By Andrea Rodrigo BSc, MSc (embryologist) and Rebeca Jiménez Alfaro MD, MSc (gynecologist).
Last Update: 11/23/2016

Lesbian couples wanting a baby have different parenting options today thanks to infertility treatments, for which they have no alternative but to seek a sperm donor. Nevertheless, depending on the country, the legal framework for same-sex partners to get pregnant and become mothers may be more or less permissive.

Lesbian conception: options and statistics

There exist three main fertility options for women in a lesbian relationship to have a child, all of them obviously with donor sperm. The first is artificial insemination, in which case they have to decide which one is going to undergo the treatment. There is the possibility that both of them do so, too. On the other hand, traditional adoption is another option.

Should artificial insemination be unsuccessful, couples may be advised to move on to in vitro fertilization (IVF).

On the other hand, there exists a method called partner-to-partner egg donation, lesbian IVF, reciprocal IVF, co-IVF, or two-mom IVF, a technique that is increasingly becoming popular, as it allows for both partners to participate actively in the journey toward conception.

Out of the 605,472 same-sex couples that can be found currently in the United States, only 20% have achieved their dream of creating a family, and 50% have a strong desire to parent. Likewise, in the United Kingdom, statistics by the Human Fertilisation and Embryology Authority (HFEA) show that, of the 42,721 women accessing fertility treatment in 2013, 3% were in a same-sex relationship.

Self-insemination or at-home artificial insemination (commonly referred to as lesbian insemination at home), as well as natural sperm insemination, cannot be considered Assisted Reproductive Technologies, as there is no medical screening or assistance for the patient in either processes. Thus, even though it could be argued that they are fertility options for lesbian couples to create a family, we will not explain them hereinafter.

Artificial insemination

Artificial insemination starts with mild controlled ovarian stimulation (COS). One or two oocytes will develop and be released to the Fallopian tubes during ovulation ready to be fertilized.

Follicle growth and size are monitored by ultrasound scan to see whether they are developing as expected. Estradiol tests are also advisable in order for the increase in its levels to be observed.

Finally, when 1 or 2 follicles reach a size of 18 mm in diameter, insemination per se can be scheduled. The insemination process involves inserting the semen sample—after sperm capacitation—inside the patient’s uterus by cannula transfer.

After that, the sperm travel through the female reproductive system toward the Fallopian tubes, where egg insemination is expected to take place.

Same-sex female couples can decide who is going to be inseminated. The doctor may give them advice on who has the greatest chances for pregnancy according to the results of each woman’s fertility tests.

For IUI to be successful, the patient should have at least one tube “patent”, that is, unobstructed, as well as a good egg supply. Also, the presence of uterine abnormalities may hinder embryo implantation or have a negative impact on pregnancy.

Another feasible option is for both women to undergo artificial insemination, better known as reciprocal insemination. In such case, they can choose between using the sperm of two different, anonymous sperm donors, or a known sperm donor, whether it is a brother, family member, or friend of the couple.

What is reciprocal or lesbian IVF?

This method, as one can see in the picture below, follows the steps of in vitro fertilization, with the difference that it is one member of the couple who undergoes ovum pick-up for egg collection, while the other has the embryo transferred to her uterine lining, and is therefore the one carrying the pregnancy to term. This process is also called egg sharing or shared motherhood.

The process of partner-to-partner assisted reproduction comprises the following steps:

  • One woman undergoes controlled ovarian stimulation (COS) for the maturation of multiple follicles in the same cycle
  • Ovum pick-up to harvest the mature eggs from the ovary
  • Egg insemination with donor sperm
  • Embryo culture and selection of the one or ones with the best quality
  • Transfer of 1 or 2 embryos to the woman not contributing the eggs
  • Quantitative hCG blood pregnancy test: it is usually carried out at the fertility clinic as indicated by the gynecologist, within two weeks before the embryo transfer

The Spanish Law, however, grants access to infertility treatments only for married same-sex couples. Lesbian IVF is not covered by insurance in Spain, and therefore there is no alternative but to seek a private clinic.

According to the Spanish Law on Assisted Reproduction, only the woman herself or her spouse is allowed to use her gametes, so marriage is a prerequisite for this treatment to be done under legal conditions.

Normally, insurance providers do not cover reciprocal IVF services unless medical necessity is documented. So you can get an idea, the costs of partner assisted reproduction are similar to those of IVF with a known sperm donor:

  • Fresh cycle of IVF: €11,000
  • Fertility medications: €2,800-€9,400 for each partner
  • Total cost: €20,000 approx.

It should be kept in mind that, in case of failure on the first attempt, a second cycle with frozen embryos would be necessary (i.e. frozen embryo transfer or FET), which would add €2,800-$4,700 to the overall cost. These prices may vary from clinic to clinic as well as by country.

