What Is Reciprocal IVF? – Everything Lesbian Couples Need to Know

By MD, MSc (gynecologist), (medical director at fertty international), MD, MSc (gynecologist), BSc, MSc (embryologist), MD (gynecologist) and (invitra staff).
Last Update: 09/23/2020

Reciprocal or lesbian in vitro fertilization—also known as two-mom IVF, co-IVF, pAiR method, intra-partner IVF or double maternity—is a popular fertility treatment that allows women in a lesbian relationship to have a baby. This groundbreaking type of IVF has a series of requirements that vary from country to country. Ethics and laws play a major role in this sense.

This practice for LGBT family building, often referred to as partner assisted reproduction, involves the reception of oocytes from partner, which is to say, one woman donates her oocytes to the other in order for them to be fertilized with donor sperm and transferred to the partner's uterus, who will bear the pregnancy. Thanks to it, both women are able to participate actively in the journey toward motherhood.

Below you have an index with the 11 points we are going to deal with in this article.

Definition

Reciprocal IVF (RIVF) can be defined as a type of in vitro fertilization aimed at lesbian couples who do not have fertility issues. The eggs from one partner are inseminated with donor sperm, and the resulting embryo(s) transferred to the other partner, who will carry the pregnancy to term and give birth.

Deciding on lesbian IVF roles is on the hands of both women. Doctors often recommend that it is the youngest the one acting as the donor, though. This is because egg quality diminishes with age, especially from age 35 onwards. This allows for embryo quality to be improved, and subsequently the chances for pregnancy. Having a good count supply is crucial.

As for the woman carrying the pregnancy, it is an essential requirement that she has a normal uterine cavity, free from anomalies that can have a negative impact on pregnancy and embryo development.

Should you be interested in learning more about available fertility options for lesbian couples, we recommend that you visit the following article: Baby Options for Lesbian Couples.

Are you interested in undergoing Reciprocal IVF to become mothers? Then we recommend that you get your Fertility Report now. It will provide you with a selection of clinics that have passed our rigorous selection process, and subsequently we consider top clinics for our readers. We will send you a report with information on the fees and conditions of each clinic for this particular treatment option.

Process step by step

Reciprocal IVF means nothing more than in vitro fertilization which is carried out with two women.

The process is the same as in egg donation with the only difference in the anonymity of the egg donor, which is, in this case, one of the future mothers of the baby. Therefore, one of the mothers will contribute with her genes (DNA) to the future child and the other mother will carry the pregnancy to term.

In the next section, we will explain the steps of Reciprocal IVF in more detail.

Ovarian stimulation

The woman who provides the eggs, or also called genetic mother, receives a treatment of hormonal medication to stimulate the maturation of more than one egg, which is what would happen naturally. This treatment usually consists of a combination of GnRH analogs and gonadotropins that allows the development of multiple ovarian follicles, which increases the probability of success of the reproductive method.

The administration of the hormonal drugs is done by the patient herself and is normally done subcutaneously through injections in the abdominal area.

Throughout the period of ovarian stimulation (10-12 days), the woman should visit the doctor periodically to perform 'ultrasound analyses' to control follicular growth and schedule the best time to obtain the eggs. This will be done when the specialist determines that the ovarian follicles are approximately 16-18 mm in size.

Ovum pick-up

Once the ovarian follicles have reached the required size, the patient should administer the hormone hCG to promote final maturation and trigger ovulation, i.e. the release of the egg.

The eggs are extracted from the ovary by aspiration of the fluid from the follicles, which are the ovarian structures where the eggs mature. This process is known as ovarian puncture and is a simple surgical procedure that lasts about 20-30 minutes. In addition, the ovarian puncture is performed under mild anesthesia and generally does not require hospitalization.

The aspirated follicular fluid will be collected in tubes at 37°C and will go to the laboratory to look for oocytes.

Fertilization and embryo culture

The eggs obtained that present an adequate maturity stage (metaphase II) are fertilized with the sperm from an anonymous donor. It is important that the donor be physically and immunologically compatible with the woman who is going to conceive, while the selection of the donor is made by the center where the treatment is carried out.

Fertilization can be performed in a conventional way or through the ICSI method (intracytoplasmic sperm injection). The choice of one method or another for fertilization will depend on the characteristics of each patient, age, egg quality, etc.

Once the union of eggs and sperm have been produced, those eggs that have been correctly fertilized (already considered embryos) are selected and left in culture for 3 to 6 days. During this time, it is checked in the laboratory that the embryos develop properly and are classified according to morphological characteristics.

Endometrial preparation and embryo transfer

The woman who is going to carry the pregnancy to term, the gestational mother, receives a different hormonal treatment than her partner. In this case, the gestational mother will take estrogens and progesterone vaginally, orally, or in patches. This treatment favors the growth of the endometrium and allows it to acquire the adequate aspect and thickness for embryo implantation.

