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 for women in a lesbian relationship to have a baby. This groundbreaking type of IVF has a series of requirements which 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.
The various sections of this article are assembled in the following table of contents.
Meaning and requirements
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 therefore the chances for pregnancy. Having a good egg supply is crucial.
As for the woman carrying the pregnancy, it is an essential requirement that she has a normal uterine cavity, free from malformations 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 you to visit the following article: Baby options for lesbian couples.
Process and timeline
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 collection so that it is done when appropriate.
- 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 taking into account the candidate is compatible with the recipient physically and immunologically.
- Embryo culture: After fertilization, those eggs which have been properly inseminated and present no anomaly will be selected and cultured for between 3 to 6 days.
- Endometrial preparation: The other partner (woman B), which is to say, the one bearing the pregnancy, 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 inside 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 can be see, thanks to this procedure, one member of the couple can contribute part of her genetics 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.
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.
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.
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 been growing non-stop for the past few years. However, only a few countries grant access to lesbian women and single women wishing to have a baby without a man.
Currently, only twenty-two European countries allow single women to turn to fertility treatments to become mothers.
In the case of same-sex female partners, the situation is less liberal, with only seven European countries granting them access to 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 women in a lesbian relationship. This is the reason why most turn to cross-border reproductive care and undergo IVF in Belgium.
As for Spain, marriage is a prerequisite in order for lesbian women to be allowed 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, which is forbidden in the country.
After 6 April 2009, the UK Law established that the birth mother of a child conceived through donor insemination will automatically be considered his legal parent, even if she is not the biological mother. If the woman is married or in a civil partnership, the spouse or civil partner will be the second legal parent.
FAQs from users
Is IVF for lesbian couples available on the NHS in the UK?
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 couple should be offered NHS fertility treatment.
Intrauterine insemination is offered to lesbian couples and, after 6 unsuccessful cycles of IUI, they may be offered moving to IVF. This applies to heterosexual couples having difficulty conceiving as well.
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 reciprocal IVF permitted in Australia?
Yes, but only if the couple has fertility problems. Besides, Australian lesbian couples using donor sperm, either for IUI or IVF, must go through a complex journey, including potential social, emotional and logistical complications.