With many available pathways to parenthood, LGBTQ+ individuals and couples have a variety of family building options to explore. Here’s a closer look at reciprocal IVF, or co-maternity, an option that includes two female partners in the biological process of reproduction and birth.

What is reciprocal IVF?

In reciprocal IVF, one partner’s egg is fertilized by donor sperm and implanted into the other partner’s uterus through the process of in vitro fertilization (IVF). While only one partner will be genetically related to their child, reciprocal IVF allows both individuals to actively participate in the pregnancy.

The IVF process at a glance

In the process of IVF, eggs are retrieved from the ovaries, fertilized with sperm outside the body, and then placed into the uterus with the potential outcome of a pregnancy. It requires extensive medication use on a precisely timed schedule.

There are several phases of a typical IVF cycle. The timeline below is an approximation, as medication protocols are tailored to individual needs.

Ovarian stimulation (day 1 through trigger medications)

The first phase of IVF focuses on stimulating egg growth. After an initial ultrasound and bloodwork, medications such as Gonal-f®, Follistim®, and Menopur® are taken to stimulate the growth of follicles — fluid-filled sacs in the ovaries that potentially contain an egg.

These stimulation medications are typically administered as nightly injections. They are taken up until the trigger medications at the end of a cycle even as other medications are introduced.

Ovulation suppression (approximately days 5-10)

After several days of stimulation medications, ovulation suppression medications are introduced. These medications prevent premature ovulation — the ovary’s natural release of eggs in each menstrual cycle — to maximize the number of eggs that can be retrieved for fertilization. Cetrotide and ganirelix are the primary suppression medications used in IVF.

These medications may be introduced as early as day four or as late as day seven. The specific timeline varies by individual.

Trigger medications (end of cycle)

Throughout an IVF cycle, routine ultrasounds and bloodwork are performed to monitor follicle development. Towards the end of the cycle, as the eggs get closer to full development, these tests are scheduled closer together. 

If the eggs have sufficiently matured after the use of stimulation and ovulation suppression medications, as determined by an ultrasound and bloodwork, 1-3 trigger shots give the eggs a final growth spurt and trigger release. Medications used for the trigger shot may include Novarel/Pregnyl® , Ovidrel®, and leuprolide.

Egg retrieval

The egg retrieval typically takes place 36 hours after the trigger shots in a minimally invasive 15 to 45-minute procedure.

Embryo transfer

After the retrieval, eggs can either be frozen for future use or fertilized right away and transferred to the uterus through another quick, non-surgical procedure. (The latter is referred to as a fresh transfer.)

Progesterone and estrogen hormones may be prescribed at this step to support successful embryo implantation in the uterine lining. Two weeks later, a blood sample measures levels of hCG (human chorionic gonadotropin), often referred to as the pregnancy hormone, to determine if the embryo transfer has resulted in a pregnancy.

What’s different in reciprocal IVF?

Reciprocal IVF is similar to a typical IVF cycle in many ways, with the same medications and procedures for the egg retrieval and embryo transfer. However, in order to do a fresh embryo transfer, it’s necessary to synchronize both partners’ menstrual cycles through the use of medication, typically the birth control pill. This optimizes the timing of the IVF cycle, preventing a delay between egg retrieval and embryo implantation.

Additional considerations of reciprocal IVF

Determining roles

A critical first step of reciprocal IVF is determining which partner will provide their eggs and which partner will carry the pregnancy. This decision is influenced by both personal preference and health factors. Sometimes both partners can fulfill either role. If reproductive health issues or another medical condition are present, there may be less flexibility with the decision-making process. For this reason, it is recommended that both partners have a fertility evaluation at the beginning of the process.

If both partners are able to provide their eggs, some couples do an additional cycle of reciprocal IVF in which the original roles are reversed.

Sperm donor

Another step of reciprocal IVF is choosing who will provide the sperm. A sperm donor can be someone you know (known) or found through an agency or clinic database (anonymous). Using a known donor involves more legal complexities, as an anonymous donor has already surrendered their parental rights.

If you choose to use an anonymous donor, ask your fertility clinic about their donor database.

Legal complexities

Any time IVF involves a third party such as a donor, there are additional legal complexities to account for. In the instance of reciprocal IVF, certain steps may be necessary to ensure that both partners have legal parentage rights, like pursuing a second parent adoption.

Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also consult a lawyer in your state who has experience in family law.

Choose the right fertility pharmacy

Alto is here to support your journey into parenthood. Our fertility pharmacy care includes:

• Temperature-controlled packaging that holds refrigerated medications at the right temperature the entire time they are in transit

• Access to fertility-trained pharmacists and resources including injection training guides

• Transparent pricing and support with savings

• An easy-to-use app for all medication management, from delivery scheduling to refill tracking and more

Interested in learning more about how Alto can support your fertility journey? Request a price quote online or reach out through secure in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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