Reciprocal IVF for LGBTQ Couples

Reciprocal in vitro fertilization (also referred to as partner-assisted reproduction, shared motherhood, co-maternity and co-IVF) is a family building option that is used by couples who possess functioning female reproductive organs. This allows for both partners to participate in the pregnancy; one woman supplies the eggs that have been retrieved and fertilized by donor sperm, and the subsequent embryo(s) are then implanted into her partner’s uterus where it can attach and be carried to term. This shared IVF and gestation process is an important option for lesbian couples and transgender men looking to biologically grow their families.

Like traditional IVF (and having a baby in general), reciprocal IVF is a big decision that comes with things to consider. Here are a few high-level points about the process.

Does insurance cover reciprocal IVF?

Most of the time, reciprocal IVF is not covered by health insurance. Insurance coverage for standard IVF is not mandated in most states, and the states that do require some amount of coverage usually do not cover the additional costs of reciprocal IVF unless medically necessary.

A 2017 Mercer survey states that only 26 percent of employers with 500 or more employees offer coverage for in vitro fertilization. What’s more, most plans require a certain number of failed IUIs (intrauterine insemination) before agreeing to cover IVF.

How much does reciprocal IVF cost?

The range is vast, equaling anywhere between $5,000 to $30,000, and the total largely depends on certain variables, including the fertility clinic, protocols for fertility medications, and additional services like screening for abnormalities or sex selection (see preimplantation genetic testing section below). Reciprocal IVF is more expensive than standard IVF because of sperm donor fees and associated legal fees. Thankfully, IVF loans and payment plans are available to provide aid. You can also request financing information from your fertility center.

What is the success rate of reciprocal IVF?

The success rate of reciprocal IVF differs from patient to patient and can be affected by factors such as medical history and lifestyle. But according to these numbers by The American Pregnancy Association, maternal age is a primary indicator in predicting a patient’s odds for success:

Before beginning the IVF cycle, partners must conclude on whose sperm will be used (and whether or not a sperm bank is needed), whose eggs will be used and who will carry the pregnancy. These decisions are often steered by fertility testing and the guidance of a fertility specialist to produce the best possible outcome.

While these basics are building blocks in contemplating reciprocal IVF, there are other aspects to include in your consideration process. Briana Rudick, MD, reproductive endocrinology and infertility specialist at Columbia University, directs the university’s Third Party Reproduction Program and is active in supporting the LGBT community. She helped shine additional light on important reciprocal IVF factors, including associated risks and emotional complications that may arise.

Do the risks differ for reciprocal IVF versus IVF involving one woman?

Yes: In reciprocal IVF, the partner donating the eggs is kind of like an egg donor while the partner who is carrying is like the recipient of egg donation. Pregnancies resulting from egg donation are at higher risk of certain types of obstetric complications, particularly preeclampsia. This is likely somehow immune mediated, in that the donor egg coming from another source is recognized as more “other” than one’s own egg. The absolute risk of preeclampsia especially in a younger, healthier recipient is not so high that we believe this is an unsafe situation, but is something to be aware of.

Are there specific considerations for deciding who donates and who carries?

All the things that determine egg health (for the egg donor) and uterine health (for the implantation recipient) should be evaluated. The partner donating ideally would be younger, since the age of the egg is what determines egg quality and therefore the chance of live birth. From a gestational carrier perspective, you ideally want someone who is healthy from a cardiovascular perspective, and you also want someone who has a normal uterus (including position and good uterine lining). If she has had a pregnancy and delivery before, then ideally there would have been no complications in a prior delivery.

What is preimplantation genetic testing, and when is it encouraged in the IVF process?

PGT involves testing resulting embryos from IVF for genetic abnormalities prior to implantation. This gives physicians the ability to select embryos predicted to be clear of chromosomal abnormalities and other genetic conditions before an embryo transfer takes place.

This option is not always encouraged, however, and it really depends on the age of the egg. If the egg donor is an age where there is a high chance of making abnormal embryos, then we consider PGT as a way of avoiding transferring any embryos detected for abnormalities. But if the egg donor is young enough (i.e. less than 35 years old), then there is a lower chance of making abnormal embryos, and we can’t say that PGT improves success rates for these individuals. Another thing to note is preimplantation genetic testing is the only way of doing sex selection, so some of it also depends on their goals.

How can couples emotionally prepare for the journey and any possible issues that come with it?

I think the potential emotional issues range from the treatment itself, as well as determining who is donating and who is carrying. The one donating may feel a loss that she can’t carry and vice versa; the one who is carrying may feel some kind of genetic disconnection [since the partner donating the egg is the only person genetically related to the baby]; one partner may feel like she is doing more than the other partner, or if one partner is unable to donate or unable to carry, there may be feelings of inadequacy there. These are themes with really any couple going through IVF treatment however, and not just for same-sex couples.

Additionally, there is a difference in terms of emotional quality when you have a couple that wants to do reciprocal IVF (when both could donate or both could carry) versus a situation in which one partner can’t donate or can’t carry. Once the concept of infertility starts to become a true issue, the dynamic often changes. However, any parent can tell you that regardless of egg source or who gets to take the pregnancy test, parenting is much more about non-biologic things. You will realize this when you are changing another dirty diaper at 2 a.m. or staying up all night with a sick infant.

Communication is of course key to having these conversations in hopes of arriving at a healthy place before starting the IVF procedure. To better prepare, Family Equality council is always a great resource in that they are a good link to other resources! We also have many referrals for mental health professionals who specialize in this area from therapists to psychologists to psychiatrists. You can also ask your healthcare provider for trusted referrals.