Millions of couples face fertility struggles each year. It's so common, in fact, that UCLA calculates that nearly 15% of all couples will struggle to conceive. Since the first IVF baby was born in 1978, in vitro fertilization has given hope as a potential pathway to parenthood. But for trans, lesbian, and non-binary couples with uteruses who want to conceive and have children that are biologically their own, it's been virtually impossible to include both parents in the process. That is until the emergence of reciprocal IVF.
Reciprocal IVF first made its way into the fertility market in 2009, making the procedure just over a decade old. However, trans male or lesbian partners can use this unique method of IVF (in vitro fertilization) to help both parents share in the conception and carrying process. In its most basic definition, reciprocal means two parties share something equally. When it comes to pregnancy and childbirth, that meaning doesn’t completely hold up; the person growing the child and then delivering said child bears the bulk of the burden and unique joy in many cases. But when it comes to sharing the overall experience of family building, reciprocal IVF can give an added layer of inclusion and connection for same-sex couples with uteruses, specifically cisgender identifying lesbians and transgender men and nonbinary folks who have the ability to donate an egg and/or be a gestational carrier.
With reciprocal IVF, both partners are scientifically parents and share in "co-maternity." Curious about how this works? Keep reading for all the details.
What is reciprocal IVF?
First, a note: You may hear reciprocal IVF referred to as partner-assisted reproduction, partner IVF, co-IVF, shared motherhood, or ROPA (reception of oocytes from partner). For the sake of this guide, this article will refer to it exclusively as reciprocal IVF.
To elaborate on reciprocal IVF, Scary Mommy asked Dr. Kecia Gaither, MD, MPH, FACOG, double board-certified in OB/GYN and Maternal Fetal Medicine, to offer expert insight. "Reciprocal IVF is a reproductive option that allows lesbian and trans men in a couple to both participate biologically and emotionally in a pregnancy," says Gaither, who serves as the director of Perinatal Services at NYC Health + Hospitals/Lincoln in the Bronx.
Gaither breaks it down further, explaining, "Reciprocal IVF is a process in which one partner acts as an egg donor to the other. One partner undergoes egg stimulation and retrieval. The eggs are retrieved, fertilized by donor sperm, and the embryo is transferred into the uterus of the other partner. Both partners can be connected biologically through the process of pregnancy, birth, and breastfeeding."
Science is truly a thing of beauty, isn't it?
What does the reciprocal IVF process look like?
Reciprocal IVF basically works just like "traditional" IVF, except that when it's time to transplant the embryos, they get implanted into the womb of the carrying partner instead of back into the body from where the eggs were retrieved. In other words, one partner becomes the "genetic parent," and the other partner is the "birth parent."
Here’s what the process might look like, step-by-step.
1. Syncing Cycles
One thing that typically has to happen for reciprocal IVF to be successful? The partners must sync their cycles. Physicians usually accomplish this by administering hormonal treatments, such as birth control. This ensures that when one partner's fertilized fresh embryo is ready, their partner's uterus is similarly prepared to accept the embryo.
However, if the couple opts to use previously frozen embryos, they don't have to sync their cycles — their treatments will be independent. It's worth noting that freezing and thawing embryos may considerably increase the cost of the process and could decrease the overall chances of successful conception.
2. Ovarian Stimulation and Lining Preparation
Both partners have to prep their bodies in different ways for the procedure. For the egg donor, a round of fertility drugs is in order. While people who ovulate typically only have one egg mature each cycle, the medications will encourage more eggs to mature. More eggs mean more embryos, which means more chances of a successful pregnancy. Fertility drugs also prevent eggs from spontaneously ovulating, which would make them unviable to use for IVF. Blood work and transvaginal ultrasounds are used to monitor egg growth.
Meanwhile, the carrying partner will need to prepare their body to accept and sustain the embryos. This means taking hormones that will thicken the lining, which helps an embryo "stick" and increases the odds of a successful pregnancy.
3. Egg Retrieval
Once the eggs have matured, they'll be retrieved using an ultrasound-guided needle with suction capabilities — a quick outpatient procedure during which the egg donor remains sedated.
4. Fertilization and Embryo Development
Once eggs have been retrieved, they'll spend time in a lab where they'll be mixed or injected with your donor's sperm. After several days, you'll know if any of your eggs were successfully fertilized. At this point, a doctor may also recommend and order a wide range of genetic testing, often including preimplantation genetic testing for aneuploidy (PGT-A). Such technology may increase the chance of success by ruling out embryos more likely to result in a failed treatment cycle.
5. Embryo Transfer
If everything has been successful thus far, the carrier parent will be scheduled for a quick outpatient procedure where they'll have the 1-2 embryos implanted into their uterus.
6. Pregnancy... Hopefully!
Assuming everything went well, the embryos will "stick." You'll know soon after if the transfer was successful and you can proceed with the pregnancy.
What are reciprocal IVF success rates? How many "rounds" will this take?
If you're familiar with IVF, you know that sometimes more "rounds" are required and that not everyone is successful the first go around. Can you expect this to be a "one and done" thing, or are you in for a long process? Not surprisingly, results depend largely on the individuals involved.
"Success rate depends on the age of the egg donor," Dr. Gaither says. "The younger, the better. And with good health, many studies report a success rate of 60% or greater. The number of rounds needed for success is individualized."
For context, in a 2017 study published in Reproductive Biomedicine Online, the average "donor" age reported in successful reciprocal IVF was 32.
How much does reciprocal IVF cost?
While a very small portion of people will find that their insurance covers the cost of IVF or reciprocal IVF, most prospective parents find they need to fully finance the procedure on their own. WinFertility estimates that, depending on where you live and what IVF centers you go to, a single round of reciprocal IVF could cost anywhere from $16,000 to $30,000. Note that second and third rounds could be somewhat cheaper if you freeze embryos from your first round. (Though freezing and storing embryos also costs.)
Does reciprocal IVF hurt?
The health risks of reciprocal IVF is similar to traditional IVF. The patient may experience minor cramping and some bloating. There may also be chest tenderness, slight bleeding after the procedure, and constipation. In some cases, the medication used to help mature the eggs for harvesting can also cause ovarian hyperstimulation syndrome, which is when the body reacts to an excess amount of hormones. Usually, there are few harmful side effects to reciprocal IVF.
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