FROM THE ARCHIVE
Pre Conceptions! Issue 191, November 2005
Currently there is no legislation covering artificial insemination in Ireland, leaving a grey area where clinics are allowed, and do refuse to treat lesbian couples. Jeanette Rehnstrom investigates the situation and looks at alternative options Irish lesbians have resorted to.
For lesbian couples who want children, becoming pregnant is not as glamorous (although it may be as tough) as Bette and Tina in The L Word might make it seem. The issue is complex no matter from what angle you look at it; from the woman who carries the child, the female partner who doesn't, the known or unknown donor, the possible partner of the donor, the child, and the surrounding families - all are affected in very particular ways.
The process can be long and arduous, and a happy outcome cannot in anyway be guaranteed. On top of all this, in Ireland, where artificial insemination treatments of lesbian women by professional healthcare workers are outlawed in all but actual law, the problems do not end at the point of decision to have a child. Indeed, that's just the start of the road.
In Ireland the practice of artificial insemination (AI) began in the latter part of the 1980s. There are currently about nine clinics in Ireland that offer the treatments, such as The Sims Fertility Clinic, The Morehampton Clinic, The Rotunda in Dubliin, The Clane in Kildare and clinics in Cork and Galway. There is currently no legislation that specifically deals with AI, so rights and regulations are steered by the guidelines of the Medical Council. This council was established in 1978 by the Medical Practitioners Act, and their guidelines are a set of principles that are meant to guide doctors through any professional and ethical issues that might arise.
The lack of legislation around the issue means that the Medical Council guidelines carry serious clout, and any breaches of them might result in disciplinary action. Thus, even though the guidelines make no comment on the treatments of single people or same-sex couples, no gay women get treated. Most of the clinics will refer lesbians back to the guidelines as a reason for their discrimination, seemingly caught between a rock of fuzzy guidelines and a hard, potentially punitory place.
Part of the reason for this seems to be that the guidelines, although not as clear as the practice arising out of them, suggest that it is up to each and every fertility clinic to decide upon who they will treat providing the welfare of the possible child remains the focus. Nevertheless, the particular decisions on the interpretations of the guidelines remain the same for each clinic. In a recent (Commission of Human Reproduction) survey of consultants, only one in seven would hypothetically offer services to same-sex couples (whereas 53% would offer their services to single women).
Other particulars come into play when hospitals deal with the issue. One of these is a fear of retribution from the Catholic Church. The Church has created its own Catholic Bishop's Committee on Bioethics. Not surprisingly, their interpretation of artificial insemination is that "it does not respect the meaning and integrity of sexuality." Just last month there were plenty of articles in the papers about the problems that arise from the medical practices of Catholic-ethos hospitals. The question often posed was: can the needs and rights of the secular world be by passed because of the morals of religious world in publicly funded Catholic-ethos institutions? More generally, recent media rumours have suggested that Pope Benedict XVI is to write his first papal paper on the issue of the evils of homosexuality, which no doubt will do little good for the present climate of discrimination in Catholic-run institutions.
So how do gay women in Ireland go about having children? The difficulties of conceiving are plentiful, and thinking your way around and past them is something that demands serious commitment and perseverance. Especially, perhaps when it comes to the legal implications for all involved; that is: What will be the rights to the child from the point of the birth mother, the partner and the donor? Nevertheless, the commitment of lesbian couples who want to raise families is not lacking. Indeed, the people that I spoke to that were either in the process of trying to have a child or were now bringing up children, seemed full of enthusiasm on the issue. However, many also felt marginalised, and more (in comparison to their heterosexual counterparts) stressed by the particular limits and circumstances within which they had to operate.
Without the access to Irish clinics the manners in which gay women here try to conceive are fairly limited. If you approach any of the clinics, or your own GP, you will most likely be told that you would do best by going to the UK for treatments (people who recently have been attempting to use services in Northern Ireland have been referred on to the UK mainland due to a lack of donors in Northern Ireland). Thus, in Ireland if you are lucky enough to find a donor (something that seems to be very fraught with difficulties) you might go ahead with either self-insemination (DIY), or you could try to access the clinics as a fake heterosexual, either single, or with a fake male partner/donor. Needless to say, the latter example would cause a lot of people additional stress, something which in itself is not very conducive to conceiving.
