What is reciprocal IVF?

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Reciprocal IVF (in vitro fertilization) is a family-forming option for couples that include one partner who can contribute eggs to form an embryo and one partner who can receive the embryo and carry the pregnancy. Around the world, reciprocal IVF can be referred to as either partner-assisted reproduction, co-maternity, co-motherhood, co-parenthood, co-IVF, or reception of oocytes from partner (ROPA).

As a reproductive endocrinologist, I’ve been able to assist many same-sex female couples in building their families in this unique way. Whereas some couples decide sperm donor intrauterine insemination (IUI) is the best choice for them, reciprocal IVF allows both partners to participate in the same pregnancy in some way.

The reciprocal IVF process 

Reciprocal IVF works by following a set of steps very similar to IVF using an egg (oocyte) donor.  

Step 1: Decide who will provide the genetic material (eggs) and who will carry the pregnancy

First, it’s important to figure out who will take what role in the reciprocal IVF process. Both partners will receive a fertility workup, which may include estimating ovarian reserve (how many eggs remain in the ovaries) and checking the uterine cavity. 

In some cases, a couple may be able to choose who will provide the eggs and who will carry the pregnancy. In other cases, a doctor may recommend that a specific partner contribute the eggs or carry the pregnancy based on medical history. If both partners are medically cleared to both provide eggs and carry a pregnancy, there’s also the option of switching roles in a future IVF cycle. In my practice, this is not an uncommon request, and it’s a great experience to be able to assist couples in achieving their family-forming goals in this way.

Step 2: Finding donor sperm

Next, a couple will choose a sperm donor. Some people may choose donors based on sharing a similar appearance or interests of one or both partners. Other considerations include:

• Deciding whether the donor will be anonymous or someone the couple knows
• Undergoing semen analysis and infectious disease testing, if choosing a known donor
• Speaking with an attorney regarding legal rights (for donor sperm, this is typically handled by the sperm bank)

Step 3: Synchronizing menstrual cycles

If the plan is to do a fresh embryo transfer — meaning the embryos generated from the egg retrieval are used without first being frozen — partners will need to sync menstrual cycles so the individual carrying the pregnancy is prepared for the implantation of the embryo.

Step 4: Hormonal preparation

For the person providing the eggs, this is when a customized protocol of hormonal medications will be taken to stimulate the growth of ovarian follicles which will later release the eggs. Follicular growth is monitored until the follicles are close to retrieval. When this time is identified by the fertility specialist, then a “trigger shot” of hormones is given to retrieve the follicles during their final stages of maturation to become mature eggs.

For the partner carrying the pregnancy, this is the time to follow a hormonal medication regimen that will help to thicken the uterine lining so an embryo has the most receptive place to implant. The uterine lining will be monitored to increase the best condition possible for embryo implantation.

Step 5: Egg retrieval

This outpatient procedure involves a fertility specialist retrieving mature eggs by inserting a hollow needle, attached to a vaginal probe and guided by ultrasound, into the follicles. Using the needle and suction, the specialist will aspirate the fluid and eggs from the follicles. The procedure is typically done under light sedation, and will only take approximately 10-20 minutes, followed by approximately one hour of recovery time. Tylenol and a heating pad will usually help with any symptoms such as cramping and bloating that may occur. 

Step 6: Incubation and fertilization of retrieved eggs

Retrieved eggs can be used for fertilization by sperm or can be cryopreserved (frozen), or both if a significant number of eggs are retrieved. The decision-making process for deciding how to use retrieved eggs is usually made together with the fertility specialist and the couple. Any frozen eggs can be thawed and fertilized with the same donor or a different donor in the future, as well.

There are multiple ways in which the retrieved eggs (either fresh or thawed) can be fertilized. The retrieved eggs may be placed in a petri dish with semen for fertilization to take place: this is called conventional IVF. Alternatively, the retrieved eggs may be injected with a single sperm. This IVF laboratory procedure is called intracytoplasmic sperm injection (ICSI). For example, ICSI may be recommended when the semen donor may have one of a number of “male infertility factors.” 

