Reciprocal IVF: Cost, Success Rates & Process for Lesbian Couples

For LGBTQ+ couples who both wish to play a biological role in the conception and carrying of their future child, reciprocal IVF can be the perfect family-building pathway. Here's what to know about the entire process, straight from a fertility specialist. 

In this article:

• What is reciprocal IVF?
• How do you choose which partner will carry the pregnancy?
• Fertility Testing Before Reciprocal IVF
• Reciprocal IVF Step-by-Step
• How long does reciprocal IVF take?
• Considerations for Reciprocal IVF
• Choosing a Sperm Donor
• Who is a good candidate for reciprocal IVF?
• Family Size & Biologically-Related Siblings
• FAQs About Reciprocal IVF
• How much does reciprocal IVF cost?
• Does insurance cover reciprocal IVF?
• Are success rates different for RIVF and traditional IVF?

What is reciprocal IVF?

Reciprocal IVF (RIVF) is a fertility treatment pathway for same-sex female couples (or a cis woman and trans man) who wish to share in the biological process of having a baby together.

In an RIVF cycle (also sometimes referred to as partner-assisted IVF or co-IVF), oocytes (eggs) from one partner are retrieved and fertilized with donor sperm to create embryos. These embryos can subsequently be transferred into the uterus of the other partner.

This allows both partners to personally participate in the same pregnancy, since one partner supplies the eggs to create the embryos, and the other partner carries the resulting pregnancy.

How do you choose who will provide eggs and who will carry the pregnancy?

This is a personal decision that varies from couple to couple. Some couples start the process with a pre-determined plan about who will undergo IVF (and "donate" their eggs), and who plans to carry the pregnancy.

Others may make the decision based on the results of their fertility testing. For example, one partner may have a higher chance of successfully creating healthy embryos than the other based on age, ovarian reserve (egg quantity), or other factors.

Your fertility specialist should always discuss any potential pros and cons with you and answer your questions before you make a final decision and move forward. 

Fertility Testing Before Reciprocal IVF

Wondering if both partners need to be evaluated? The answer is yes! Both partners will need to undergo some diagnostic testing, which includes a pelvic ultrasound and blood work. This is standard for all patients undergoing IVF and/or planning to become pregnant.

Genetic carrier screening is also important for the partner providing eggs, since they will be the one who is biologically related to the resulting child. If both partners wish to carry a pregnancy, both should undergo genetic screening. Having this detailed information about your genetic makeup can help increase your chances of a successful, healthy pregnancy and child.

The partner who carries the pregnancy will also do a saline ultrasound (SHG or SIS) to further evaluate their uterus prior to pregnancy. During this test, sterile saline (salt water) is infused into the uterus, which helps to better visualize the inside cavity where the future embryo will implant and grow.

Note: If any abnormalities such as fibroids, polyps or scar tissue are discovered during your saline ultrasound, your doctor will discuss potential solutions with you, which may include minor surgical procedures performed prior to undergoing RIVF.

Reciprocal IVF, Step-by-Step

Reciprocal IVF is similar to traditional IVF treatment, with the exception of both partners being able to be intimately involved in the process. Some couples like the idea of both being biologically connected to the child, since one is genetically linked by contributing eggs, and the other is bonded by carrying the pregnancy to term and delivering the baby.

Pretty incredible, right? Let's break down the process to see how it all works.

Step 1: Ovarian Stimulation (Partner A)

With reciprocal IVF, the pregnancy is biologically related to Partner A, but carried by Partner B. Partner A will go through the standard IVF process to create embryos, taking injectable fertility medications to stimulate the ovaries and mature multiple eggs at the same time.  

Step 2: Egg Retrieval (Partner A)

During an egg retrieval (which is a minor surgical procedure), those resulting eggs will be carefully removed from Partner A's ovaries, then fertilized with the couple's chosen donor sperm in the IVF laboratory in order to create embryos.  

Step 3: Embryo Development

The resulting embryos will be cultured and closely monitored by specially-trained embryologists in the lab until they reach the stage at which they can be transferred and/or frozen.  

If the couple elects to have preimplantation genetic testing (PGT) of their embryos, the testing will be performed after the embryos reach around Day 5 of development. Once PGT results are received, and the couple discusses any concerns or questions with their reproductive endocrinologist (fertility specialist), an embryo transfer will be scheduled.

Step 4: Embryo Transfer (Partner B)

During an embryo transfer, the embryo (created from Partner A's egg and donor sperm) will then be transferred into the uterus of Partner B. Most of the time, the embryos are frozen and a single thawed embryo is transferred to the uterus of Partner B in a separate cycle.

However, it is also possible for Partner B (the embryo recipient) to take fertility medication to prepare their uterus for embryo implantation and have a "fresh" embryo transfer around five days after Partner A's egg retrieval.

Note: If Partner B (who will be carrying the pregnancy) prefers to coordinate the embryo transfer with their body's natural menstrual cycle, this will require less fertility medication. 

Step 5: Pregnancy Test Results

Around nine days after embryo transfer, the carrying partner will return to their fertility clinic for blood work. The results of that blood work will indicate whether or not the transfer was successful, and your doctor will discuss any results or next steps with you.

