Reciprocal IVF for the Lesbian Couple

Reciprocal IVF Guide Exclusively for Lesbian Couple

For lesbian couples aspiring to become mothers, the journey to complete their family is one of extraordinary significance, requiring careful consideration and profound dedication. In a world where reproductive medicine continues to advance, the dream of having a child has become more attainable than ever. Reciprocal in vitro fertilization (IVF), or ROPA (Reception of Oocytes from Partner), offers a distinctive path that enables same–sex female couples to share the creation of life: one partner contributes her oocytes, providing the genetic blueprint, while the other experiences the journey of pregnancy and birth. This article delves into the multifaceted world of reciprocal IVF, exploring the scientific, medical, emotional, financial, and legal intricacies inherent in this pathway to parenthood.

What Is Reciprocal IVF?

Reciprocal IVF is a unique type in vitro fertilization treatment that allows both partners of same–sex female couples to be involved in creating and growing a baby. Unlike IVF with donor sperm that might be an alternative option if both women decide to conceive and carry the babies at the same time, ROPA offers more sophisticated solution as it allows both women to be physically involved in the process of making the baby. 

Basically, reciprocal IVF is an adaptation of traditional IVF where both women select a sperm donor, one partner donates her eggs to be fertilized with donor sperm and becomes the genetic mother, while the other partner embraces the role of carrying the baby in her uterus and becoming the gestational mother. It’s exceptional experience created for straitening the couple’s shared bond and desire for motherhood, and one that’s especially helpful to those in the LGBTQ+ community.

Why Lesbian Couples Choose Reciprocal IVF instead of Intrauterine Insemination?

Nowadays, more and more lesbian women seeking fertility treatment prefer ROPA to standard IUI and IVF treatment. But why this option for lesbian couples is so desirable? 

Among the most common reasons why lesbian couples need using reciprocal IVF procedure instead of normal IVF is the dual roles of both women involved in the pregnancy. The couples may choose who will give the oocytes while the other partner will carry the baby, enabling to unite genetics (one partner will share her DNA with the baby) and gestation (the other partner will be the gestational carrier). 

Many lesbian couples prefer ROPA to IUI treatment because they would like to be more connected to each other. Intrauterine insemination does not allow both partners to be physically involved in the pregnancy until both women undergo insemination synchronously. Depending on the case, the medical history, the expectations and the desired outcome, IUI can be suggested as one of fertility options but it would be all about the one partner as only she will conceive and carry a pregnancy to term. 

Some lesbians select reciprocal IVF in cases when one partner is ready to get pregnant while other is not. In such scenarios, experienced fertility specialists recommend that after fertility workup, the woman who is not ready to conception and gestation will take the role of the donor and have to produce multiple eggs, while the other partner will take the role of the one who experiences pregnancy and delivery. 

Same-sex female couples who underwent fertility preservation in the past may opt for ROPA too. Their eggs to create embryos will be devitrified and fertilized with donor sperm via ICSI technique. The cycle will be shorter including fertility testing, thawing of oocytes, fertilization using donor sperm, and transfer of an embryo; and non-invasive as oocyte pickup will not be performed. The gestational mother will have to take fertility medication to prepare her uterus for implantation. 

Reciprocal IVF has unlocked new possibilities for female couples wishing to share motherhood. There is something uniquely special about this path to parenthood, as it allows both partners the opportunity to participate in the fertility journey alongside a sperm donor. For many, it offers a profound connection by allowing one partner to contribute genetically and the other to experience the pregnancy firsthand, thereby intertwining their legacies and deepening their mutual involvement in the creation of life.

What to Consider Before Starting ROPA?

Shared motherhood may be a brilliant option for all those women who wish to share the experience of motherhood. However, it is essential to note that this can be costly and emotionally challenging. Prospective parents often find themselves engaging in consultations with healthcare providers, financial advisors, and mental health professionals to ensure that they are well–prepared for the journey ahead.

Furthermore, shared motherhood may also have legal and social implications, especially in countries where marriage or adoption by same–sex couples are not yet recognized. These can range from difficulties in securing parental rights for the non–biological mother to potential hurdles in the child’s inheritance rights or citizenship. Therefore, female couples need to research and understand the legal and social implications before commencing reciprocal IVF.

