Reciprocal IVF: What to Consider, Process and Costs

Eran Amir

CEO and Founder of GoStork

Reciprocal IVF (RIVF) allows two women, or one cis-woman and one transgender man in a relationship to both contribute to the biological development of their baby. One partner provides the eggs, which are then combined with donor sperm in a laboratory and the resulting embryo is transferred into the other partner’s uterus to carry the pregnancy. Reciprocal IVF (or partner assisted reproduction) was first introduced around 15 years ago.

“Similar to the standard In Vitro Fertilization (IVF) procedure, Reciprocal IVF is an option for lesbian couples and trans men- who have functional female reproductive organs, to participate in the actual IVF and gestation process. Reciprocal IVF is also commonly referred to as partner IVF, partner-assisted reproduction, reception of oocytes from partner (ROPA), or co-maternity IVF.” 

RESOLVE, The National Infertility Association

Read on to learn more about Reciprocal IVF, what to consider before starting treatment, costs, and financing options. 

What is Reciprocal IVF?

Also known as co-IVF or co-maternity, RIVF is a family building option for lesbian or trans male couples who both want to be biologically involved in the birth of their child. The process is similar to standard IVF where mature eggs are collected from the ovaries, fertilized by sperm in a lab and then transferred to the uterus. In this case, eggs from Partner A are fertilized by donor sperm and the embryo is transferred to Partner B. 

Partner A is genetically related to the baby, and Partner B, while not genetically related, will have a significant impact on the development of the baby as well as their future health – this is due to epigenetics. The uterine environment plays an important role in fetal brain development, childhood metabolism and immune health, among other factors.

While the process may seem similar to that when using a known egg donor, medically, it’s not regarded as such. In fact, in its guidelines on oocyte donation, the American Society for Reproductive Medicine specifically excludes reciprocal IVF: “In this setting, the partner does not donate her oocytes. The oocytes should be considered shared between sexually intimate partners because sperm is shared between heterosexual couples, presumed to be sexually intimate”. This is important as egg donors must meet stringent requirements as well as undergo screening, before they can be approved.

What to consider before starting Reciprocal IVF

There are a number of things to consider before starting the reciprocal IVF process:

  1. Who will provide the egg? Who will carry the pregnancy?

These decisions are highly personal and you may have already decided who will provide the egg and who will carry. However, remaining flexible can lead to a higher success rate. As Dr. Lisa Hansard, a board-certified reproductive endocrinologist at Texas Fertility Center notes, “I recommend keeping an open mind and deciding on roles after consulting with a physician and getting a complete fertility evaluation”. This is because your decision should ideally be based on your overall general health, medical history, family medical histories and age. Fertility testing and screening prior to starting treatment will help you determine the role each of you takes.

  1. What is the law in your state/country on LGBTQ+ parent rights? 

Laws on parenthood through assisted reproductive technology (ART) vary from one state to the other. As ART Attorney Richard Vaughn, notes, “the legal status and parental rights of each partner are not automatically equal and are not guaranteed by either’s role”. Just because you’re both listed on the birth certificate doesn’t automatically mean that you both have parental rights, either. You should always seek legal advice from an experienced attorney before starting RIVF.

  1. Do you want a known sperm donor or anonymous? 

Some couples ask a friend or relative to be their donor – in this case it’s a known sperm donor. Others prefer anonymity and work with a sperm bank. Sperm donors must meet strict criteria before they’re allowed to donate. You can read more about this in our article Sperm Donation: 10 Informative Facts to Get You Started.

The Reciprocal IVF Process

Step 1 – Identify a sperm donor

The first step involves selecting a sperm donor. There are two types of donors: known and anonymous donors through a sperm bank. Once a donor is selected and the sample screened the next stage begins.

Step 2 – Egg Retrieval

The partner providing the eggs undergoes an ovarian stimulation cycle. Egg growth is monitored through blood work and transvaginal ultrasounds. Once the eggs mature, they’re retrieved using an ultrasound guided needle. The retrieved eggs are then fertilized with donor sperm. 