How much does fertility treatment cost?

Learn how much it costs for same-sex female couples to have a baby, how to navigate insurance coverage (if you have it), and ways to afford care. 

How long does reciprocal IVF take?

All in all, a single reciprocal IVF cycle can take anywhere from 2-6 months, depending on the following factors and other potential variables:

• Fertility testing: Portions of the pre-IVF diagnostic work-up are timed to the menstrual cycle, so completing this necessary pre-cycle testing can take a month or two.
• Choosing a donor: It also takes time to complete other parts of the process, like selection of donor sperm and getting insurance authorization for your treatment cycle, if applicable.
• IVF cycle: An actual IVF cycle takes about two weeks, and consists of a series of hormonal injections for ovarian stimulation, followed by an egg retrieval. It takes another 5-7 days to culture the embryos in the laboratory until they can be transferred or frozen.
• Other variables: When embryos are frozen and the transfer to the carrying partner occurs in a separate IVF cycle, this process takes an additional month. If preimplantation genetic testing (PGT) of embryos is desired, this can take 1-2 weeks. Additionally, if there are any issues that need addressing prior to undergoing RIVF (such as polyps that need to be removed surgically), this will add to the length of the process.

Remember: You may need more than one RIVF cycle to achieve a successful pregnancy. If you do end up needing to repeat this process more than once, this can add to your timeline as well.

Considerations for Reciprocal IVF

While reciprocal IVF is an incredible family-building option for many couples, there are some important things to understand before moving ahead with this treatment pathway:

Who is a good candidate for reciprocal IVF?

Ideal candidates for reciprocal IVF are typically same-sex female couples (or cis female/trans male couples) who:

• Both want to be involved in the creation of a pregnancy
• Are open to going through the fertility treatment process
• Are otherwise good medical candidates for IVF and/or pregnancy

Choosing a Sperm Donor

Some couples may choose a donor who shares physical characteristics or ethnic background as one or both partners. Other things to consider include:

• Whether to use a known or de-identified (anonymous) sperm donor 
• If using a known donor, they will undergo semen analysis and infectious disease testing
• Speaking with an attorney regarding legal rights (if using donor sperm, this is typically handled by the sperm bank)

Note: Many fertility clinics recommend both partners undergo genetic carrier screening prior to choosing a sperm donor in order to make sure you are both genetically compatible with the same donor.

Family Size & Biologically-Related Siblings 

For couples who want to have multiple children, some plan to use sibling embryos from the same egg and sperm, with one partner carrying all pregnancies. Others plan to undergo separate cycles of IVF, often with the same sperm donor, and to each have a transfer of an embryo from their partner’s eggs, so that both partners are connected to all pregnancies.

Planning for Future Pregnancies

Consider your full family-building plan (for all potential future children) at the very start of the process. Discuss family size, pregnancy spacing, and other pertinent details with your partner, and don't hesitate to seek out support from a licensed counselor if you're struggling to make decisions together.

For example, if Partner A is planning to go through IVF and create embryos first, but Partner B wishes to do so in the future for a second child, you may want to purchase additional vials of donor sperm upfront. This will typically allow you to use the same donor for all pregnancies, meaning your children will share a genetic link.

FAQs About Reciprocal IVF 

There is a lot to consider when exploring reciprocal IVF, and it's natural to want to learn all you can about the process before making your final decision. Here are some of the most common RIVF questions we hear from our patients at Illume Fertility:

How much does reciprocal IVF cost?

Due to various factors (including your insurance coverage and choice of fertility clinic), the cost of reciprocal IVF varies widely, and can be anywhere from $10,000 to $25,000 or more. Traditional IVF and reciprocal IVF typically cost about the same, with the exception of donor sperm and related add-on services. 

Does insurance cover reciprocal IVF?

Unfortunately, reciprocal IVF is typically not covered by insurance (particularly when a couple has no known fertility issues) and many employers still don't offer fertility coverage. In many cases, qualifying for medically-assisted fertility treatment coverage requires a clinical diagnosis of "infertility" (typically defined as trying to conceive without success for 6-12 months).

This outdated definition excludes millions of LGBTQ+ couples who need the assistance of a third party (an egg or sperm donor or a gestational surrogate, for example) to grow their family. 

Note: As of June 2023, 21 states have passed fertility insurance coverage laws and 14 of those state mandates include IVF coverage. That being said, the archaic definition of infertility above still typically applies - even when a state has mandated coverage.

Are success rates different for RIVF and traditional IVF?

The success rates for RIVF are about the same as for traditional IVF, and primarily depend on the age and ovarian reserve (egg quantity) of the partner who is providing the egg. Couples with no fertility issues typically have an excellent chance of success with RIVF.

Explore Your Family-Building Options

Don't think reciprocal IVF is right for you? You have other options! Additional treatment methods may include intrauterine insemination (IUI) with donor sperm or traditional IVF (where the same partner both contributes the eggs and carries the pregnancy).

If you are considering reciprocal IVF or other biological family-building pathways, we're here to help answer any additional questions you may have. Reach out to our team today for more support or take the next step by requesting a consultation.