Specifically, the embryo transfer will be scheduled when the endometrium of the gestational mother is 7-9 mm thick and has a trilateral aspect. However, these endometrial characteristics do not guarantee 100% that the embryos will implant, since other factors also play a part.

When the uterus of the woman who is going to gestate is receptive, the best quality embryo is selected and deposited in the uterine cavity. This is a painless and quick process that does not require anesthesia or special care. It is simply recommended to come with a full bladder to facilitate the visualization of the uterus.

Nowadays, most clinics tend to transfer only one embryo, which is also known as Single Embryo Transfer (eSET), although in some specific cases specialists also may carry out a transfer of two embryos.

According to guidelines of the American Society for Reproductive Medicine (ASRM), it is recommended not to transfer more than three embryos due to the risk of multiple pregnancy. In countries such as the U.K., the transfer of a maximum of three embryos is regulated by law.

Freezing of surplus embryos

In theory, it is possible to transfer up to three embryos. However, this is not a common practice since transferring a higher number of embryos increases the chance of a multiple pregnancy which itself implicates risks for both the mother and the fetus.

Viable embryos that are not transferred will be cryopreserved for future treatments. This situation may occur due to a failure of the first embryo transfer or if more offspring are desired.

The left-over embryos can also be donated to other couples or for research purposes. Furthermore, once the women's reproductive period is over, the embryos can be destructed. In any of these cases, the female partner must sign an informed consent with the fate of their embryos.

Pregnancy testing

When about 10-12 days have passed since the embryo transfer, the gestating woman will have a beta-hCG test done to confirm if the technique has been successful. This period is known as two-week wait and it is emotionally challenging. However, specialists advise continuing with the daily routine and trying not to think about whether fertility treatment has been successful or not.

We advise not to perform the pregnancy test before the date indicated, as this could lead to an erroneous and unreliable result. Furthermore, in the case of a positive result, it is important that the value of the beta hormone hCG doubles every 48 hours to establish that the pregnancy is evolutionary.

Medical requirements for each mother

As mentioned earlier, reciprocal IVF is a type of IVF tailored exclusively for lesbian couples who want to have a child. The decision on the role assigned to each mother-to-be is up to you, although you should take the advice of your doctor in consideration.

The main reason why lesbian couples turn to RIVF is that it allows both members of the couple to participate actively in the journey toward motherhood. Oftentimes, it is used because one member is unable to carry a child until birth due to poor egg quality, low ovarian reserve, absent ovaries and/or uterus, presence of genetic abnormalities...

Doctors typically recommend that the youngest woman should be the one acting as the genetic mother, as egg quality diminishes as women age, especially from age 35. Having a good ovarian reserve is crucial in this sense. Being genetically screened, including a karyotype test, is strongly recommended as well.

Keeping all these factors in mind, you are likely to increase the number of viable embryos to transfer, and their quality. In other words, pregnancy success rates will rise.

As regards the gestational carrier and birth mother, her uterine cavity should be normal, without anomalies or conditions that may prevent pregnancy or affect fetal development.

Last but not least, the birth mother should be free from any disease that is considered a contraindication to pregnancy, like thrombophilia or certain autoimmune diseases.

Average cost

The average cost of lesbian IVF varies from country to country. In general, insurance coverage is not mandatory or, if allowed, it may cover just part of the treatment. Coverage is only available if there exists a medical necessity.

Cost in the USA

Should part of the treatment be covered by your insurance provider, it may include doctor visits and diagnostic testing for the woman who is going to carry the pregnancy. In case the partner not getting pregnant is diagnosed with ovarian failure, the recipient may qualify for coverage, including testing, treatment, office visits, etc.

Some fertility clinics offer low-cost packages with egg-sharing programs. It involves receiving free IVF treatment in exchange for some unused, healthy eggs. It is known as partner-to-partner egg donation.

Broadly speaking, the cost of RIVF is similar to that of IVF with a known egg donor. If it is a fresh IVF cycle, the price is around $12,000 plus the cost of fertility drugs, which is not included on a regular basis in the initial cost estimate. This may add about $5,000-$8,000 to the overall fees.

In case the first cycle is unsuccessful and a second cycle is required with frozen embryos, the costs will be lower. The average in these cases is $5,000 per cycle plus the medication fees. It varies from clinic to clinic, though. The good news is that the cost of medications is lower in frozen cycles.

Cost in the UK

In principle, the NHS covers up to 6 IUI cycles with donor sperm for lesbian couples. However, they won’t be offered cycles of IVF treatment on the NHS unless they meet the basic criteria established by the NICE on who should have access to IVF treatment on the NHS. In other words, they have no option but to have treatment at a private clinic.

