27 questions and answers about assisted reproduction for two women
The questions have been pouring in after the Danish People's Party, the Norwegian People's Party and the Norwegian Socialist Party presented their proposals for changes to the Biotechnology Act. Even more after they were passed on May 26, 2020. Maybe you're wondering about many of the same things? Here we have collected 27 answers to questions about assisted reproduction for same-sex couples.
What will the practice of assisted reproduction be like? We are eager to give you answers to what the changes in the Biotechnology Act really mean. That is why we organized a live Q&A session on June 2nd where our fertility coach, Mari Fevaag Heger, answered the questions asked by the participants.
Access the recording of the live Q&A session
We also interviewed the front person for the legislative amendments, MP Åshild Bruun-Gundersen, in MedicusPodden. She clarified some ambiguities and went into more depth about the background to the proposed amendments.
Want to hear the podcast episode? Listen to the MedicusPodden with Åshild Bruun-Gundersen here
1. How long do I have to wait to seek help to get pregnant?
You or you are welcome to contact us to get an investigation anytime. Heterosexual couples are welcome to try on their own for one year, while lesbian couples and singles are recommended to contact us as soon as they are ready to have children.
2. What documentation is required to receive assisted reproduction? What must be obtained from the GP?
If you do not start the assessment with us (we can perform all examinations and tests), we need documentation of the examinations that have been performed and blood test results from your GP and/or gynecologist.
In addition, it requires a childcare certificate from anyone who wants assisted fertilization. This will be new in the Biotechnology Act from July 1, 2020. (See more information under question 3.)
3. What is a childcare certificate, and how does it work in practice?
Everyone who applies for assisted reproduction must present a child care certificate from July 1, 2020. This is a certificate from the police stating whether the applicant has previously been charged or convicted of a crime, such as sexual crimes, drug crimes, and violent and robbery crimes.
A remark on the certificate does not immediately mean a rejection of the application. The childcare certificate becomes part of the overall suitability assessment the doctor makes to determine whether everything is in place to ensure that the child will have a safe environment to grow up in.
4. Can we get an examination and have blood tests and examinations at Medicus rather than at a GP or gynecologist?
Yes, you can. Most of our patients choose to do so, but those who live far from our clinics often take the preparatory examinations where they live.
5. How long is the waiting period for assisted fertilization?
There is usually a short wait at Medicus – just contact us to book an appointment and you will be in quickly.
6. Can assisted fertilization be performed at your clinic, even if you live far away from the clinics?
All examinations, blood tests and examinations can be done after a referral from us at a doctor or gynecologist where you live. We make an assessment of the answers we receive and continue the dialogue with you. Examinations and ultrasounds related to the treatment can also be done locally after a referral from us. For insemination, you must come to one of our clinics. The same applies to egg retrieval and transfer during IVF treatment.
7. What is the advantage of choosing assisted fertilization privately over publicly? What is the advantage of treatment in Norway vs. Denmark/abroad?
You will certainly receive good treatment regardless of whether you choose private or public. The advantages of private treatment are that you do not have to wait long, and you often get more personal follow-up. The advantage of public treatment is that it will cost less.
We cannot see any advantages in choosing treatment in Denmark/abroad when you can now get the same treatment in Norway – except if you want to choose the donor yourself or want an anonymous donor. This is legal in Denmark, but not in Norway.
We think the non-anonymous donor system in Norway is a good and orderly solution for the child.
8. Is there an upper age limit for assisted reproduction?
The law sets an upper age limit of 46 years. This means that you cannot start treatment after you have reached the age of 46. We basically have an age limit of 43 years, but make individual assessments when you are 44–45 years old when it comes to starting new trials. It is important that you have a certain degree of probability of success and this is related to age.
9. Who will assess “suitability”? Is there a doctor at the clinic/hospital where the treatment will be carried out?
That's right. The doctor at the clinic or hospital assesses suitability based on the legislation – similar to the practice today.
10. Is there still any chance of having children with your own eggs with a low AMH, for example 1.2 pmol?
Yes, it can be. But a more holistic assessment needs to be made than just looking at the AMH value.
11. How do we proceed when we have already started the process of sperm donation abroad? Will the process be transferred to Norway?
In principle, there should be no problem in continuing the process in Norway. Your medical records abroad can be transferred here to us, but we must also ensure that the requirements for processing in Norwegian law are met.
12. Once we have started treatment abroad, do I have to go through all the blood tests and gynecological tests again before I can get help here in Norway?
In principle, you do not have to, but it depends on which tests were performed and how old they are. If the tests were recently performed, you most likely do not need to take the tests again. Via our website you can send us the papers you already have, then we will make an assessment and follow up with you further.
13. We were originally going to start treatment in Denmark and have already reserved a donor through that clinic. Can we use the same donor if we choose treatment with you?
The Biotechnology Act does not allow you to know the donor code. In order to use a reserved donor, it is therefore assumed that only the clinic in Denmark knows the donor code.
In our interview with Storting politician Åshild Bruun-Gundersen, however, it seems that the intention of some of the changes in the Biotechnology Act is to allow full siblings to be given to previous children using the same donor – even from a foreign clinic.