Legal Considerations When Undertaking ROPA IVF with Donor Sperm

Reciprocal IVF can be a complicated process filled with challenges, milestones, and legal issues. Before starting any assisted reproduction treatment involving the donor, it’s best to speak with a reproductive attorney in the country or state of residence/birth. Legal statutes regarding parental rights, donor anonymity, and the legalities surrounding the non–biological mother’s parental status can differ dramatically across jurisdictions. Early legal counsel can help couples establish a clear path to secure both partners’ parental rights post–birth, avoiding potential legal challenges. In addition, a reproductive attorney can provide invaluable guidance on the necessary legal documentation, such as birth orders or second–parent adoptions, to ensure that both mothers are legally recognized. This preemptive legal groundwork reinforces the family’s legal structure, giving peace of mind as couples embark on the path to parenthood through reciprocal IVF.

How Does Reciprocal IVF Work?

Like any other IVF cycle, reciprocal IVF starts with comprehensive health assessment, screening, and testing of both partners to tailor the treatment protocol uniquely to their needs or blueprint it from the beginning. 

In the next step, one partner undergoes an ovarian stimulation cycle to stimulate the growth of multiple follicles in the ovaries and obtain more oocytes, thus increasing the probability of generating more embryos. Depending on the ovarian response, the stimulation phase may take longer (if the follicles are slower to mature) or a shorter timeline. It’s worth noting that some couples have a SingleStim protocol with one stimulation and one egg retrieval while the others (especially with a low ovarian response (less than 5 oocytes recovered), sub–optimal response to stimulation (5–9 oocytes recovered) or with some other poor prognostic factors such as age over 38 or failure of previous treatments) may need DuoStim protocol with two ovarian stimulation cycles in the same menstrual cycle.

Meanwhile, the second partner — the recipient — prepares her womb for pregnancy by thickening the endometrial lining, creating an optimal environment for an embryo to implant.

Onсe the oocytes have matured, they are retrieved and fertilized with donor sperm (either from a sperm bank or a known donor) to create the embryo in the IVF lab. If fertilization has been successful, the embryo will begin to develop and once it reaches the blastocyst stage (on Day 5 or 6), it will be transferred into the uterus of the other partner, who assumes the role of the gestational carrier. If implantation is successful, this partner will go on to carry the baby. The following nine months of gestation will be like any other pregnancy, allowing both mothers–to–be to share the miracle of growing the small bundle of joy.

The remaining embryos will be vitrified and deposited for future use in a cycle known as frozen embryo transfer when the stimulation phase is eliminated, and the prospective mother undergoes only endometrium preparation and transfer.

How Long Does ROPA Take? 

It’s important to note that the IVF process is unique for everyone who undergoes treatment, including the timeline. As the basic aspects of reciprocal IVF treatment do not vary from traditional IVF, the timeframe for a SingleStim IVF with one egg retrieval lasts approximately between six to eight weeks, with some cases ending in ten to twelve weeks or even more. For cases with DuoStim protocol and two or more egg retrievals, the standard timeline extends to eight to ten weeks as during the first month, two stimulation cycles are run followed by two egg retrievals, and after completing them, there can be preimplantation genetic testing that may take between 1 and 10–14 days. For example, PGS/PGT–A/CCS test results can be received within 24 hours. If the embryo biopsy is performed on day 5 of embryo development, diagnosis of PGS/PGT–A/CCS is available on day 6 so as to transfer the fresh embryo without the need to cryopreserve it.

From the time you confirm your sperm donor to the successful implantation of an embryo, reciprocal IVF can take as little as 6 to 10 weeks and as much as 10 to 12 weeks, depending on the endometrial status of the gestational mother (receptive or non–receptive), transfer technique used, add–ons (preimplantation genetic testing takes more time to be completed, thus, screened embryos need to be vitrified after this test and devitrified after getting the results), number of transfers (fresh, frozen), the embryonic potency to implant and gestate. 

ROPA Timeline

Of course, timing can vary considerably from person to person, especially if you end up needing to try a few cycles before finding success. Below, a breakdown of the general process:

Getting Started: Up to 1 week

As a newly enrolled same–sex female couple, you will complete your profile, and the IVF clinic’s dedicated case manager will conduct in–depth intro call to recap your situation, needs, preferences, and expectations. If you are ready to move forward, the case manager will book the slot for an initial consultation with IVF team (virtual or in–person). At this time you will be able to ask questions and gain a better understanding of the clinic’s unique process, timeline, and costs.