Broadly speaking, the cost of RIVF is similar to that of IVF with donor eggs. If it is a fresh IVF cycle, the price is around £3,800–£4,500 plus the cost of fertility drugs, which is not included on a regular basis in the initial cost estimate.

In case the first cycle is unsuccessful and a second cycle is required with frozen embryos, the costs will be lower. The average in these cases is £2,900–£3,700 per cycle plus the medication fees. It varies from clinic to clinic, though. The good news is that the cost of medications is lower in frozen cycles.

Success rates and statistics

The success rates of lesbian IVF cycles depend on the age of the woman contributing the eggs to a large extent: if she is under 35, the chances for pregnancy are expected to be high.

Although the decision on who will donate the eggs and who will carry the pregnancy is on their hands, couples should keep in mind that the likelihood of becoming pregnant is better when the younger partner provides the oocytes.

The following are the average live birth rates of IVF with fresh embryos:

  • 32.2% for women aged under 35
  • 27.7% for women aged under 35-37
  • 20.8% for women aged 38-39
  • 13.6% for women aged 40-42
  • 5.0% for women aged 43-44
  • 1.9% for women aged 45 and over

For this reason, using the egg cells of a young, healthy woman usually improves the success rates of IVF treatments. However, they must be pre-screened, paying special attention to the woman's history and age. Based on this information, the doctor may recommend who is the ideal candidate for carrying the pregnancy.

Should the woman contributing the eggs produce high-quality eggs, the likelihood of getting pregnant will be high, keeping in mind that sperm donors produce high-quality sperm. If both women agree, they may be offered the chance of undergoing 3-6 cycles of intrauterine insemination first, and move on to IVF in case of failure.

Reciprocal IVF across Europe

The number of laws and regulations on Assisted Reproductive Technology (ART) across Europe has increased significantly over the past few years. However, only a few countries give lesbian and single women the right to have a baby without a man.

Currently, only 22 European countries allow single women to undergo fertility treatment to become mothers.

In the case of same-sex female partners, the situation is less liberal, with only seven European countries giving them the right to access fertility care: Belgium, Bulgaria, Denmark, Finland, Latvia, Spain, and the United Kingdom.

In France, for instance, access to donor sperm is prohibited for single women and same-sex couples. This is the reason why most of them turn to IVF in Belgium.

As for Spain, being married is required to undergo reciprocal IVF, in accordance with the Law 14/2006 governing assisted reproduction techniques. Otherwise, it would be considered a known egg donation process, a type of donation that is forbidden under Spanish law.

After 6 April 2009, the UK Law established that the birth mother of a child conceived through donor insemination will be automatically considered the legal parent, even if she is not the biological mother. If she is married or in a civil partnership, the spouse or civil partner will be the second legal parent.

Interview with Dr. Maria Arqué

In the following video, Dr. Maria Arqué details the steps of shared motherhood and it's requirements for the couple.

FAQs from users

Can leftover embryos from reciprocal IVF be transferred to the woman who donated her eggs?

By Sergio Rogel Cayetano MD (gynecologist).

Of course. The embryos belong to both women. If they wish so, the embryos can be transferred to any woman member of the couple.

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.

Is reciprocal IVF covered by insurance?

By Rebeca Reus BSc, MSc (embryologist).

No, it isn't. Unfortunately, insurance providers don't cover IVF when one partner carriers the pregnancy and the other provides eggs unless it is required for medical reasons. However, diagnostic testing and doctor visits for the pregnant woman may be covered. My advice is that you verify it with your provider, as coverage varies by provider.

Is donor insemination for lesbian couples available on the NHS?

By Rebeca Reus BSc, MSc (embryologist).

According to the National Institute for Health and Care Excellence (NICE), IUI is offered on the NHS if you meet one of the following conditions: 1) you are unable to have vaginal sex; 2) you have a condition that makes it impossible or very difficult for you to conceive; 3) you are in a same-sex relationship.

NHS funding for fertility treatment is limited for everyone, and varies across the UK according to the criteria set by the Clinical Commissioning Group (CCG). Until February 2013, no official guidelines existed on what NHS funding should be offered to same-sex couples.

Now, gay couples are mentioned on the guidelines published by the NICE, which expects lesbians to have tried to conceive up to 6 times using IUI before being considered for NHS-funded treatment.

Reciprocal IVF vs. donor insemination, what's better?

By Rebeca Reus BSc, MSc (embryologist).

It is not a matter of choosing one over the other, but about considering the pros and cons of each option. Usually, women in a lesbian relationship are recommended to start with IUI and after 3-6 failed cycles, they are recommended to move to IVF, as higher success rates are expected to be reached.

