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3. Reciprocal IVF

For two partners who both have ovaries, there are a number of different options for having a child. One is RIVF, or reciprocal IVF, a method that allows both partners to participate biologically in a pregnancy. It means that an egg from one partner is fertilized in a lab and then transferred to the other partner who carries the pregnancy to term. Madison and her wife Krystal went through RIVF to have their daughter, and on today’s episode, Madison walks through each step of the experience.

Show notes

Madison O’Brien and her wife Krystal went through reciprocal IVF to conceive their daughter.  

Madison’s blog chronicles the RIVF journey and other aspects of her and Krystal’s life as new moms.

This series of how-to videos makes egg freezing and IVF self-injections less intimidating.

Transcript

Marie (00:04): Madison is a new mom in Southeast Texas, and one of the adorable things she's been doing with her new baby is setting up little monthly photo shoots throughout her baby's first year. She gathers props that are on theme for that month and arranges them around her daughter for the cutest photo backdrop imaginable. Maybe she gets some inspiration from what she does for work.

Madison (00:29): I am a technical theater teacher.

Marie (00:31): Is that teaching the skills about how to do all of the backstage and behind the scenes work?

Madison (00:36): Yes. Yay, you know what that is. That's awesome. Yes, so I do all the building and the lights, the sound, costumes.

Marie (00:46): Madison is a professional, but the other reason for these photo shoots is that it's important to her to celebrate each monthly milestone, maybe partly because conceiving her baby was not always the most straightforward journey. Madison and her wife had their daughter via reciprocal IVF. Today, we'll go through what that means, what the process was like, and how this couple decided it was the right choice for them.

Marie (01:20): This is Baby Steps, a podcast from Carrot Fertility about the many diverse paths that people take in the pursuit of parenthood. I'm your host, Marie McCoy-Thompson.

Madison (01:33): I am Madison. I am married to my wife, Krystal. We have been married for three years in April, but we have been together for six years. We have one daughter, she is almost nine months old, and we did reciprocal IVF for her.

Marie (01:56): IVF, or in vitro fertilization, is an option many people take to have kids. It just means that an egg is fertilized by sperm in a lab and then that embryo is transferred to the womb to carry the baby to term. Reciprocal IVF, or RIVF, means that the egg that is used in this process comes from one partner and then is fertilized and is then transferred to the other partner. It's an option that allows two partners who both have ovaries to be able to both participate biologically in the pregnancy. And that's what Madison and Krystal ultimately decided to do, but long before they got to that point, they first had to have conversations about what would be the best fit. For Madison, having kids was always part of the plan.

Marie (02:45): So you work with kids all day?

Madison (02:47): Yes, I do. I do. I have taught high school for five of the six years that I've been a teacher. I tried middle school. It takes a very special person to teach middle school and I cannot do it, but I love teaching high schoolers.

Marie (03:03): As a former middle schooler, I can also say that it must take a special person to teach that group. So then if you're working with kids, you like working with kids, did you always know that you wanted to have kids?

Madison (03:16): I did. Before I came out and realized about my sexual identity, I always knew I wanted to be a mother, but I wasn't too sure about this whole married thing. I was like, "I'll just be a single mom, that's just how it's going to be." Then as I came out to myself and figured out my sexual identity and all of that, I realized, okay, this is also possible to be married to a woman and to have kids, and there's multiple ways to be able to do that. But I have always known that I wanted to be a mom.

Marie (03:54): How did you meet your wife?

Madison (03:57): We met at Texas A&M. We were both seniors and we met a day before her graduation.

Marie (04:03): When you first met her and you started dating, what was it about her that drew you to her so strongly?

Madison (04:12): She has such a kind heart, she will do anything for anyone and she's my best friend. I think we're a really good compliment to each other. I think that's what really made us stick, is we're each other's balance.

Marie (04:28): That's so sweet. When did the two of you start talking about having kids?

Madison (04:34): Oh gosh. Well, I mean, we're lesbians, so we U-Hauled it pretty fast, I mean.