We have subsequently investigated with the Directorate of Health, and they confirm that the donor whose code you know cannot be used.
14. When will the practice of egg donation become available to women in Norway?
From January 1, 2021, but it is uncertain how quickly the treatment will be up and running after the law comes into force. Fertility clinics must have the necessary approvals in place. We at Medicus work every day to be as well prepared as possible, so that we can offer the treatment as soon as all the formalities are in place.
For those of you who are two women, you can start the path towards the child you want with partner donation right now.
15. Is egg donation legal for lesbians? That is, double donation?
When the changes to the Biotechnology Act came in 2020, egg donation from a partner had to be medically justified. This was changed in May 2021, so that women in same-sex couples can choose which of the women will become pregnant with the couple's child without there being a medical reason.
16. What is the reason why the child must have a biological connection to one of the parents? A couple where both have become infertile cannot get help?
Not yet. Member of Parliament Åshild Bruun-Gundersen gave us this answer when we interviewed her in MedicusPodden:
– The basis for the changes to the Biotechnology Act was about helping involuntarily childless people have children of their own. Double donation is a topic we don't want to get into yet. The changes that are coming now are already pushing boundaries far.
If there is no requirement for genetic connection to one of the parents, we are actually moving into a different debate. There are several ethical issues that must be considered in that case, such as embryo donation. Double donation may come up for discussion later, but was not part of the debate this time.
17. Can we choose between simple or extended donor profile? What is the difference?
When donating sperm, one can currently choose three "desired donors" from which the doctor normally chooses. The choices are made based on the donor's physical characteristics. These can be simple or extended profiles.
Extended profiles provide more insight into who the donor is – such as personality, family background, education and interests. In addition, you can see a child's photo.
18. How does egg freezing work?
When you freeze your eggs, you are stimulated as if you were going through an IVF process. You are given hormones to mature more eggs in a cycle so that we have more eggs to retrieve. The quality of the eggs is assessed by the lab before they are frozen. This is done by vitrification, which is a method where the eggs are frozen very quickly in liquid nitrogen.
Please note that storing unfertilized eggs does not guarantee that you will be able to undergo assisted fertilization later. Any use in later treatment requires that the applicable conditions for assisted fertilization are met.
19. How much does it cost to retrieve eggs for freezing?
The price has not yet been set. But we imagine it will be around 30.000,–. If you want egg freezing on non-medical grounds, i.e. “social freezing”, the costs must be covered yourself. If it is on medical grounds, the costs are covered and the treatment will normally be carried out in a public hospital.
20. How long does the egg retrieval treatment take?
Treatment starts when you start menstruating and ends after egg retrieval. Some people need multiple retrievals to get enough eggs. (It becomes harder to retrieve many eggs as you get older.)
21. Is there an upper age limit for freezing eggs – and for when they can be used?
Initial discussions with the Norwegian Directorate of Health have resulted in a recommended age limit of 25–35 years, but this is not absolute. The doctor makes a medical assessment.
The eggs must be used before the age of 46.
22. How long does the egg freezing treatment take?
Treatment starts when you start menstruating and ends after egg retrieval. Some people need multiple retrievals to get enough eggs. (It becomes harder to retrieve many eggs as you get older.)
23. Do all eggs survive freezing? Am I guaranteed a pregnancy by freezing eggs?
There is no guarantee that all eggs will survive, nor a pregnancy. The chance of getting pregnant is much higher if you freeze eggs when you are between 25 and 30 years old, than in your late 30s. The older the woman gets, the worse the quality of the eggs.
Please note that storing unfertilized eggs does not guarantee that you will be able to undergo assisted fertilization later. Any use in later treatment requires that the applicable conditions for assisted fertilization are met.
24. Will I become less fertile after freezing eggs?
No, you won't. The hormones you receive when treatment starts mature more eggs. The cycle is better utilized, but no more eggs are used.
25. How long can I keep eggs or embryos frozen?
Both frozen eggs and embryos must be used before you are 46 years old. Previously, embryos could be stored for a maximum of 5 years, but with the changes to the Biotechnology Act from July 1, 2020, this time limit will be removed.
In our interview with Storting politician Åshild Bruun-Gundersen in MedicusPodden, she adds the following:
– The law has retroactive effect, but some cases may need to be assessed individually during a transitional phase. The clinic must contact the Ministry of Health and Care Services if someone is at risk of not being able to attend the placement due to the changes in the law.
26. When will NIPT testing be allowed for everyone?
The amendment to the Biotechnology Act was supposed to come into effect on July 1, 2020, but the Ministry of Health and Care Services has postponed the start of the offer for NIPT test until after November 1, 2020. We want to offer NIPT testing as soon as the investigation and guidelines are in place.
27. What requirements and frameworks apply to NIPT tests?
There will be requirements for providers of NIPT test delivers a "package" with the test, good information in advance, explanation of the meaning of the answers, and follow-up afterwards.
Private operators must apply to the Norwegian Directorate of Health to offer the NIPT test.
The Norwegian Parliament has asked the government to ensure that NIPT is allowed for all women, but a report on how the decision will be implemented in the health service must first come from the Norwegian Directorate of Health. The NIPT test will be available after November 1, 2020.
