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Pregnancy Options & Fertility Treatment for Lesbian Couples

Pregnancy Options & Fertility Treatment for Lesbian Couples

Lesbian couples opting to start or expand their families have a range of fertility options. One of the most unique and exciting is called reciprocal IVF — reception of oocytes from the partner, also known as ROPA, ROPA method, shared IVF, shared motherhood, and lesbian shared IVF). Basically, it is an in vitro fertilization with donor sperm, but this version of IVF allows both women to be actively involved in the baby–making process, unlike traditional IVF with donated sperm. The couple selects a sperm donor, but instead of just being inseminated with the donor’s sperm via intrauterine insemination (IUI), one partner goes through ovarian stimulation (to provide the oocytes) and follicular aspiration procedure to retrieve their oocytes for fertilization (genetic mother), and the other partner has the embryo implanted in their uterus to carry and give birth to the child (gestational mother).

It is worth noting that non–ROPA IVF with donor sperm and ROPA cycles are different. Same–sex female couples undergoing reciprocal IVF may have and may not have fertility disorders, the semen is always donated by an anonymous/open identity/known donor (like in IVF with sperm donor), and the pregnant partner is not the one providing the oocytes (unique option).

Unlike ROPA, non–ROPA IVF with donor sperm involves only one partner undergoing ovarian stimulation, egg retrieval, embryo transfer, and pregnancy. In this scenario, only one partner contributes their own genetic material (oocytes) to the conception, hosts an embryo(s)/fetus (fetuses), and gives birth to the baby (babies). The newborn baby is usually genetically connected to the partner who provided her oocytes and delivered the baby, and the other partner has to adopt the child. Both ROPA and non–ROPA IVF offer distinct advantages for lesbian couples seeking to build a family, and the choice between them will depend on individual preferences and medical considerations.

Pregnancy Options & Fertility Treatment for Lesbian Couples

Women in same–sex relationships – who have functional ovaries and/or a uterus – have multiple ART options to conceive — starting with intrauterine insemination of one or both partners using sperm from one donor to having an in vitro fertilization (one partner or both partners) with donor’s sperm to having a cryotransfer using a frozen embryo to using the donor’s oocytes if neither of partners can provide healthy oocytes to adopting an embryo to shared IVF (reciprocal IVF) and ending with using the gestational surrogate mother if neither of partners can carry the baby.

Generally, reciprocal IVF (ROPA) is one of the multiple options available to lesbian couples. ROPA is a multi–step in vitro fertilization process designed for same–gender female couples, enabling both women to be physically involved in the pregnancy. Although many lesbian couples prefer shared IVF, some of them may opt for alternative options, such as: 

Intrauterine Insemination (IUI) with Donor’s Sperm

Sperm from the donor is injected directly into the uterus of one or both partners via a simple artificial insemination procedure. Once deposited, the sperm can travel up the fallopian tubes to meet an egg released during ovulation, potentially resulting in fertilization.

In Vitro Fertilization (IVF) with Donor’s Sperm

This method involves creating embryos in the IVF laboratory. One or both partners can choose to undergo ovarian stimulation to produce oocytes. The retrieved oocytes are then fertilized with sperm from a chosen donor (most lesbian couples undergoing an IVF cycle at the same time typically choose a shared sperm donor). The resulting embryos are monitored for development, and after careful selection, one or both partners can have the embryos transferred to their uterus for pregnancy. This allows for the possibility of each partner carrying a baby genetically related to themselves. If only one woman undergoes a full round of IVF, including stimulation, follicular aspiration, and embryo transfer, then she is considered both the genetic and gestational mother of the child.

Shared Motherhood with Both Partners’ Oocytes

In this variation of reciprocal IVF, both partners contribute their eggs. The eggs are fertilized with sperm from a shared donor. The resulting embryos can then be transferred to the partner who is ready for pregnancy (in case of double blastocyst transfer, one embryo contains the partner’s oocytes and the shared donor’s sperm, and the other embryo contains the gestational mother’s own oocytes and the shared donor’s sperm. This option allows both partners to be biologically connected to the babies, while one partner carries the pregnancy. It is ideal for couples where one partner isn’t ready to carry a pregnancy yet but wants to contribute eggs.

Concurrent IVF

Each partner goes through the IVF process, including stimulation and egg retrieval. The embryos are created using oocytes from the opposite partner, and then the embryos are transferred to both partners. If the pregnancies are successful, both partners will be pregnant at the same time with a baby that’s genetically related to the other partner.