Marie (04:40): For those who are listening and might not know that reference, can you explain that a little bit? What you just said?

Madison (04:46): U-Hauling is a term that lesbians use, and usually it's like you've packed up your U-Haul and you've moved in on the second date and by the third date you're saying I love you and you're picking out the china pattern for your wedding.

Marie (05:02): Right. So you'd say that you sort of fell into that a little bit.

Madison (05:06): Oh, definitely, definitely. But we talked pretty early on in our relationship, and actually when we first talked about it, Krystal was like, "No, I really don't have any desire to have kids." Then as we started figuring out our career paths and our relationship together and what that meant, it became really obvious to both of us that something that we wanted for our future was to have kids. So yeah, we started talking about it pretty early on.

Marie (05:39): We'll fast forward a little bit to the point where you are ready to start trying to have kids. Did you know at that point what your options were?

Madison (05:50): We knew about like what people would refer to as the turkey baster method, which is what most people would call an ICI, which is intrauterine cervical insemination, I think.

Marie (06:05): I just checked and it's actually intracervical insemination, but yeah, very close to what Madison said.

Madison (06:12): Basically it's just a big syringe with a long tube kind of thing, so a little bit more of a medical device. That was still an option, probably the most cheapest option. Then we considered IUI, which is intrauterine insemination, which is more of a medical version of the turkey baster. Then we had talked about reciprocal IVF and that was our dream.

Marie (06:41): At this point, there's essentially three viable options that you know about.

Madison (06:47): Mm-hmm (affirmative), yes.

Marie (06:47): One is the "turkey baster" method, one is IUI, which would be a little bit more perhaps medically precise, involves some testing, and then the third is reciprocal IVF.

Madison (06:58): Yes, that's correct. Yeah.

Marie (07:01): When you say that reciprocal IVF was sort of the dream, what was it that felt right about reciprocal IVF for you?

Madison (07:09): Krystal never wanted to carry children, and still to this day has no desire to carry children. I remember being in college, not so much being like, "I want a baby," but like, "I want to be pregnant." I don't know why. I've just always had that desire to be pregnant.

Marie (07:28): I know you're saying that you don't really know why. I would love to just ask you a little bit though about what it is about pregnancy that draws you to it. Just from my personal perspective, I would love to be a mom one day. The idea of pregnancy genuinely terrifies me, it is maybe my biggest fear in life is having a pregnancy complications. What is it about it that you were drawn to?

Madison (07:56): I have always found pregnant women just beautiful. I think it's just such a cool process. I mean, you're growing this human. You can feel them moving inside you and nine months later you have a fully-baked human being.

Marie (08:19): Madison knew pretty early on that she would like to carry their baby, she would like to experience pregnancy. Even knowing that, she and Krystal still had to decide exactly how to go about that and that required doing some research.

Madison (08:37): Our first step was researching fertility clinics. Since we live in such a small town, the only fertility places that are available in Corpus are faith-based fertility clinics. As a gay couple, and neither of us extremely religious, we did not feel comfortable going into that kind of situation.

Marie (09:02): It's sort of within their messaging on their website, the language that they're using, the values that they're eschewing are all tied to faith and religion. Is that right?

Madison (09:12): Yes. We wanted someone that had paperwork that was not heteronormative. We wanted someone that didn't get our names confused because we're both women. We wanted it to be an easy accepting process and so we started researching fertility clinics. We found Aspire Fertility in San Antonio, and they have several locations here in Texas, and they were the only one that was, I think it was endorsed by the Human Rights Campaign, the HRC.

Marie (09:46): Once you did all this research and you found your clinic in San Antonio, which by the way, how far of a drive is that for you?

Madison (09:54): It's about two and a half hours, so it's not bad at all.

Marie (09:57): I think it just speaks to you being a true Texan when you say two and a half hour drive is just not that long.

Madison (10:04): Well, it takes us like 15 hours to get across the state, so.

