For lesbian and other LGBTQ+ couples, a fertility journey isn't always straightforward. After all, you've got to work out the whole sperm + egg + uterus thing, and you may not have all of the above. Needless to say, things can get complicated; not to mention any fertility hiccups along the way.
One option for lesbian couples (and for some couples where at least one partner is transgender or nonbinary) is called reciprocal IVF. In reciprocal IVF, one partner's egg is used, but the other partner carries the pregnancy. This way, each partner gets to play a role: one is the biological parent, and the other gets to feel all the kicks and jabs (and morning sickness…blah) and deliver the baby. This could help both partners feel super involved in the pregnancy and connected to the baby.
Sounds kind of perfect. But with reciprocal IVF, there's a lot to understand and consider before diving in.
Reciprocal IVF 101
Here's how it works: First, you'll both have to take drugs that will get your periods synced up. It's important that you're ovulating at the same time. Then, the partner donating the eggs will take fertility meds to help her ovulate, and hopefully one or more eggs can be retrieved. They'll be fertilized in a lab with donor sperm in hopes of getting at least one viable embryo.
Resulting embryo(s) can then be transferred fresh or frozen to her partner. Basically, it's pretty similar to the standard IVF process, except the transferred embryo was made with the other partner's egg.
If your fertility specialist recommends freezing embryos (and possibly chromosomal screening), syncing your cycles is not a necessary step. Eggs can be extracted first, embryos created and frozen and implant planned in the future. The menstrual cycles don't need to be synced.
Who's doing what
You'll have to decide: Who's going to be pregnant for nine months, and who's going to go through the egg retrieval process? You may be able to choose based on the question of who's more into the idea of being pregnant. But you might not have the luxury of choice—if one partner has trouble with her egg reserve or her uterus, for example, or has a health problem where pregnancy is dangerous.
Neither role is free of risks. Because you'll both be taking fertility medications, you may experience side effects. The woman carrying the baby will carry all the risks of pregnancy and childbirth.
Sperm: anonymous vs. known
You're going to need some sperm to make reciprocal IVF happen, so part of the process is choosing where it comes from. Would you want an anonymous donor from a sperm bank? Or is there someone you know who'd be willing to donate some sperm to you?
Going with a sperm bank is pricey, but the sperm is screened for illnesses, and in the U.S., usually the donors have signed paperwork waiving any parenthood rights. If someone in your life donates, they often do it for free (besides the necessary costs of sperm workup/bloodwork you’ll need to consider), and you both can go through this process with someone important to you. However, as the Family Equality Council suggests, you should draft a contract with that person. Also, with widely available genetic testing, bear in mind that no donation is truly anonymous these days.
But what about money?
If neither you nor your partner have been diagnosed with infertility, your health insurance may not cover the costs of reciprocal IVF. Bummer, we know.
Reciprocal IVF costs are similar to that of regular IVF. A cycle of IVF can cost anywhere from $16,000 to more than $30,000 when all is said and done. And, we're going to be candid here: it doesn't always work the first time. If you're using frozen embryos left over from the first cycle, additional transfers may cost less—more like $3,000 to $5,000 per cycle, plus fertility meds.
The laws aren’t great
Parenting laws are complex and vary from state to state. And frankly, they haven't quite caught up with fertility technology. So they may not automatically recognize both parents as biological parents of the child, whether you're legally married or not. So, so frustrating.
An attorney experienced in assisted reproduction laws can help you through all the legal rigamarole. Some states allow "second parent" adoptions, where one parent is deemed the biological parent and the other is able to adopt the child, so they both have equal rights and responsibilities as parents.
If your state doesn't allow second parent adoption or doesn't allow married or unmarried same-sex couples to adopt (yes, both are a thing), the Human Rights Campaign suggests drafting a co-parenting agreement or custody agreement with your partner. A good attorney can help you through all of that.
What about being pregnant at the same time?
Some couples even choose to both be pregnant at the same time, which is known as concurrent IVF.
In concurrent IVF, each woman goes through IVF followed by embryo freezing for each. Once each woman's uterus is deemed by her doctor as ready to receive the embryos created from her partner's eggs, each partner's embryos are transferred to the other. They can therefore carry each other's baby at the same time.
But keep in mind, concurrent IVF could pose some challenges. "Their babies could possibly be born very close to the same birth date," Dr. David Diaz, MD, reproductive endocrinologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California notes. While it could be a wonderful option, "If one woman's pregnancy is complicated, it may be difficult for her pregnant partner to easily care for the woman struggling with the complication."
And then you'll have two newborns. "After the birth, it may add physical stress and fatigue in caring for two newborns by both moms who are recovering from childbirth," says Dr. Diaz.
Think about the future
If you're hoping to have more than one child, you may consider a few different options. Perhaps you freeze some of the embryos from this cycle for a later transfer. Or you could swap roles: the egg donor becomes the pregnant partner and vice versa next time.
All that said, reciprocal IVF can be a good choice for lesbian partners who want to have a baby together—so long as you've discussed all the above with each other, your doctors and a lawyer. Be sure you'll both be comfortable with your role in the pregnancy and beyond. And get ready to become parents…together!
Elena Donovan Mauer is a writer and editor who creates content for a variety of print and digital publications, including The Bump, Parents, Real Simple, and Good Housekeeping. She covers a variety of health and lifestyle topics, including fertility, pregnancy, parenting, nutrition, fitness, and mental health. Elena began her career in magazines and found her way to the pregnancy and fertility space after having her first child. She was formerly Deputy Editor of The Bump, where she worked with top writers, OBGYNs, pediatricians, and other industry leaders to deliver best-in-class fertility, pregnancy, and parenting information to millions of expectant and new parents. She was part of the digital team that launched The Bump app, and she headed editorial for The Bump Magazines. She also helped compile The Bump Book of Lists and The Bump Pregnancy Planner. Elena is passionate about helping people through their fertility journeys. In addition to writing for Cofertility, Elena has been a contributing writer to Parenting.com and Care.com and an editor at CafeMom and SheKnows. Today, she leads the editorial team for Twill Care, an app and website that helps people care for their physical and mental well-being. She creates all the content for Twill Care's pregnancy vertical. Elena lives in the Hudson Valley with her husband and two children.
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