Planning of the cycle: Up to 2 weeks

Unique to your own circumstances, you may utilize this time to discuss any add–ons for your cycle, reconsider the timeframe, select sperm donor, consult with an attorney, prepare some tests, book the tickets and accommodation if the cycle takes place in different state or abroad, or financially plan your reciprocal IVF journey ahead. 

Pre–ROPA screening: Up to 2 weeks

Before starting any IVF cycle, you and your partner will undergo comprehensive medical screening and psychological evaluation. This step may take just one week or up to two weeks depending on the procedures and tests performed. 

Sperm donor selection, stimulation and embryo creation: Up to 8 weeks

Although embryo creation alone typically takes up to two months on average to complete if you’re selecting an IVF clinic and Sperm Donor from scratch, most of reciprocal IVF cycles from start of the IVF cycle to embryo generation are completed in 6 weeks. The cycles with advanced protocols, such as DuoStim, may take up to 8 weeks including stimulation and embryo creation phases. 

Embryo transfer and transfer confirmation results: 1 day plus 14 days after the transfer

The embryo transfer itself is a quick procedure, completed in a single visit that lasts anywhere from 15 to 30 minutes. Following this, you'll have a two–week wait before undergoing early pregnancy tests, which include both urine and blood tests, to verify if the transfer was successful. An ultrasound scan is then scheduled between 4 to 6 weeks after the transfer to further assess the outcome.

Releasing from IVF clinic to OB care: 8–10 weeks from transfer

Approximately 8 to 10 weeks after the transfer, if the pregnancy tests are positive and an ultrasound has confirmed embryonic heartbeat, you will transition from the IVF clinic's care to that of your obstetrician (OB) for ongoing prenatal care. 

Pregnancy: 30–32 weeks from release to OB

Once you're under the care of your obstetrician, typically 8 to 10 weeks after the embryo transfer, the remaining pregnancy period will generally be around 30 to 32 weeks. During this time, regular prenatal check–ups will monitor the health and development of the baby. You can expect a journey filled with growth, change, and anticipation as you prepare for the arrival of your new addition.

ROPA IVF Success Rates

The success rates of Reciprocal IVF are similar to the success rates of standard IVF cases, but with each case comes unique challenges. The success rates of Reciprocal IVF can be affected by the age and health of the genetic mother and gestation mother, the Rh factor, the ovarian reserve and ovarian response to stimulation of the genetic mother, the quality of the oocytes of the genetic mother, and the quality of the donor sperm. Other critical aspects include the compatibility of the egg and sperm, the fertilization technique employed, and the condition of the gestational mother’s uterus, including how it responds to the preparation protocol and the endometrial thickness at the time of embryo transfer. Additionally, the embryonic genetic quality — whether normal or mosaic — and the strategy of embryo transfer (day 2–3 vs. blastocyst transfer) are also determinants of success. 

Statistical Outlook on multiple transfers in reciprocal in vitro fertilization

• For women under 35, traditional IVF yields a 60% chance of a positive pregnancy test per cycle, with cumulative rates reaching approximately 89% when including transfers of cryopreserved embryos (1 fresh transfer plus 2 cryotransfers using devitrified embryo, without PGD and elective vitrification of only high potency embryos).
• For women aged 35–39, the per–cycle success dips to around 46%, but cumulative rates remain high at 88%.
• Women aged 40 and above face a steeper challenge, with a 30% chance per cycle and a cumulative rate of 72% when factoring in additional transfers and preimplantation genetic diagnosis (1 fresh transfer plus 2 cryotransfers using devitrified embryo with PGD). 

It’s essential to note that reciprocal IVF may not always lead to success on the first try. Some couples may require multiple cycles to achieve a pregnancy that results in a live birth. Following an unsuccessful attempt, fertility specialists at a reputable clinic will conduct a thorough review to determine the cause of a failed IVF cycle and advise the ideal options moving forward. 