Marie (10:09): Right, exactly. How often were you doing a two-and-a-half-hour drive to go to the clinic?

Madison (10:14): Minimum, once we really got started, twice a month, sometimes as much as four to six times a month. We set up an appointment, and since our dream was reciprocal IVF, we both went in and we both had an ultrasound and some blood work to make sure that everything was good and to see how to start that process and what it would begin like, and to get the money talk and all of that kind of information so we could make an educated decision.

Marie (10:50): Once you've determined the clinic that's the best fit for you, then what's the next step after that?

Madison (10:57): They gave us all of our options, which the options that they provided were IUIs or IVF, which would just be me, and then reciprocal IVF, which would be Krystal and I. They gave us the price points for all of that. We had a lot of time to think and figure out and get all of our ducks in a row.

Marie (11:21): What's going into that time? What are you thinking about and what are you discussing with each other?

Madison (11:26): Mostly we were discussing two things, how we define family and what's important to us in making of our family, and we were also discussing the finances, because money played a big role in it. I mean, IUIs were $1,500, not including the sperm, and then reciprocal IVF can be tens of thousands of dollars. I mean, I think our fertility clinic started at 25 to 30,000. So money was a big factor and we decided we were going to do the IUI.

Marie (12:09): Did insurance offered a cover ... Well, not offer, they're not going to offer to cover anything. Did your insurance cover any of that?

Madison (12:19): They covered the first visit, which was basically coded like your annual well woman's exam, and then we were on our own till we were eight weeks pregnant.

Marie (12:38): In having to cover all those bills themselves, Madison and Krystal decided that IVF was probably out of reach for them, so they agreed to instead move forward with IUI, which would be less expensive. With IUI they'd find a sperm donor and then use that sperm to fertilize Madison's egg and she would carry the pregnancy, and for a while it seemed like that's what they were definitively going to do.

Madison (13:04): We were driving, I think we are driving into San Antonio, not for the fertility clinic, but just as a road trip or something, and we were talking about when we were going to plan on having a baby. I asked Krystal, I said, "Are you good with our decision to do IUI? How are you dealing with not having a genetic connection to the child?" She started crying, which means I started crying, and through that conversation we figured out that although IUI was the cheapest option, it was not the right option for our family. Krystal really craved having that genetic attachment and bond with the child, and so by the end of that road trip we had decided that we were going to do reciprocal IVF.

Marie (13:57): It's amazing what a good road trip can do, right?

Madison (14:01): Right? To this day, I have no idea what prompted me to ask that question. At this point I think we were waiting a couple months and then we were going to wait till I started my period and we were going to start, and everything changed.

Marie (14:21): If I'm going along this timeline, once you decided that reciprocal IVF was the way you were going to go, is the next step then to choose a sperm donor?

Madison (14:31): Yes, it is. The fertility clinic that we worked with used Seattle Sperm Bank or California Cryobank, and so we went back and forth between those two and eventually found one that we liked. As I said before, we wanted all of our future children to have the same donor, so we purchased five vials in order for us to not have five children, but have the ability to have multiple attempts should a pregnancy fail.

Marie (15:04): In the process of selecting a sperm donor, what are you looking for?

Madison (15:08): Because we were using Krystal's egg, we didn't want someone that matched Krystal's features. We wanted more of a combination of both of us. We were very big on education, so we wanted to know what the education level was. As a theater teacher, our art and artistic ability is a big part of my life, and so I wanted to make sure that they also had a creative side. Both Krystal and I are very short, she is 4'11" and I am 5'2", so height played a factor in selecting a sperm donor.

Marie (15:50): So you were looking for someone who was taller?

Madison (15:53): Yes. Yes, exactly.

Marie (15:55): Sure, sure.