Some lesbian women also try to conceive by having sexual intercourse with a man. However, it can be argued that this is not really evidence of a choice for lesbian women, but rather evidence of lack of choice in a heterosexually conditioned world. There are also issues around STI transmission that arise with this method, especially if the donor is a one night stand.
Another method of conceiving is by arranging for sperm via so-called cryo or sperm banks. However, extensive research needs to be carried out prior to signing up for any scheme. The potential for abuse in this line of business is huge, as women without any rights to proper clinics are tempted to take enormous chances to get what they are looking for. Just consider, for example, the now infamous UK-based www.mannotincluded.com. When they opened up for business in 2002, the straight founder John Gonzalez reported that he had been overwhelmed by 8,000 registrations in the first 48 hours of business. Mr Gonzalez offered fresh local sperm at different prices, depending on the number of tests done on the semen, the number of donations, assistance with picking donors, screenings and accessing consultations with a fertility doctor, the number of ovulation and pregnancy kits supplied, etc. A photo of the donor could only be obtained by opting for the ‘Crystal Package', which cost a hefty stg£5,985. The fact that there could be no actual proof of tests being done on the sperm, that it was fresh sperm being used (which cannot be screened for HIV, which has a three-month incubation period) and that you could pay according to how many tests you wanted done on the sperm (meaning that if you had meagre funds you would be more at risk if there was a problem) immediately suggested that something was amiss.
Nevertheless, people desperate to have a child were willing to take a gamble and spend the money with mannotincluded. A couple of years into business, Gonzalez was rocked by the admissions of former employees, and customers, as to the atrocious reality of his service. There were problems with the lack of coherence between the picked donor and the actual donor used. The same donor was used for several women in the same area at the same time, donors were not given proper health screenings and samples would arrive late and cold. The business is now supposed to be bankrupt, but the website is still up and running, while investigations are ongoing and further allegations ensue.
Finally, there is, of course, the availability of shipments from international sperm banks. Indeed some of these services (I researched the Californian ones in particular) are reputable, and can be easily accessed, even in Ireland; all you need is a credit card. However, you also need to be aware of that the type of packaging used demands a particular way of dealing with the containers when they arrive, and you must thaw the sperm prior to insemination. The websites often suggest that you get a professional to help you. Much smaller but similar Irish services can be found on obscure websites, but users should be very careful, do good research, and take known routes whenever possible.
Given the above-mentioned methods and their complications, many women who can afford to do so opt for the range of costly out-of-the-country clinic treatments. Once abroad you go through the preliminary appointments with a doctor, a nurse and a counsellor, who assess your suitability for the programme. Providing there are no major issues, you then go on to learn more about the treatments that you can access; for example, artificial insemination and the more complicated IVF (InVitro Fertilisation) method. The artificial insemination treatments themselves are generally divided up intofour different types, depending on where the spermis placed. There is Intrauterine insemination or IUI (sperm placed just inside the uterus), Intracervical or ICI (sperm placed just inside the cervix), Pericervical (near the cervix) and Vagina-pool (inside the vagina). The latter two can be performed by professionals and non-professionals alike.
A quick look at the London Women's Clinic list of available treatments suggests that it can get even more intricate. You have to, for example, choose to go through the natural cycle (withoutmedication) or a stimulated cycle (with medication). Naturally the costs for the treatments are high. There are long lists (see the London Women's Clinic website at www.lwclinic.co.uk) of different services that you have to pay for, depending on your particular situation. For example, if you have your own donor sperm, then there will be costs involving checking and cleaning the sperm, although the costs in this situation are lower than if you choose to use an unknown donor's sperm. Additionally, you will have to spend money on travel and accommodation. An extremely conservative costing estimate comes in at £3,500 for a six-month period of treatments.
