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.
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, whom 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.
Process step by step
The difference is that, in this case, the egg donor is not an anonymous person or third-party, but one of the members of the couple, that is, one of the intended mothers. This is the reason it is also known as two-mom IVF.
The timeline involves the following steps:
- Ovulation induction: The woman contributing the egg cell (woman A) is given fertility drugs to induce the production of multiple eggs in a single cycle. While on treatment (around 10-12 days), regular visits to the doctor are necessary with the purpose of monitoring ovarian development through ultrasound and scheduling egg collectione.
- Ovum-pick up: The oocytes are retrieved from the ovaries by aspiration, a process medically known as follicle puncture or ovum pick-up (OPU). This surgical procedure takes about 30 minutes and is done under mild anesthesia.
- Egg insemination: The mature eggs obtained are fertilized with donor sperm, always provided that the candidate is compatible with the recipient physically and immunologically.
- Embryo culture: After fertilization, the eggs that have been properly inseminated and have no anomaly will be selected and cultured for between 3 and 6 days.
- Endometrial preparation: The other partner (woman B), which is to say, the birth mother, undergoes hormonal treatment with estrogens and progesterone to trigger endometrial development. This allows it to acquire the appropriate pattern and thickness—about 7-10 mm—for embryo implantation.
- Embryo transfer: As soon as the recipient’s uterine lining is on its receptive phase, the embryo with the highest quality will be selected and placed in the uterine cavity. This step is not painful at all, and takes only a few minutes. Neither anesthesia nor special aftercare is needed.
- Cryopreservation of leftover embryos: Unused embryos from IVF can be cryopreserved for future cycles in case of failure on the first attempt or if the couple wishes to have more children.
- Pregnancy test: The levels of beta-hCG hormone can be checked within 15 days post embryo transfer in order for the woman to confirm whether IVF has been successful or not. This period, known as two-week wait or 2WW, can become an emotional rollercoaster for many patients.
As one shall see, thanks to this procedure, one member of the couple can share part of her DNA with that of the child, which means she will be the biological mother. On the other hand, woman B is the gestational mother, whom will give birth to the baby of both.
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 because 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, the 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.
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 programmes. 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.
FAQs from users
How does reciprocal or two-mom IVF work?
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?
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?
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?
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?
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 fertilisation 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.
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.