Egg Freezing, ICSI & Embryo Transfer

This option allows couples to preserve their fertility potential by freezing eggs (oocytes) for later use. One or both partners can choose to undergo this process. The eggs are retrieved through a minor surgical procedure and then vitrified (frozen at very low temperatures) for storage. When the couple is ready to conceive, they can select a sperm donor. The frozen eggs (oocytes) are then thawed and fertilized with the donor sperm using a specialized technique called Intracytoplasmic Sperm Injection (ICSI). This method injects a single sperm directly into the egg, increasing the chances of fertilization. The resulting embryos are monitored for development (usually until they reach the blastocyst stage), and after the accurate selection process, they can be transferred into the uterus of one or both partners for pregnancy.

Frozen Embryo Transfer (FET)/Cryotransfer

This procedure involves thawing frozen embryos from a previous IVF cycle and transferring them to the uterus for pregnancy. This can be done regardless of whether the embryos were created using the couple’s own oocytes or the donor’s oocytes.

Egg Donation IVF/ Double Donation IVF

This type of fertility treatment involves using eggs from a donor, fertilized with donor sperm. The resulting embryos are then transferred to the uterus of one partner for pregnancy. This option is ideal for lesbian couples who may not have healthy oocytes available for fertilization, or who prefer to use donor genetic material due to transmittable genetic conditions or chromosomal abnormalities.

Embryo Adoption

This unique option allows couples to adopt embryos created by another couple who underwent IVF. These embryos may be left over from a successful IVF cycle or specifically donated for adoption. Embryo adoption can be a less expensive route to parenthood compared to other fertility treatments.

Gestational Surrogacy

This method involves using a gestational surrogate mother, who carries a pregnancy for another person or couple. One partner’s egg (or a donor egg) is fertilized with sperm from a donor. The resulting embryo is then transferred to the gestational carrier’s uterus for pregnancy.

Considering Adoption

Adoption is a wonderful option for lesbian couples to build a family. There are various types of adoption available, including domestic infant adoption, international adoption, and foster care adoption.

Why Lesbian Couples Choose Reciprocal IVF?

Reciprocal IVF is a treatment route available to lesbian couples in which both partners have a uterus, functional fallopian tubes (at least one tube), normal to diminished ovarian reserve, and functional ovaries (at least one ovary should be able to produce viable and healthy oocytes). One partner’s oocytes will be retrieved via follicular aspiration, fertilized in vitro with donor sperm either conventionally or via intracytoplasmic sperm injection (ICSI), then carried by the other partner.

There are three main reasons why same–gender female couples choose reciprocal IVF over nonreciprocal IVF — the first is to share the motherhood experience and be both involved in the process of making a baby, the second one — is for medical indications, when one or both partners have some condition(s) that could affect their fertility, and the third is legitimacy.

In nonmedical cases, lesbian couples have had multiple and nuanced motivations for choosing reciprocal IVF, and the major is the desire to share the journey of motherhood with their partner as it enables both women to be equally and proactively involved in the clinical process, as they both have to undergo fertility testing and routine blood screening tests, do injections and attend ultrasound scans; that is why it is very much like they are in this process together, and it feels like they are making a baby. For some same–gender female couples, being equally involved in the process did provide feelings of equality after their child was born, as reciprocal IVF is a much closer shared journey that wasn’t previously available to same–sex couples.

Beyond opting for reciprocal IVF, decisions made during the treatment process are also driven by a desire to share experiences. Few couples chose to have their oocytes collected at the same time because they consider going through the IVF and the egg collection enables them both to have a very similar experience. A few couples share their experiences by choosing to be pregnant at the same time to understand how it all works (pregnancy and childbirth), carrying embryos created from each other’s eggs. Moreover, shared IVF provides an opportunity to create a baby who feels like a part of both partners, which makes it attractive and unique to couples.

Medical indications may include hormonal imbalances that interfere with ovulation, oocyte maturation, or/and oocyte release (anovulation, irregular ovulation, hyperovulation, spontaneous ovulation, and other conditions), low ovarian reserve, poor oocyte quality, ovulation disorder, polycystic ovary syndrome, or a genetic disease of the gestational mother when she cannot use her oocytes in IVF to make a healthy embryo. Conversely, the genetic mother may have endometriosis, uterine disorders, or any medical issue contraindicating pregnancy. While she can provide viable and healthy oocytes to be fertilized with donor sperm to create an embryo, she will need someone to host her baby.

When medically indicated, shared IVF can potentially improve chances of successful pregnancy for lesbian couples through the possibility of selecting the woman who can provide healthy oocytes (oocyte provider) and the woman who will be the gestational carrier between two gestational mothers, considering that both women wish to participate in the pregnancy.

One more reason to be mothers via reciprocal IVF is that others would question their legitimacy as parents. Being legitimate in the eyes of others when they ask: “Who is the mom?” is essential for many same–gender female couples. Many two–mother families described being motivated to use reciprocal IVF instead of traditional IVF with the donor’s sperm so that others would accept that they are both mothers. After coming home with a newborn, they can say that they are both mothers as one of them is a gestational mother because she gave birth, and the other partner is the genetic mother, as her DNA has been used to create an embryo. So, no one can doubt that both women are parents, eliminating doubts about their family roles.