Success rates depend upon the method you use. If you use fertility drugs your chances of becoming pregnant increase substantially. There are many other factors that affect the results that you might have, such as the health of either the woman who is inseminated or the donor, the age of the woman, whether or not you use fresh or frozen sperm, and how calm or stressed you are about the process. It has even been suggested that you have a chance of having a more positive outcome if you are sexually aroused during the insemination.
All in all, it seems that the success rate lies somewhere between 5-30%. However, for gay women there might be further issues that come to affect the chances of getting pregnant. A study done by London's Women Clinic in 2003 suggested that Polycystic Ovarian Syndrome is more than twice as common in lesbian women as heterosexual women, making lesbians more likely to have infertility problems.
Of course, Ireland is not the only European country which discriminates against its lesbian citizens when it comes to pregancy. In the UK the welfare of the child is also used as a reason to discriminate. Of the 25 out of 100 clinics that treat gay women, many are located in the London region, so that women in Scotland, Wales, much of southwest, midlands and north England do not have easy access. None of the lesbian-friendly clinics are publicly run. British clinics are also following similar guidelines to Ireland (issued in the Human Fertilisation and Embryology Authority's Code of Practice) and each clinic makes up its own policy in this regard. However, the author and activist Lisa Saffron - who has written a number of books on the issue of lesbian parenting - called in 2001 for the Human Rights Act to be implemented. Should this happen it would specifically force changes in how the discriminating British National Health Service presently operates. The civil rights group Liberty has offered to take a test case to the British courts, believing it would have sufficient grounds to win.
Beyond the UK, there are plenty of ways to find loop holes, which in themselves can come to effect the manner in which the case is dealt with in Ireland. One couple that I spoke to had a very particular setup where the child had been born to an American working in Ireland (the partner being Irish, and the known donor also being American), but their legal contracts had been drafted in Pennsylvania (a US state which offers equal parenting rights to samesex couples), which could come to mean that the situation would not be as clear cut in relation to the Irish context (i.e. no rights to the same-sex partner) should anything go wrong. Anyone who is interested can find further information on worldwide discussions and rules and regulations in regards to artificial insemination on the Gay Law Net website at www.gaylawnet.com
The current picture may seem depressing for Irish lesbians (even wealthy ones), but there are some movements towards change. The Commission on Assisted Human Reproduction Initiative was set up by the former Minister for Health and Children, Micheál Martin in March 2000. The commission was established to assist in forming public policy on the issue. They produced a report in February 2003. This report, along with the 2005 update, compiled substantial research from surveys and meetings of professionals discussing the issue. The March 2005 report is still trying to find its way through to an Oireachtas committee. The recommendations in the report are positive in regards to the possible treatment of same-sex couples, saying that services should be available without discrimination on the grounds of gender, marital status or sexual orientation, subject to consideration of the best interest of any children that may be born.
The Commission also recommends that any relevant legislation on the provision of Assisted Human Reproduction services should reflect the general principles of The Equal Status Acts 2000- 4. Although we again come across the issue of the ‘welfare of the child', there is a very thorough part of the 2005 report which offers to prove that the welfare of the child is not dependent on having parents of opposite genders. What will happen with these recommendations is not certain, but the hope is that they will come to influence legislation, making the case for same-sex prospective parents stronger.
Clinics in Ireland will also be subject to provisions of any relevant EU Directives on the issue. Directives set out in 2004 suggested safety and quality standards for "donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells." Given that Ireland is required to comply with these Directives no later than 7 April 2006, we are due some changes in the relatively near future.
Finally, although we might not have come as far as the UK when it comes to all manners of gay rights, there are similar options for us here in Ireland. In last month's issue of GCN, Niall Crowley, CEO of the Equality Authority, emphasised the necessity for gay people to come forward with challenges to the Equal Status Act, as well as legislation in general. There is no doubt that rights to artificial insemination will be among those possible battles. All we need is a pioneer.
Hannah and Clare's Story
In their early 30s, Hannah and Clare began to think seriously about the possibility of having a child. They had been together for four years, and felt that a child would be a much-wanted addition to their family. They decided that Hannah would be the one to carry the child, and that they would not consider any actual sexual contact with a possible donor.
