If you’re an LGBQT+ couple and either of you could use your eggs or to potentially carry and birth a baby from either of your bodies, there are many options and considerations if you’ve decided on in vitro-fertilization (IVF), and even if you haven’t yet.
With so many decisions, overwhelm can follow like a tailgating car.
First, let’s go over what Reciprocal IVF is.
Reciprocal IVF is the attempt to have a partner’s eggs harvested in order to create embryos, with the intention of transferring an embryo or embryos to your uterus to carry a baby, or vice versa (your eggs harvested with the plan for your partner to carry the pregnancy). The main benefit is having each of you physically involved in the family building with genetics coming into play from each of you: carrying a baby or through eggs. That’s a beautiful opportunity for many couples.
But, what matters is each of your desires, values, financial possibilities, ages, family hopes and health and you’ll slowly work through what’s important to you.
Second, how this plan is created is up to you, but you’ll work to get on the same page with your partner. The plan can change over time, and it’s best to reaffirm the plan even if you’ve talked about it before because opinions can change once it gets ‘more real’ instead of being a hypothetical plan in the future. Here are some potential questions to reflect on yourself and/or discuss with each other:
- Where do your ideas about family come from?
- With deeper reflection, what are your personal opinions and beliefs about family now that you can define them with your personal beliefs?
- How do your/our financial goals come into play?
- How important are genetics to you?
- What could it be like from the perspective of our future donor-conceived children?
- What is most important as we try and build your family?
As you get on the page, or reaffirm you’re on the same page, then it might be welcome to go over these considerations below to become even more clear.
Considerations for Reciprocal IVF
1. If you’re hoping to have more than 1 child. Discuss with your partner if you haven’t already if you’re hoping for an only child or 2 or more. This matters if you’re choosing whose eggs or uterus. Creating embryos can preserve fertility and make it easier to create or bank enough embryos in the hopes to have the potential for a sibling one day with the same egg and sperm combination. However, you might be trying for one and just focussed on that because of concerns even having one causes fears around if it will work, or you just know you are a one-and-done family. In this situation you might be trying for fewer embryos and might even be considering Mini IVF (lower dose medication in hopes for only fewer eggs).
Ask your doctor for their advice – if you’re a candidate for Mini IVF and how many embryos they think will result from your cycle if you are only attempting one live birth. Three embryos are needed for 1 live birth, on average.
2. Similar to consideration 1, if you’re hoping to have 1 baby from your egg(s) and another baby from your partner’s egg(s). This would mean that you each go through RIVF, but leads to having each having genetics from each of your eggs represented collectively among your children, if it works out. Thinking through if it matters to you or to your partner if you have bio siblings or biologically half siblings comes into play. Opinions can change as this becomes a more concrete reality, so it can take a lot of reflection and multiple conversations. There’s also the possibility of having RIVF and use embryos from that egg retrieval for the person doing the egg retrieval to try and carry a sibling later on (ie traditional IVF with donor sperm) which would make them biologically full siblings.
Ask your doctor for their advice – on who tries with their eggs first and who tries with their eggs second. It matters your individual situation such as fertility testing results, general health and age, but quite often the person who is older or has more fragile fertility would have their eggs harvested first while time is more at play.
3. Getting pregnant at the same time. In this scenario is traditional IVF with donor sperm and RIVF at the same time. This is less common when the toll of pregnancy and birth and postpartum might be on each of you and requiring a partner’s support, but this is an option where you can go through something at the same time and essentially have twins.
4. Hoping for twins with RIVF. If you are hoping for a twin pregnancy, called a pregnancy with multiples, then there are considerations. This might have an impact on who you choose to pick for the eggs versus carry the potential twins because it would be a high risk pregnancy. Age plays a factor as well and potentially other health factors such as diabetes.
Ask your doctor for their advice – if either of you is a candidate for carrying twins and if there’s a policy at the clinic if you can transfer 2 or 3 embryos. If you transfer 2 embryos it doesn’t mean twins necessarily, unfortunately. It certainly increases your chances though, especially if the embryos are tested.
5. Age might play a factor. Like I mentioned about, usually the older of the 2 of you would use their eggs first if you’re both trying to supply eggs or even carry a pregnancy from the others’ eggs, but depends on the age of each and fertility work up of follicle count, FSH, AMH and other factors like PCOS and endometriosis and being emotionally and mentally ready for pregnancy and that timing. It’s a personal decision how age plays into family building and there’s no one-fits-all approach. You could also potentially use donor eggs and then age factors in a lot less.
6. If you’re considering IUI versus IVF. This takes out the possibility of Reciprocal IVF to start with, but IUI might be an option. There are other advantages and risks to IVF other than choosing genetic material such as genetic testing, screening for chromosomal aneuploidy, preserving fertility potentially, and more being cost-efficient with donor sperm, but IUI is less invasive and much less expensive if you’re paying out of pocket for the procedure or medication or both.
Ask your doctor for their advice – if you’re a good candidate for IUI and what are the pros and cons between IUI and IVF for your specific scenario. I can answer some questions also.
