding, and joy along the way.