In South Africa, same-sex marriage has been legal since the Civil Union Act came into effect on 30 November 2006.
Many of these couples try to start a family, and very often they seek medical advice as it is highly unlikely for them to fall pregnant by themselves.
One study reports that same sex couples have significantly fewer children than the heterosexual subjects in the research.
This has resulted in an increase in lesbian couples and single women seeking and receiving donor insemination, leading to the clients requiring stronger treatment options that lead to better chances of pregnancy, shows another study.
Dr Elna Rudolph is a medical doctor, sexologist and clinical head of My Sexual Health. She is also the first doctor in South Africa to obtain a Higher Diploma in Sexual Health and HIV Medicine through the Colleges of Medicine in South Africa.
Dr Sindi Van Zyl is a Johannesburg based professional medical practitioner and also a public figure well known through her activism, social media and broadcasting channels.
We asked them both a series of popular questions and they provided us with some answers which we share below.
What options are there for same-sex couples looking to fall pregnant?
Dr Van Zyl outlined two treatment options available for lesbian couples and single women in South Africa: The Surrogacy route and The Sperm Donor route.
She believes that different private sectors in South Africa provide these adequate options for sexual and reproductive health services.
What are the costs involved?
According to fertilitylaw.co.za costs will vary depending on a number of factors - what clinic you use, how many rounds of IVF that you require, what treatment you undergo (use of a sperm/egg donor or not); what attorney you use, what the agreed monthly reasonable expenses are, the level of medical aid and life insurance that you choose to use, the gross income of your surrogate, as well as loss of earnings and so on.
Surrogacy may take a couple of months depending on the number of IVF cycles a couple goes through, adding to the expense each time.
Cost in South Africa may include the following:
- IVF Medical costs: R50 000 - R135 000
- Screening Costs: R 17 000 - R 25 000
- Legal Costs: R 60 000 - R 85 000
- Monthly costs during the surrogate journey: R10 000 - R 15 000
Lesbian couples and single women looking for sperm donations can go to sperm banks and many other fertility clinics and they will be assisted for around R5 000.
Which conception options are less expensive and have a better chance of success?
"The only affordable way to conceive is naturally, so doctors try to investigate every possible reason for infertility issues in the couple before suggesting other options, because they are aware of the cost and the stress that may be caused by the treatment process," Dr Van Zyl tells Parent24.
"The challenge in SA is that the medical aid schemes do not pay for fertility procedures such as IVF (In vitro fertilisation), and couples have to pay out of their pockets. Each cycle can go up to R50 000, which makes it difficult for couples to afford it."
"This is something of concern and something that future policies may have to change to make the IVF process affordable for medical aid holders," she says.
"Success of conception depends on many factors - fertility specialists make the decision on which option to choose from based on their thorough clinical examination, and the medical history of the couple," Dr Sindi adds.
What would you advise transgender women looking to alter their bodies and then falling pregnant?
"Couples looking to fall pregnant in future must consider saving their sperm because once the hormone treatment is started on your body, your sperm count will decrease which may result to future infertility for some couples," says Dr Rudolph.
She adds, "some couples may not notice this, especially if they are still having penetrative intercourse with their partners. But the key thing is to save your sperm or freeze your eggs because, in future, they might want to conceive".
Both our experts agree that such matters need to be discussed with a patient during consultation and should also be discussed at length with your therapist for future fertility before starting on the hormone treatment for transitioning.
What causes the sperm count to decrease?
The reason for the sperm count to decrease, explains Dr Rudolph, is because the hormone treatment lowers the testosterone in the body and increases the oestrogen, in order to have hormones that look like actual female hormones, and those hormones will then alter their bodies.
She also mentions that for now, the South African health system does not have treatment options specifically for transgender women who want to fall pregnant.
In fact, according to her knowledge, nowhere in the world have doctors been able to help a transgender women fall pregnant.
How long do most couples have to wait before they fall pregnant through the treatment options?
Dr Sindi maintains that one of the most important ways to fall pregnant is to have regular condom-less sexual intercourse. "But most couples skip the 'regular' part."
"You need to have sex at least three times a week and if after six months of regular condom-less sex there is no conception, then this is cause for some investigations," she explains.
Treatment can be considered after an examination of the cause of infertility is found. The couple can then start with the recommended treatment, which may take a couple of months for one cycle.
If you have questions about falling pregnant, let us know and we'll find the answers.
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