However, a couple may wish to undergo this process in order for both women to participate in the pregnancy actively. It is their choice.

Is IVF for lesbian couples available on the NHS?

By Rebeca Reus BSc, MSc (embryologist).

According to the National Institute for Health and Clinical Excellence (NICE) guidelines, NHS-funded IVF should be offered up to the age of 42 in certain circumstances, though the IVF age limit is 39. It states that same-sex couples should be offered NHS-funded fertility treatment.

Intrauterine insemination is offered to lesbian couples and, after 6 unsuccessful cycles of IUI, they should move to IVF. This applies to heterosexual couples having difficulty conceiving as well.

Suggested for you

As explained above, two-mom IVF is a type of in vitro fertilization exclusively tailored for lesbian couples. In case you are interested in delving deeper on IVF treatment, read: What Is In Vitro Fertilization (IVF)? – Process, Cost & Success Rates.

Have you considered donor insemination? It is also a very common option amongst lesbian couples who wish to have children. Learn more here: Lesbian Artificial Insemination – Process, Success Rates & Cost.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Ballesteros A, Castilla JA, Nadal J, Ruiz, M. Manifiesto de la SEF sobre la donación de gametos en España. Publicado a través de la Sociedad Española de Fertilidad (SEF).

Comisión Nacional de Reproducción Humana Asistida (CNRHA) (2015). Aspectos legales y éticos de la donación. En: Registro Nacional de Donantes de Gametos y Preembriones. Ministerio de Sanidad, Consumo y Bienestar Social de España.

Grupo de trabajo conjunto de la Sociedad Española de Fertilidad (SEF) y la Asociación para el Estudio de la Biología de la Reproducción (ASEBIR). Recomendaciones para la aplicación del RD 1301/2006- Diciembre 2012.

Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida. Jefatura del Estado «BOE» núm. 126, de 27 de mayo de 2006 Referencia: BOE-A-2006-9292

Marina S, Marina D, Marina F, Fosas N, Galiana N, Jové I. Sharing motherhood: biological lesbian co-mothers, a new IVF indication. Human Reprod. 2010; 25(4): 938-41.

Pennings G. Having a child together in lesbian families: combining gestation and genetics. J Med Ethics. 2016; 42(4): 253-5.

Saus-Ortega C. La maternidad biológica compartida en parejas lesbianas. La técnica de fertilización «in vitro» con el método de recepción de ovocitos de la pareja (ROPA): revisión de la literatura. Matronas Prof. 2018; 19(2): 64-70.

Sociedad Española de Fertilidad (SEF) (2011). Manual de Andrología. Coordinador: Mario Brassesco. EdikaMed, S.L. ISBN: 978-84-7877.

Vitule C, Couto MT, Machin R. Same-sex couples and parenthood: a look at the use of reproductive technologies. Interface-Comunicação, Saúde, Educação. 2015; 19(55): 1.169-80.

Yeshua A, Lee JA, Witkin G, Copperman AB. Female couples undergoing IVF with partner eggs (co-IVF): pathways to parenthood. LGBT Health. 2015; 2(2): 135-9.

Zeiler K, Malmquist A. Lesbian shared biological motherhood: the ethics of IVF with reception of oocytes from partner. Medicine, Health Care and Philosophy. 2014; 17(3): 347-55.

FAQs from users: 'Can leftover embryos from reciprocal IVF be transferred to the woman who donated her eggs?', 'How does reciprocal or two-mom IVF work?', 'Is reciprocal IVF covered by insurance?', 'Is donor insemination for lesbian couples available on the NHS?', 'Reciprocal IVF vs. donor insemination, what's better?' and 'Is IVF for lesbian couples available on the NHS?'.

Read more

Authors and contributors

 Candela Gallardo Román
Candela Gallardo Román
MD, MSc
Gynecologist
Bachelor's Degree in Medicine from the University of Málaga, with training period as a resident doctor at Reproduction Unit of hospitals Costa del Sol (Marbella, Málaga) and Virgen de las Nieves (Granada). Member of the Spanish Fertility Society (SEF), Medical Director of MASVIDA Reproducción and medical supervisor of egg bank CEIFER Biobanco. More information about Candela Gallardo Román
License: 412910055
Dr. María Arqué
Dr. María Arqué
Medical Director at Fertty International
Doctorate in Reproductive Medicine at the Autonomous University of Barcelona, specializing in Obstetrics and Gynecology. Dr. María Arqué has many years of experience as a Reproductive Medicine and Gynecologist Consultant and currently works as Medical Director at Fertty International. More information about Dr. María Arqué
Licence number: 080845753
 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
 Rebeca Reus
Rebeca Reus
BSc, MSc
Embryologist
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
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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