Madison (15:56): One of the best pieces of advice that we got when we were in the process of picking a sperm donor, so our fertility clinic requires you to do almost like a mental health assessment, but they have a resident psychologist and she talked to us about selecting a sperm donor as well and she said, "You know, it's okay to select someone based on these preferences or checking these boxes," she said, "But it's also okay to pick someone just because they feel right, just because in your gut that's just who you gravitate towards, that's just who you lean towards." Ultimately, what really was the deciding factor was listening to the donor's voice and their reasoning for becoming a donor in the first place. It wasn't like, okay, this donor checked off all of our boxes. It was this one just feels right.

Marie (16:55): That is really good advice. With something that is so personal, it makes sense to pay attention to that intangible factor that maybe you can't quite put your finger on, but something that just feels right in a way that maybe you can't explain.

Madison (17:09): Yeah, exactly. Exactly.

Marie (17:14): Madison and Krystal found a sperm donor who felt like the right fit for them and then it was time for the first major phase of the actual RIVF process, Krystal's egg retrieval.

Madison (17:28): It was a pretty smooth process. Krystal started her suppressants, the birth control. Then once we started the stimulants, at her baseline ultrasound they had already found one follicle, which is not good because we wanted multiple follicles. So we restarted her stimulants, which are the hormone injections, and it was very smooth. She wasn't super hormonal like everyone says. Maybe we were just giving each other a little bit more grace during that time period, but she handled them all very well. We did the egg retrieval and got 25 eggs. By the end of the day five we had 10 blastocysts. We were incredibly, incredibly lucky to have as many embryos as we did.

Marie (18:20): After the egg retrieval, then are you moving right into the next step?

Madison (18:26): We are. At that point, we didn't want to overlap. We didn't want to have Krystal going through all of her hormone injections and all of that and me also trying to prep for transfer. Once Krystal was done, at that point I'd already been on birth control and so I went on estrogen and we started that process of getting my body prepared. You want to thicken the uterine lining so that the embryo can implant at the transfer.

Madison (18:55): For the transfer, it's a pretty fast process. I want to say like five days before my transfer I started the progesterone shots. Then we had the transfer and then you're in the two week wait, continuing those estrogen and progesterone shots.

Marie (19:11): For anyone who might be listening to this who is going through IVF, perhaps not reciprocal IVF, but if you are going through IVF of any kind, this is going to apply to you. Is that right?

Madison (19:25): Yes.

Marie (19:26): The progesterone injections, which I think I saw on your blog, you have some specific tips for?

Madison (19:36): Yes. I was on progesterone injections till I was 10 weeks pregnant. They were going in to my butt, and the oil starts to build up and so you have these huge lumps in your ass. I mean, like size of your fist and they're super painful. I figured out that if the oil was warm, it was easier to inject, so I would put it under my arm or put it in my bra to kind of warm it up. It was also hurt less if I put ice to kind of numb the area. One of the best investments ever, other than a heating pad, was I think it was called a cellulite roller. I would roll it over my butt and it would kind of work out those knots once I had been sitting on a heating pad.

Madison (20:33): Unfortunately, after my transfer my progesterone levels were low, and so instead of one milliliter, I was injecting two milliliters. Towards about, I want to say my last week, I called the doctor and I was like, "Listen, I cannot do this anymore." I was crying and in dread before having to take these injections. I was able to give myself them, but towards the end I just couldn't pull the trigger. I would just sit there with the needle hovering, like I can't do it. So they gave me vaginal progesterone, and although not pleasant, it definitely be having to do two milliliters. I was able to do one vaginal and one milliliter, and so the knots kind of went down. But I was on a heating pad 24/7. I got heat rash on my butt because I had so much heat, but that was the only way, to just constantly be massaging and getting those knots out.

Marie (21:38): Everything you had to go through sounds so painful and you just did it and you powered through.

Madison (21:44): It was definitely worth it. I look back now and you know what they say, that you forget all the pain of childbirth and all the pain of pregnancy and all of that and it's definitely true, because if I remembered so vividly how painful all of those injections were and all that process was, I probably would not want to have another kid.

Marie (22:06): Right. They always say that they make babies so cute so that you just look at them and forget everything you had to do to get the baby.

Madison (22:13): Yes. Yes, exactly.