Reciprocal IVF Cost

The average cost for Reciprocal IVF typically ranges between $19,000 and $25,000 but can escalate to $39,000 and higher. This cost may vary depending on the insurance coverage, stimulation protocol (SingleStim or DuoStim), number of egg retrievals (one or more), medication protocols, sperm donor cost, and add–on services such as ICSI (intracytoplasmic sperm injection), PGT–A (preimplantation genetic testing of identifying each selected embryo’s number of chromosomes present), mock embryo transfer, elective vitrification of the embryos left after fresh transfer, additional attempt(s) using devitrified embryo(s). 

Any additional embryo transfer cycle can add $3,000 to $6,000 to the total cost per cycle. The purchase of sperm from a sperm bank also contributes to the overall cost, with each vial typically priced at around $1,000. Clinics may advise securing two or more vials to increase the chances of successful insemination and fertilization.

When selecting an international sperm bank, couples must also consider extra costs for legal services, specialized transport and handling of the sperm, and currency exchange rates — all of which can substantially increase the financial burden.

Indirect costs, such as travel and accommodation for clinics that are not local, time taken off from work, and any extraneous medical or psychological consultations, should also be factored into the overall budget. To assist with these expenses, many clinics offer financing plans or package deals that encompass multiple cycles, which may result in savings compared to paying for each component of the process separately.

What Are the Alternative Fertility Treatment Options for Lesbian Couples?

There are several alternative options available for same–sex female couples who want to have a baby. Options to explore include intrauterine insemination (IUI), IVF, egg donation, surrogacy, and adoption. Some female couples may also require Egg Donation, especially if both prospective mothers have low ovarian reserves and poor oocyte quality. The other cases of using donor eggs in reciprocal IVF are issues with ovaries (premature ovarian insufficiency (POI), ovarian failure, absence of viable oocytes), advanced maternal age, perimenopause, genetic factors (genetic diseases, carrier of genetic mutation), failed previous cycles (embryonic arrest, no viable embryos, implantation failure, miscarriage, pregnancy loss, stillbirth). 

Unanticipated Issues with ROPA 

While ROPA offers an intimate shared motherhood experience in conception for same–sex female couples, it’s not without potential unanticipated challenges. 

• Synchronization issues may arise, where aligning the menstrual cycles of both partners proves to be more complex than expected, potentially leading to delays or the need for additional hormonal treatments.
•  Emotional and psychological stress is not uncommon, as the physical and hormonal demands of IVF can be taxing, and the pressure of success weighs heavily on both partners. 
• There may also be unexpected medical concerns, such as poor ovarian response to stimulation drugs, lower than anticipated egg quality or quantity, or complications with the pregnancy for the gestational partner. 
• Additionally, legal and ethical considerations can emerge, particularly with respect to parental rights, donor anonymity, and future access to biological information for the child. These issues underscore the importance of comprehensive counseling and support services throughout the ROPA journey to help couples cope with the rollercoaster of emotions and decisions that may surface.

Ethical Considerations in Reciprocal IVF

It is important to acknowledge the ethical complexities surrounding reciprocal IVF. Questions regarding the ethics of sperm donation, such as informed consent, anonymity, and potential exploitation, deserve deeper exploration. Additionally, navigating the legal landscape of parental rights and surrogacy regulations can vary significantly depending on geographic location. Addressing these nuances could provide a more complete understanding of the ethical considerations involved in this family-building journey.

How We Can Assist You with Your Journey?

Choosing the right fertility clinic is essential for ensuring a safe and effective outcome with reciprocal IVF. We go beyond price comparisons to offer personalized assessments and expert recommendations, tailored to meet specific needs and preferences. By connecting you with qualified clinics and providing valuable resources, we empower individuals and couples to navigate their fertility options with confidence.

Embracing the journey to parenthood

Reciprocal IVF, sometimes referred to as shared motherhood, is a fertility treatment option available for same–sex female couples. Designed with both partners in mind, reciprocal IVF allows one partner to contribute genetically by providing the eggs, which are then fertilized with donor sperm. Simultaneously, the other partner embodies the role of gestation, offering her uterus as the nurturing environment for the embryo to develop. This synchronized approach not only bridges the gap between biological and emotional ties to their child but also strengthens the couple’s shared bond and desire for motherhood, affirming their mutual investment in every step of the process. For the LGBTQ+ community, reciprocal IVF is more than a medical procedure; it’s a celebration of connection, family, and love, exemplifying the remarkable ways in which modern science and deep–seated desire for parenthood can intertwine to create new life.