"When we began talking about the subject, a gay male friend who was happy to act as a donor volunteered," says Hannah. "However, as we began researching the actual structures of such an arrangement we became aware of how complex it is. We contacted Pink Parents UK to get a better overview, and from there were referred to an Irish solicitor who had previously dealt with the issue.
"We borrowed a contract that friends of ours had used. Everything seemed to be running smoothly until the donor approached his own solicitor. With all the paperwork involved, he decided to back out, even though the contract could not be legally binding under Irish Law.
"During that time we also came across the British website mannotincluded.com, which offered fresh unknown donor sperm, rather than frozen sperm, which would be available in Dublin. We registered, searched the database for local donors, and coincidentally the only Dublin one worked in the same organisation as me, which would in one sense have been good - fresh sperm cannot travel too far! - but it also caused a lot of agonising, as he was a bit too close to home.
"We then began looking a little closer at the idea of going out of Ireland for insemination. We looked at the less costly option of Northern Ireland and were given a name of a doctor in a clinic and went up to meet him. The doctor explained the necessary procedures, the tests and counselling that would need to be done, and seemed to able to take us on as clients. However, some misunderstandings and miscommunications about the next step, lead to the treatment ending before it had even begun.
"We then looked at the possibilities being offered in continental Europe as well as the UK. Although we found that places on the continent like Belgium were a lot less expensive - stg£600, until you got pregnant - we decided to go with the UK. The reason for this was that we could see someone immediately rather than being put on a waiting list. We approached the Women's Clinic in London for information and the welcome we got was very encouraging.
"We went over to London and had the required three preliminary appointments in one day. First we saw a nurse who explained the practicalities of the treatment, the tests that I would need to get done for STDs and hereditary diseases, and my general fitness and abillity to carry a child. The nurse also asked for a list of what physical attributes we expected of the donor so that a match could be found. Next we saw a counsellor who asked questions and ticked boxes. I was very surprised by this. It was so different from what I had imagined of a counseling session. Finally, we went to see the doctor who explained everything in more detail. The doctor also did a scan to ensure that I would be able to actually carry a baby. We decided to go through the natural cycle, that is, avoiding taking drugs to enhance or regulate the cycle. We got an ovulation kit and set off back to Dublin.
"After completing some tests in Ireland, including a HIV test, the UK nurse contacted us with possible donor matches, which also showed the number of times that this particular donor had got someone pregnant, and we picked one. We then waited for me to come to the surge point in my ovulation cycle.
"This was a really stressful time. We had to be ready to get up and go within a day or two for the first treatment. Clare was present for the first insemination. The actual procedure just took a few moments and then we got back on the plane to Dublin, feeling really odd and nervous. The following necessary scans and medical attention were taken care of by the Fertility Clinic at Clane Hospital in County Kildare. It was very difficult to locate a clinic which would take us on as clients, since the main part of our treatment was done elsewhere. We are really grateful to the Clane Hospital and its lovely staff. When we found out our first attempt had not been successful, even though we had been fully aware of the slim odds of becoming pregnant, the loss had a real emotional impact.
"We went to London to try the natural cycle again, but had no luck. Then we decided to try a drug called Clomid, which is supposed to help with ovulation problems. The doctor sent the prescription from the UK and we picked it up from a pharmacy here in Dublin. However, we were forced to miss a cycle as the tests showed that there was a chance of multiple pregnancies.
"The doctor then halved the dosage of Clomid, and I self injected another drug called Pregnyl, into my stomach, which was supposed to compliment the effects of the Clomid. We then did a third insemination, with the same donor as the two previous attempts, but again got a negative result.
"After this attempt new tests had to be done to ensure that there were no major problems, which might have been missed in the initial tests. We also decided to change the donor. "I have just been treated for the fourth time at the London's Women's Clinic. We are continuing to hope for a positive outcome to this long, expensive, trying, stressful, and exciting time. It's taken four and half years so far. We are still considering most of the other options open to us, except IVF, and have not discarded the idea of a DIY with a known donor. However, until the moment when the right donor turns up, or we get too old to have even a minimal chance of conceiving, we will continue to work with the Women's Clinic."