Baby Options for Lesbian Couples with Donor Sperm

By BSc, MSc (embryologist), MD, FACOG, FACS, FACE (reproductive endocrinologist), (gynecologist), MD, MSc (gynecologist) and (invitra staff).
Last Update: 08/20/2020

In recent years, we have witnessed an increase in the number of families who have moved away from the traditional concept of father, mother, and children. Single women and lesbian couples are some examples of these new family models.

A same-sex female couple can have a child thanks to conventional assisted reproduction techniques: artificial insemination (AI) and in vitro fertilization (IVF). In both cases, it is necessary to resort to sperm donation. Nevertheless, depending on the country, the legal framework for same-sex partners to get pregnant and become mothers may be more or less permissive.

There is also a method available to lesbian couples only: reciprocal IVF, also known as co-IVF or shared motherhood since both women of the couple are able to participate actively in the pregnancy.

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 process. 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

One of the women undergoes AI with sperm from an anonymous donor chosen by the fertility clinic based on her physical characteristics.

This requires gentle stimulation so that 1 or 2 eggs mature and are released into the fallopian tubes at the time of ovulation. During this ovarian stimulation, the patient will visit the clinic periodically to monitor the growth of the ovarian follicles containing the eggs.

When follicular development has taken place, ovulation is induced and the specialist introduces the semen sample, which has been previously capacitated in the laboratory, into the woman's uterus so that fertilization can take place.

AID is a simple process that does not require anesthesia, so it is performed in the clinic itself. In addition, the patient will be able to carry out her daily routine until the time of the pregnancy test.

Read more about AI with donor sperm in the following article: IUI with Donor Sperm - Definition, Process & Success Rates.

In vitro fertilization

It may be the case that the woman who wants to carry the pregnancy to term has fertility problems and AI is not effective. The second reproductive option for these women will be IVF.

Here, the woman receiving treatment undergoes ovarian stimulation so that several eggs mature at once. These are obtained by follicular puncture and fertilized in the laboratory with the donor's sperm. The embryo or embryos obtained will be transferred to the woman's uterus on the basis of their quality criteria.

Related topic: How Does IVF with Donor Sperm Work? - Cost & Success Rates.

In the case of both AI and IVF, even if only one of the two women undergoes the treatment, both will sign an informed consent, so that both will be the legal mothers.

What is reciprocal or lesbian IVF?

Reciprocal IVF is an exclusive IVF procedure for a woman couple with a reproductive desire that allows both to participate in the process of pregnancy, one providing the eggs and the other carrying the baby.

Specifically, there are two parts of the treatment and both of the women participate in each of them:

  • One woman provides the genetic load: she undergoes IVF ovarian stimulation and her eggs are extracted by follicular puncture.
  • One woman carries out the pregnancy: she receives the fertilized embryos in the laboratory with donor sperm and carries the pregnancy to term.

Both women receive hormonal medication: the first for ovarian stimulation and the second for endometrial preparation.

The choice of which woman donates the eggs and which one becomes pregnant will depend on the couple's own decision, always considering medical advice.

Egg donation from your partner

Although less common, 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.

The laws on assisted reproductive technology (ART) differ from country to country. In the U.K., for example, the law governing ART can be found in the Human Fertilisation and Embryology Authorisation (HFEA) Act 1990.

The law establishes that in order for both to become the legal mothers of the baby, they must be civil partners at the time of conception. The conception through IVF needs to be carried out at a licensed fertility clinic or, in cases of artificial insemination, it also can be done by a private arrangement at home.

Couples who are not in a civil partnership can still become legal parents by undergoing fertility treatment in a licensed clinic. However, should they conceive by AI in private, the mother who doesn't give birth has no legal parenthood and needs to adopt the baby in order to become the legal mother.

Patients from the U.S., on the other hand, need to consider that legislation on reciprocal IVF varies from state to state and it might be necessary for one of the mothers to legally adopt her child born through this assisted reproductive technique.

This ensures that both women become legal parents and appear together on the birth certificate.

FAQs from users

What options do lesbian couples have for getting pregnant?

By Dr. Miguel Angel Checa Vizcaino (gynecologist).

Couples of women should use assisted reproduction techniques with donor sperm to achieve a pregnancy. Once the sperm donor is selected, pregnancy can be achieved by in vitro fertilization (IVF), artificial insemination (AI) or through reciprocal IVF.
Read more

Can a lesbian couple use the same sperm donor to do an AI for each one?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Yes, following all appropriate screening.

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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References

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Bos, H. (2013). Lesbian-mother families formed through donor insemination. En A. Goldberg y K. Allen (Eds.), LGBT-Parent families. Innovations in research and implications for practice (pp. 21-37). New York: Springer.

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LGTB paths to parenthood. NHS. Last actualization: 4 May 2020. Link

FAQs from users: 'What options do lesbian couples have for getting pregnant?', 'Can a lesbian couple use the same sperm donor to do an AI for each one?', 'How does reciprocal or two-mom IVF work?', 'How successful is reciprocal IVF?', 'Do lesbian couples need a sperm donor contract?', 'Can lesbian couples choose the profile of their sperm donor?' and 'Is there any way for lesbian couples to use a sperm donor for free?'.

Read more

Authors and contributors

 Andrea Rodrigo
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 about Andrea Rodrigo
 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
Dr. Miguel Angel Checa Vizcaino
Dr. Miguel Angel Checa Vizcaino
Gynecologist
Dr. Miguel Angel Checa has a degree in Medicine and Surgery and a doctorate in Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health from the Autonomous University of Barcelona. More information about Dr. Miguel Angel Checa Vizcaino
Zulassungsnummer: 080830513
 Rebeca Jiménez Alfaro
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 about Rebeca Jiménez Alfaro
License: 303009153
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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