Marie (22:15): You went through all of these steps, you went through the painful process of going through all these injections and everything, and then once this period is finally coming to a close, what does it result in?

Madison (22:30): You know, they say that you're not supposed to do an at-home pregnancy test because the progesterone levels could trigger a false positive. But of course, why listen to all sound medical advice? We did two at-home pregnancy tests and one was I think a week in and it was inconclusive. You could kind of see a faint second line but you couldn't really. Then we did a pregnancy test the night before the blood work and it came back positive. So we were like, "Okay, well, we might be pregnant. We might be." Then we got a confirmed pregnancy test at the end of our two-week wait.

Marie (23:14): Was there a single moment when you remember all of that really sinking in for you?

Madison (23:20): It wasn't until I was much bigger and showing and I could feel the baby move that it was like, "Okay, this is happening." I don't know, you just read so much. I mean, we were incredibly lucky that we got pregnant on our first try. I mean, I was relatively healthy throughout my whole pregnancy. I had morning sickness horribly and I was exhausted all the time, but I had a completely healthy pregnancy. Me and Krystal both kind of have bad luck and so I think we were just waiting for the other ball to drop and it was like, "Oh wait, it's not going to. We are pregnant, we're going to have a baby." And yeah.

Marie (24:06): And then you did. You did have the baby.

Madison (24:08): Yes, we did. We did.

Marie (24:10): You have your child, you're in the hospital room, the birth has gone well. At some point you have to sign the birth certificate. Can you talk about what happened for you there?

Madison (24:23): Yes. I did a lot of research before we had Amelia, and I wanted to make sure that there wasn't going to be any problems as far as having Krystal's name on the birth certificate. I think it was the next day or the day that we were getting discharged, they called and they were like, "Okay, well whose name goes on the birth certificate?" I was like, "My name and Krystal's name." You can tell Krystal's name is a female, and they were like, "No, we can't do that," and they go, "Well, what about the father?" I was like, "Well, the father is a donor," and they were like, "Okay, well, we need to have the donor's name on the birth certificate."

Madison (25:08): I remember being on the hospital phone and thinking like, "I just had a baby, you are not going to mess with me right now," and I said, "No. You need to check with your supervisor because you are legally required to put my wife's name on the birth certificate if I request it, and we don't even know the donor's name so that's not an option." She was like, "Oh, okay, okay. I'll check with my supervisor."

Madison (25:37): When they brought the birth certificate up for us to sign, it had Krystal's name on it and that was kind of it. But I think I may have scared ... I think it was like her second day or something. I felt a little bad, but I mean, they just need to figure out that that's a thing and that they can do that.

Marie (25:56): Oh yeah, you should not feel bad at all. No, that's not something to feel bad about on your part. Obviously, thought it was something that you were very much in your right to say and I'm glad that they finally gave you what you should have been given in the first place.

Madison (26:12): Yeah, yeah. I mean, I hope that they don't challenge, because I think in my head I feel bad for someone that doesn't say, "Oh, okay. Well, I just won't put my wife's name on there." That's a lot of paperwork to have to go back and fit and it's kind of anticlimactic to have this kid and then your wife not be put on the birth certificate even though it's genetically hers.

Madison (26:40): That was another thing that was so confusing, because when they do all this patient intake and even at the pediatrician's office they were like, "Okay, well, what's the medical history?" and it's like, "Well, do you need my medical history as the mother who's giving birth or do you need the baby's medical history, because they are not one and the same?" They would always give this blank stare, like, "I don't understand what you're saying."

Marie (27:07): Even for you, once you had both of your names on the birth certificate, you also then had to still go through the process of legally adopting your daughter after she was born. Is that right?

