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What is reciprocal IVF, and how can it benefit LGBTQ couples?

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What is reciprocal IVF, and how can it benefit LGBTQ couples?

June 20, 2019 in Ask the Doctor, The Real Deal

It’s 2019, and medical technology is changing what families look like—for the better.

Reciprocal IVF (in vitro fertilization) is an option that allows lesbian or trans men partners in a couple to both participate, biologically and emotionally, in a pregnancy. How is this possible? Read on for our guide to reciprocal IVF.

How does reciprocal IVF work?

Also known as partner-assisted reproduction, shared motherhood, partner IVF, co-IVF, or ROPA (reception of oocytes from partner), reciprocal IVF is a process in which one partner acts as an egg donor to the other.

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In traditional IVF, a person’s ovaries are stimulated with hormone medication to produce multiple eggs, which are extracted in a procedure called an egg retrieval. In the lab, the eggs are then inserted or combined with sperm to fertilize them and create one or more embryos. After these embryos develop for 3–5 days, one is transferred back into the uterus of the person carrying the baby. Hopefully, it will implant and result in a pregnancy.

In reciprocal IVF, one partner goes through the process of stimulation, and their eggs are retrieved and fertilized with donor sperm. Then, the embryo is transferred into the uterus of the other partner. Medically speaking, it’s the same process used when a woman works with an egg donor, or when a couple works with a gestational carrier.

As one couple, Ashleigh and Bliss, reported in 2018, the process gives both partners the opportunity to be actively involved in building their family—an experience that they wouldn’t get otherwise. Ashleigh, the mother who carried the baby, felt a closeness because her son “grew inside my body,” she says, “but when I look at him I get to see my wife.”

How are both partners biologically connected to the baby?

It’s clear that the partner who acts as the “egg donor” is genetically connected to the child. But after reciprocal IVF, the other partner is connected through the process of pregnancy, birth, and breastfeeding—all powerful biological experiences that tie a parent to their child.

And interestingly, there’s early evidence that the uterine environment may actually influence how certain genes are expressed. A ground-breaking study, published in 2015, was performed on mice, but it points to the potential for a similar effect in humans: molecules known as microRNAs, secreted by the uterine lining, act as a communication system between the parent carrying the pregnancy and the growing fetus. As Dr. Carlos Simon, a researcher on the study, explains, this endometrial “milk” is involved in gene regulation, potentially influencing the baby’s long-term health.

So in the case of reciprocal IVF, both parents may have an even more robust biological influence on the baby than previously believed.

Which partner acts as the donor, and which as the carrier?

This depends. As our chief medical officer Dr. Joshua Klein explains, the partner who is younger and has a more robust ovarian reserve is the better candidate to go through egg retrieval, and a partner who has a healthy uterus or has had kids before would be a better fit to carry the pregnancy.

But sometimes the emotional and psychological dynamics of the couple may come into play. For example, a trans man may be physically able to carry a pregnancy, but may choose not to because he’d have to cease testosterone treatment, or because pregnancy doesn’t align with his gender identity. So there’s no hard and fast rule here—it’s a decision best made by an individual couple in conversation with their doctor.

What’s the success rate of reciprocal IVF?

Because this is a fairly new technique (the first paper describing this method was published in 2009), there aren’t many studies that look specifically at success rates for reciprocal IVF. The research that has been performed is encouraging: in one study from 2017, 60% of couples involved in reciprocal IVF, with an average “donor” age of 32, achieved pregnancy. Success rates for couples engaged in reciprocal IVF may be higher than the published success rates of fertility patients, because, in many cases, these patients aren’t truly “infertile”—it’s their relationship, not their biology, that makes medical intervention beneficial.

Because reciprocal IVF is essentially egg donation, we can look to success rates with egg donation for basic information. What we know from egg donation and IVF statistics nationwide is that the factor that most strongly impacts success rates is the age of the egg donor (in the case of reciprocal IVF, the partner who’s giving the eggs)—the younger the eggs, the higher the chance of a healthy pregnancy.

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