Another option is to fertilize the retrieved eggs with semen within a small chamber (such as InvoCell) that is placed within the vaginal cavity for incubation of either the egg donor or the embryo recipient. Often couples may choose to have fertilization take place within that of the egg donor, as this person will then have had a chance to “carry” the embryo prior to when it is transplanted into the recipient who will carry the pregnancy. In this way, both partners get to carry the pregnancy for different periods of time. 

Step 7: Embryo development

Once the initial fertilization has occurred, the embryos will form and continue to develop for several days prior to embryo transfer. In most cases, this happens after 5 – 6 days of incubation (in the laboratory or in a chamber transvaginally). This timeframe corresponds to when the embryo enters into what is developmentally called the “blastocyst stage.” An embryo that has reached the blastocyst stage is ready to be either transferred, frozen, or genetically tested if required, prior to freezing.

Step 8: Embryo transfer

Finally, the blastocyst (or blastocysts) will be transferred to the partner who will be carrying the embryo for a chance at implanting. The transfer may use either fresh or frozen embryos. Using fresh embryos is often the standard choice for the first reciprocal IVF cycle following egg retrieval, however, outcomes with frozen embryos will likely be comparable. Freezing the embryos might be necessary if genetic testing is required, or if multiple embryos are generated and extra embryos are frozen for a future embryo transfer cycle. At this point, if a first or multiple attempts for pregnancy are not successful, the couple may choose to try an embryo transfer with the partner who donated eggs. If no frozen embryos are left, then another ovarian stimulation cycle could be attempted from either person if medically possible. 

Curious what the actual experience of doing reciprocal IVF is like? Listen to Madison and Krystal’s story on Baby Steps, a Carrot podcast.

Legal considerations when undertaking reciprocal IVF

Reciprocal IVF can be a complex journey. Before starting any donor-assisted reproduction journey, it’s best to speak with a reproductive attorney in the country or state of residence/birth. Laws around determining parentage vary between states and countries, so getting a lawyer involved sooner rather than later is important. 

What are the costs of reciprocal IVF?

In the U.S., the following provides some estimated price ranges for the reciprocal IVF process. These costs don’t include any costs related to pre-cycle medical procedures or legal services since both of these can vary significantly depending upon the individuals and their unique circumstances. 

• Consultation: ~$200 – $400
• Donor semen sample: ~$500 – $1,000 per vial
• Medications (can vary per individual): ~$5,000 per cycle
• Cost of a conventional or ICSI IVF laboratory cycle, including fertility specialist interventions: ~$10,000 – $13,000 per cycle
• Genetic testing of the embryos (if required or desired): ~$5,000‍
• Second-parent adoption: Variable

Does insurance cover reciprocal IVF?

In the U.S., only 13 states have fertility insurance coverage laws that include IVF, and only 12% of the 1,061 people Carrot surveyed in May 2021 had fertility benefits through an employer. 

In many cases, qualifying for medically-assisted fertility treatment coverage will require a clinical diagnosis of “infertility” — which is usually defined as trying without pregnancy success for  6-12 months (depending on the age of the person attempting to become pregnant). For same-sex couples, this type of definition does not apply. Or, same-sex female couples may be asked to attempt self-insemination with donor semen for the same period of time before receiving coverage.

How can Carrot help?

Carrot Fertility is the leading global fertility benefits company designed to support all employees on their unique path to parenthood — regardless of age, sex, sexual orientation, gender identity, or geography — including reciprocal IVF. If you don’t have access to Carrot at your company, fill out this request form and Carrot will be happy to reach out to your employer’s HR team. If you want to learn more about bringing coverage for reciprocal IVF and other fertility treatments to your global employees, get in touch with us.

Already a Carrot member? Take the next step in your fertility journey today.‍