Egg donation from your partner

Although less commonly, IVF can be done with one partner’s eggs and the semen of a sperm donor.

The steps to be followed are:

  • Controlled ovarian stimulation
  • Ovum pick-up to retrieve the mature eggs
  • Egg insemination with donor sperm
  • Embryo culture and selection of the embryo(s) with the highest quality
  • Embryo transfer back to the uterus of the partner who has contributed the egg(s)
  • Quantitative hCG blood pregnancy test: it is done by the staff at the clinic within 2 weeks after the transfer approximately

Donating to your partner is a fertility option that is becoming increasingly common among lesbians planning to have a baby. It is common for same-sex couples who choose this treatment to have another baby, thereby swapping roles for a second pregnancy. This option is not recommended for women under the age of 32-35.

FAQs from users

How does reciprocal or two-mom IVF work?

By Rebeca Jiménez Alfaro MD, MSc (gynecologist).

Reciprocal or just lesbian IVF is a type of IVF with ICSI that has been created exclusively for lesbian couples with a desire to start a family. Moreover, both of them can participate actively in the pregnancy—one contributes the egg, while the others carries the baby until birth.

In particular, the treatment is made up of two parts, each woman participating in one:

Woman who contributes the genetic material
She undergoes IVF ovarian stimulation and goes through follicular puncture (egg retrieval).
Woman who bears the pregnancy
She receives the resulting embryos after fertilization in the lab using donor sperm, and carries the baby until birth.

Both women have to take hormonal medications: woman A for ovarian stimulation, and woman B for endometrial preparation.

How successful is reciprocal IVF?

By Andrea Rodrigo BSc, MSc (embryologist).

The success rates of lesbian IVF are similar to those of conventional IVF procedures, as the process followed is essentially the same. Optimal rates can be achieved if the woman providing the eggs is younger than 35.

They depend basically on the quality of the eggs used for fertilization. For this reason, the partner providing the eggs is required to undergo preliminary screening procedures, including:

  • Review of medical records
  • Physical examination
  • Blood testing
  • Review of family history
  • Psychological evaluation

On the other hand, the uterine lining of the partner carrying the pregnancy needs to be synchronized with the stage of embryo growth for a successful pregnancy to be possible. Also, the menstrual cycles of both partners are synchronized by means of Lupron and birth control pills. Should it not be possible, the embryos would be frozen for being transferred in a subsequent cycle.

Do lesbian couples need a sperm donor contract?

By Andrea Rodrigo BSc, MSc (embryologist).

Absolutely yes, especially in the case of same-sex couples and single women who decide to collaborate with a male friend or brother (i.e. known sperm donor). Sperm donor agreements are intended for those who do not use a sperm bank as intermediary.

The purpose of this type of contract is to make sure the donor is not the legal parent despite being the biological father of the child.

Can lesbian couples choose the profile of their sperm donor?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, in this sense, it would work similarly to a known sperm donation process. Although patients are recommended to select a man whose profile is similar to their phenotypical characteristics, some lesbian-friendly sperm banks may allow you to choose the profile. There have been cases where a white same-sex couple have chosen a black sperm donor, a gay donor or even their brother (intrafamilial gamete donation).

Is there any way for lesbian couples to use a sperm donor for free?

By Andrea Rodrigo BSc, MSc (embryologist).

The only way this option could be possible would be by looking for a natural sperm donor, which basically involves one of the partners engaging into sexual intercourse with a man. However, this practice is totally unadvisable for various reasons.

On the one hand, his semen has not been screened for infectious, genetic and viral diseases likely to be transmitted to offspring. On the other hand, legal problems may rise regarding the parental responsibilities and rights of the donor.

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Authors and contributors

 Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information
 Rebeca Jiménez Alfaro
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the University of Murcia, with specialty in Obstetrics and Gynecology, and Master's Degree in Human Reproduction by the King Juan Carlos University and the Valencian Infertility Institute (IVI). Currently, she is part of the medical team of the clinic Tahe Fertilidad. More information
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2 comments

  1. Featured
    melissa graham

    Hey Sandra,

    My wife and I (lesbians) wish to have twins, is it possible through IVF? We’d like to learn how, thx.

    Best

    • Sandra FernándezBA, MA

      Hello Melissa,

      A twin pregnancy can be achieved by transferring multiple embryos, but this is unadvisable due to the number of risks multiple pregnancies carry. Besides, we cannot make sure both embryos would implant, so there is no way we can be totally sure that two fetuses are going to develop. In case it happened, they would be fraternal twins, as they have been created with two different embryos.

      With single embryo transfers, there is a small chance for you to have twins (this time identical) if the embryo divides while developing. But, again, there is no way we can control this or cause it to happen.

      I hope this helps,

      All the best