Madison (27:19): Right. Our legal journey kind of had two steps. In order to proceed with the fertility clinic, we had to have a reciprocal IVF agreement, which basically covered what would happen to the embryos if Krystal died or if I died, if we got divorced, if we decided we weren't going to have a child, basically any scenario. Literally, if there was a natural disaster, what would happen to these embryos? We had to have that on file with our fertility clinic before we proceeded, and it stated that even though Krystal would be considered a donor in the eyes of the law, her intention was to be a parent. I had to say that even though I was considered a surrogate, or gestational carrier I think is the correct term, in the eyes of the law, my intention was to be a parent to this child of the donor egg that Krystal gave me.

Madison (28:23): That had to be on file, but that alone with her being on the birth certificate did not secure legal guardianship for Amelia, because in Texas, the person that is physically giving birth would be considered the mother. But because of the fertility process that we went through, I could also be considered the gestational carrier. Krystal, even though the baby was genetically related to her, could be considered the donor, which a donor gives up their rights whenever they make their donation.

Madison (29:03): So we were kind of in this gray area of who does the baby belong to. We both adopted Amelia just so that if there were any other legal issues in the future there would be no question as to whether I was a legal parent as well. So Amelia has been adopted by both of us, I think when she was maybe like four months old, five months old. But it was actually a long process, because we started it when I was seven months pregnant. We had to do an FBI background check, birth certificates, marriage certificates, reference letters. Once Amelia was born, we had to have a home visit from a social worker from San Antonio. Then we drove to San Antonio and adopted her.

Marie (29:54): You went through quite the journey to have your daughter. All of the reciprocal IVF process and everything that involved, and then also going through the adoption process at the very end. Do you have any advice for anyone who is at the start of this or maybe considering what their options are and thinking about reciprocal IVF?

Madison (30:18): I would say find a group of people that you can talk to. It's amazing what social media can do, because through Instagram I have found so many families like ours. Follow those accounts on Instagram, have a support system. Me and Krystal, we were the first of our friends to go through this process, and although we wouldn't trade the timing or anything, it was very isolating because we were both going through such different parts of the process. Don't be afraid to message someone that went through the same process on Instagram and say, "Hey, what did you do in this scenario?" There's no reason for anybody in their fertility journey, whether they are gay or straight or single or anything, to feel isolated, because there's so many of us out there and we just need to normalize it.

Marie (31:16): I think that is excellent advice.

Marie (31:23): Baby Steps is a podcast from Carrot, the leading global fertility benefits provider for employers. To show you how Carrot helps its members, I am sitting down with Adam who is the head of Carrot's Care Navigation. Hi, Adam.

Adam (31:38): Hello.

Marie (31:40): I'm going to read a question to you that you've received from a Carrot member and you are going to walk through how you would help that person.

Adam (31:48): Sounds great.

Marie (31:49): Here is the question from one of your members. "I'd like to check my husband's and my fertility. Do I call the hospital directly to get an appointment and pay for it first or will it be covered automatically?"

Adam (32:00): Good question. Carrot, unlike insurance, is a benefit, which means that when the member wants to receive care, they're actually going to coordinate that care with the clinic themselves, unless they're working with one of our partner clinics, which is one that we've negotiated lower rates for our members and we're able to provide priority bookings. If a member decides to receive care at a clinic that's not a partner of ours, they're going to want to reach out to them directly, schedule that appointment, and then pay for the care out of pocket on their side. Once they've done so, they can then submit that care for reimbursement through their personalized Carrot account and we'll reimburse them.

Adam (32:40): Alternatively, we just introduced our Carrot Card, which is a debit card that's connected directly to the member's Carrot account. Basically, with this card, members can go and receive care and pay for it without fronting the cost of the care that they're receiving. This is great, because it provides access to everyone for care.

Marie (33:01): There you have it. If you'd like to learn more, you can visit CarrotFertility.com.

Marie (33:13): Baby Steps is produced and edited by me, Marie McCoy-Thompson, and also edited and mixed by Jim Metzendorf, who often uses the fun explosion emoji in our Slack conversations and it hypes me up. Our original music is by the power team of Chris Ploeg and Chili Corder, and our artwork is by Allie Packard, who has very cool art on display in her home that I can see when we video conference. This has been an All Turtles production. Thanks for listening.