Reciprocal IVF Process: Fresh Transfer

Reciprocal IVF is similar to traditional IVF with donor’s sperm with one exception — it offers a unique opportunity for lesbian couples to be intimately involved in the process.

Step 1: Fertility Testing 

The couple will decide which partner will provide the oocytes to create the embryos (if there is no vitrified oocytes and embryos stored or the couple prefers fresh transfer), and which partner will carry the pregnancy. The partner who will undergo the embryo transfer will proceed with a fertility work–up, which includes pelvic ultrasound scan and a hysterosalpingogram to determine the health of the uterus and fallopian tubes, and blood work on the third day of her period to test hormone levels and identify hormonal imbalances that may affect pregnancy. The other partner (who will donate her oocytes), will have to complete ovarian reserve testing — a combination of blood tests: Follicle Stimulating Hormone (FSH) responsible for developing antral follicles into dominant follicles and oocyte maturation, Basal Estradiol (E2, a marker of ovarian reserve in women), and Anti–Müllerian Hormone (AMH); and an ultrasound scan (antral follicle count or AFC) to help evaluate the number of oocytes that remain into the ovaries.

Step 2: Sperm Donor Selection 

If fertility screening shows no infertility issues, then the couple will select the donor whose sperm will be used in IVF to achieve the pregnancy.

Step 3: Ovarian Stimulation, Egg Retrieval, and Embryo Creation

The partner whose oocytes will be used, but will not carry the pregnancy, will be taking injectable fertility medications to stimulate the ovaries and mature multiple oocytes and will also undergo a surgical egg retrieval procedure.

The eggs will be fertilized with the donor sperm and once becoming the blastocysts, the embryo transfer will be scheduled.

Once the eggs are fertilized, the couple will have the option to have them tested for potential chromosomal or genetic abnormalities (PGS/PGD), to identify the embryos with pathologies and exclude them from the cohort suitable for transfer.

Step 4: Embryo Transfer 

The embryo or embryos (depending on the couple’s preference) will be transferred in the uterus of the partner who will carry and give birth to the baby.

Step 5: Pregnancy Test

The couple will have to wait the typical two–week period before taking a pregnancy test post–fresh embryo transfer for the accurate results. If the routine blood test confirms pregnancy, the fertility specialist will schedule an ultrasound scan to confirm pregnancy.

Using Frozen Embryos

Some female couples opt to use frozen embryos, which frees up the timing of when oocytes are retrieved and transferred. In this case, the fertility specialists will work with the couple’s scheduling preferences and use fertility medications to facilitate the egg retrieval for the woman contributing her eggs.

When the couple is ready to conceive, the fertility specialist will time the embryo transfer with Day 5 after ovulation.

As with fresh embryo transfers, the couple will have to wait for 14 days, after which both partners will come in for the pregnancy test. If the pregnancy test results are positive, the fertility specialist will schedule an ultrasound scan to confirm the viable intrauterine pregnancy.

Understanding the Cost of Reciprocal IVF: A Global Look

The cost of reciprocal IVF is incredibly variable and depends on:

  • Location: Costs vary significantly depending on the country and clinic. Generally, Europe offers lower costs compared to North America.
  • Legal fees: Legal counsel might be necessary to establish parental rights for both partners, especially in regions with unclear ROPA laws.
  • Program type: Basic ROPA cycles may be offered with additional services like genetic testing or multiple embryo transfers impacting the price.
  • Sperm donation: Sperm source (anonymous vs. known donor), additional fees for premium donors, and import/export costs can influence the cost.
  • The number of cycles: Multiple egg retrievals, embryo transfers, and additional procedures can add up.
  • Add–on services: Optional services like assisted hatching or sex selection come with extra fees.

Estimated Costs by Region in 2024:

  • North America (US & Canada): $10,000 – $30,000+ per cycle.
  • Europe: Under $11,000 (variations based on country).

Explore the cost factors, legal considerations, and clinic options for ROPA around the world in this Guide: Reciprocal IVF / ROPA | Countries | Laws | Programs | Costs | Clinics

Building a Family Through Reciprocal IVF

Reciprocal IVF offers lesbian couples a unique path to parenthood, allowing both partners to share in the experience of creating a family. While standard IVF with donor sperm is an option, reciprocal IVF provides a deeper sense of connection for many couples.

Lesbian couples can choose from a variety of fertility services and fertility care options to tailor their reciprocal IVF journey. This may involve using sperm from an anonymous donor, a known donor, or even frozen sperm from a sperm bank. Ultimately, the goal is to create a loving and supportive environment for the child.

If you are a lesbian couple wanting to have a baby but facing fertility issues, consider exploring reciprocal IVF. Consult with a healthcare professional to discuss your options and embark on this exciting journey to parenthood.

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