Step 3 – Embryo Transfer

In the days leading up to the embryo transfer, the partner who is carrying is given fertility drugs to prepare the uterus. The embryo is then transferred into the uterus of the partner carrying the pregnancy. 

These two cycles are usually synced together, so when the eggs are fertilized, Partner B is ready to receive the embryos. When this is not possible, the embryos are frozen for a later transfer.

How much does Reciprocal IVF cost? 

Reciprocal IVF costs slightly more than standard IVF. Here is the breakdown:

  • The average cost of reciprocal IVF is $20,000, but this depends on various factors, including the clinic you work with, medication protocols, and other services such as:
    • Donor Sperm – This average excludes donor sperm – one vial from a sperm bank costs roughly $1,000 but you may need more than one. 
    • ICSI – Your doctor may also advise intracytoplasmic sperm injection (ICSI) where a sperm cell is directly injected into the egg, and in which case the cost increases by another $2,000. 
    • Genetic testing of embryos- this averages at around $3,000 to $4,000. If pregnancy isn’t achieved at the first cycle, an additional embryo transfer can cost up to $5,000 (excluding fertility medications). 

Does insurance cover Reciprocal IVF?

Insurance may not cover reciprocal IVF, especially if neither you nor your partner has been diagnosed with infertility. Additionally, most insurance plans with IVF coverage require a number of failed IUIs before they cover IVF. It helps to look into your options before deciding on the best health insurance for you, as well as to advocate with your employer for a more inclusive plan. There are also other financing options available, which we’ll outline below:

How can we finance Reciprocal IVF?

It’s no secret that IVF is expensive, but there are ways you can make it work.

Insurance: Even if your insurance does not cover IVF, check with your provider to see what is covered peripherally. It’s possible that some monitoring or blood work may be included which helps to some extent.

Loans: There are different lending options available, such as secured and unsecured loans, home equity loans, 401K loans and fertility-specific financing loans. You can also apply for a fertility loan directly on GoStork

Company Fertility Benefits: companies in competitive industries often offer fertility benefits to their staff in a bid to retain talent. While your employer may not cover the whole cost of reciprocal IVF, fertility benefits can get you off to a good start. Look into your benefits or speak with your Human Resources / Benefits contact about options available to you. It doesn’t hurt to encourage your employer to look into adding fertility treatment coverage if they’re still not offering it – fertility benefits are becoming more commonly expected by employees, regardless of industry.

Grants: There are multiple fertility grant programs which you can apply for to assist you along the way. While they can be more difficult to obtain than loans; if you are accepted, grants can help you cover some expenses without having to worry about repayments. 

Creative Financing Options: From creative contests to inspiring side hustles, there are plenty of ways you can source additional funds for your family-building journey. Check out our chat with the Fertility Finance Coach, Devon Baeza for actionable and creative tips on how to finance treatment.

Additional family-building options for lesbian couples

There are other options for same sex female couples who both want an intimate and directly impactful role in the birth of their children. These are:

Concurrent IVF – Each partner goes through the IVF process and an embryo created using eggs from the opposite partner is transferred into both partners. If the pregnancies are successful, both partners will be pregnant at the same time with a baby that’s genetically related to the other partner. 

Effortless Reciprocal IVF – a more affordable option, effortless IVF allows intravaginal culture (IVC) through the use of an FDA-cleared device called INVOcell*: “IVC is an innovative approach where a woman’s body acts as a natural incubator for fertilization”. One partner undergoes the egg retrieval process as in normal IVF, but instead of the egg and sperm being fertilized in a lab, they’re placed in the INVOcell* capsule. The capsule is inserted into the vagina for 5 days where the embryo(s) develop. It’s then removed and one or more embryos are transferred into the other partner. 

A few final thoughts

Reciprocal IVF is an option for female or trans male couples who both want an intimate role in building their family. There’s a lot to consider before you take the first steps, but with the right fertility providers, reciprocal IVF is a beautiful, shared experience.

At GoStork, we’re here to support you as you research your family-building options, connect with providers that may be your ideal match, and make your final decision about which to move forwards with. Join us today to keep learning about your fertility options, and to find the ideal providers to help you on your journey. Start by creating your account here.