Consent and counselling for decisions relating to assisted reproductive technology

Consent an essential part of any assisted reproductive technology procedure. When you give consent, you are saying that you understand the risks and implications of a procedure. When you provide consent, you can also put limits on the process that the clinic must follow.

Effective consent is:

• a voluntary agreement, not obtained by coercion or deception
• by a person who is known to be able to make reasonable decisions
• applies to a specific treatment or procedure
• informed through the provision of accurate and up-to-date information
• is provided in writing.

• anyone undergoing an artificial insemination (AI) or in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) procedure and their spouse/de facto partner (if applicable)
• sperm, egg or embryo donors and their spouse/de facto partner (if applicable)
• sperm, egg or embryo recipients and their spouse/de facto partner (if applicable)
• anyone undergoing pre-implantation genetic testing (PGT)
• research participants.

Consent applies to a specific treatment or procedure. You may be asked to provide separate consents at different times during an ART process.

Consent is required before:

• any artificial insemination (AI), in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) procedure
• before conducting any other add-on procedure
• using donated sperm, eggs or embryos
• performing preimplantation genetic testing (PGT)
• allowing an embryo to succumb
• using excess ART embryos
• undertaking innovative procedures or research.

You need to be given information in person (or via telehealth) and in writing before you can provide consent to a procedure.

This includes:

• what happens if you provide consent
• that you can change the consent or withdraw it at any time
• accurate, objective information about treatment options and success rates
• potential risks, side effects, long term outcomes for you and any child born from a procedure
• whether a treatment is an innovative or routine practice
• limitations in current knowledge
• how your treatment data and information will be handled and the requirement for information to be submitted to the WA Department of Health Reproductive Technology Registers (external site)
• information on counselling and when counselling is optional or required
• information that posthumous use of sperm of eggs is not permitted.

Donor assisted conception

Your clinic should provide you with the following additional information during donor assisted conception:

• effect of the Artificial Conception Act 1985 (external site) on legal parentage status
• medical and social implications of donation
• rights of donors, participants and children to access information from the WA Department of Health Reproductive Technology Registers (external site)
• how long any sperm, eggs or embryos should remain in storage and what should happen if something happens to a participant and they can’t withdraw or vary their consent in future
• advice on the need for recipients to refrain from sex during treatment (so there’s no confusion over the parentage of the child).

If you are considering donating excess assisted reproductive technology (ART) embryos you must be provided with information on:

• your rights to place conditions on the use of the embryos and the right to withdraw consent at any time
• any limitations on storage time
• your right to refuse any further requests for specific use that may be made in the future.

It is important the counsellors have appropriate training and expertise in assisting participants in their decision on whether to consent to an assisted reproductive technology procedure.

Counsellors must be eligible for full membership of the Australian and New Zealand Infertility Counsellors Association (ANZICA). Counsellors are not involved with assessing suitability for treatment and cannot be one of the people who are performing a procedure. They are there to provide information and support to the participants.

Counsellors are an integral part of the clinic team; however, you can decide with your fertility provider to see a counsellor outside of the practice if preferred.

Counselling costs are included in the cost of treatment, so there’s no discount for skipping the counselling part of the process. Cost of counselling for donors is generally met by the donation recipients.

Counselling is a mandatory part of the donation process.

If you are using a donor from interstate or overseas, your clinic still needs to confirm that the donor was able to access counselling and provide effective consent. The qualifications and role of the counsellor should be equivalent to what is required in Western Australia.

Counselling will cover:

• why the donor wishes to be involved in donor assisted conception
• potential long-term psycho-social impacts of donation and significance of biological connection for all involved parties
• the rights of donor conceived people to obtain identifying information on their donor
• the possibility that a donor conceived person may attempt to contact their donor after they reach 16 years of age.

There are additional requirements where the donor and recipients know each other and there is a cooling off period before proceeding with the donation.

The initial counselling should include:

• at least 3 hours across 3 sessions
• the recipient and donor (plus spouses/de facto partners) being seen separately and then together.

After counselling there will be a cooling off period of 3 months prior to the donation:

• after the cooling off period, participants and donors should have contact with the counsellor to confirm if they are willing to proceed
• counsellors should also be involved if the donation does not proceed.