7. Sibling spacing. If you know you want to try to have more than one child genetically part of your family, or alongside other forms like adoption or fostering, then there’s the timing of sibling spacing to potentially consider. Having the emotional and financial ability to care for a new family member and the age of each can factor in. There’s no such thing as the perfect sibling spacing but every family has their own unique needs and considerations. It could happen where you each try to get pregnant soon after one another.
8. Risk of miscarriage. Miscarriage is a risk for 1 in 4 pregnancies and then that increases with age and especially near or over age 40. Not to cause alarm, it’s just common but often unexpected part of the RIVF journey for anyone.
Ask your doctor for their advice – what the individual risks of miscarriage is for each of you from their medical opinion.
9. Choosing the sperm donor. There are options here, like a known donor (someone you know) or buying sperm from a donor bank where in some cases you can actually meet the donor first. There’s a lot to consider, such as whether you want them to be contactable when the child turns 18 or if they’ll remain anonymous or even be part of their life in some way earlier on. Sperm and the presence of a donor is a key part of the RIVF process. It can be daunting, and it’s a step-by-step process like all of this, so if it’s all too much, turn this into a project plan and break it down into bite size pieces, or contact a fertility coach for added support.
10. Choosing a fresh or frozen transfer. If you’re not doing any extra testing like PGT-A or PGT-M then you probably have the option of doing a fresh transfer a few days after egg retrieval. This means that whoever is receiving the embryo(s) needs to have their menstrual cycle synched up, which can be done with medication. With traditional IVF there can be the concern of the person having the egg retrieval healing from the surgery in time for the pregnancy but with RIVF this opens up the possibility for a fresh transfer in many cases.
Ask your doctor for their advice – if a fresh transfer is possible, you want one, and weigh in on what protocol they recommend for the person carrying the embryo. There are many options.
11. Lifestyle considerations. Preparing for an egg retrieval and preparing for a pregnancy require different nutrients, lifestyle changes and appointments that will affect your usual routines. Each is unique to each of you and which role you’re playing in the family planning. For example, if egg quality is a concern then there might be changes to make 3 months or prior and during the IVF cycle. Another example is being less physically active right before and after egg retrieval. Preparing for pregnancy requires keeping up physical exercise and taking folic acid for a few months, among other dietary supplements, for this stage. There are some add-ons to consider that affect both such as acupuncture and self care regimes.
Ask your doctor for their advice – on what protocol nutrients, and lifestyle chances are appropriate for each phase. Book a call with me to go over this also.
12. ICSI versus traditional IVF. ICSI (Intracytoplasmic Sperm Injection) is an add-on to the IVF process. It increases the cost but provides more of a guarantee of fertilization, although not 100% though. The sperm donor’s sperm makes a difference here. There’s also this rare option to have fertilization attempted in a small chamber (such as InvoCell) that is placed within the egg supplier partner’s vagina so that there’s somewhat of an attempt to have the embryo carried by both partners.
Ask your doctor for their advice – based on the donor sperm you’re using and if they suggest the added cost of ICSI. If you’re interested in both carrying the embryo, ask your doctor if your clinic provides that option.
13. IVF pregnancies are slightly different than pregnancies that aren’t through assistance, so it’s good to be aware if you did PGT-A, you age, and to know your increased chance of miscarriage and ectopic pregnancy with IVF and potential tests to do like NIPT, your chances of complications, your chances of placenta issues and preterm birth and any changes to make with increased risks.
Ask your doctor for their advice – depending on your age, if you’re carrying the pregnancy then talk to them about taking Aspirin and if there are any other considerations for an IVF pregnancy. I can also provide support with this.
14. Choosing a clinic and doctor. There may be few choices around you or a lot. There are some who are LGBQT+ themselves or have more experience doing RIVF. There’s a wealth of clinics available, but check your insurance, employee benefits, provincial funding, and more before signing the contract with your clinic.
Ask your potential doctors how many RIVF couples they have worked with.
15. What to do with any potential leftover embryos. This is getting ahead of ourselves in a way, but soon enough you’ll be signing the contract with your clinic and needing to have this question answered. You will likely be able to change your mind, but something to start thinking about early.
16. Talk to a fertility lawyer in your jurisdiction. A reproductive attorney in your country, province or state where you’ll give birth is a wise decision to make sure that everything around parentage is legal and as seamless as possible.
Ask your doctor -for their input also.
17. Consider who else you want on your fertility team. There are so many options in terms of who is supporting you on your journey to build your family. The finances can add up, but this is a special time and consider what you need to be as well and supported as possible. There are fertility coaches, fertility counsellors, naturopaths, acupuncturists, hypnotherapists and Chinese medicine doctors, to name a few.
It’s also OK if you don’t know any of the answers to these considerations yet. These are meant get you thinking. Book a call if you want to talk about your specific situation. You deserve answers upfront.
LGBQT+ and Fertility Resources:
In the US – Resolve
On Instagram – @nashandcolesworld – Reciprocal IVF; @mermainmaman – LGBQT+ American Black women; @samkwiatkowski – Queer East Coast Canadian lovelies
I am a proud LGBQT+ ally.