Reproductive Attorney, Law Office of Brian Esser
IVF, or in vitro fertilization, is a more intensive and expensive treatment option than IUI — it requires that eggs are removed from the ovaries, that those eggs are inseminated with sperm in a laboratory, and that a resulting embryo is placed in a woman’s uterus with the hopes that it implants and leads to a healthy baby.
A lesbian couple might strongly consider IVF if:
Generally speaking, IVF success rates vary by age. If a woman has an underlying fertility issue, as you can see below, the cumulative odds of success vary dramatically.
More than half of women under age 40 deliver a child after 3 IVF cycles whereas for women over the age of 40, rates of IVF success tend to be much lower.
The above data reflects success rates for heterosexual couples with an underlying fertility issue.
A better analogue for lesbian couples might be IVF success for women with no underlying fertility issue and who underwent treatment (using donor sperm) on account of their partner’s male factor infertility issues. The below chart reflects data from all couples meeting this criteria treated in the UK from 2003 to 2010. As you can see below, after 3 cycles, roughly 70% delivered a child.
IVF is a complex process, with myriad decisions going in to a single cycle. We’ll summarize it below, but if you want the full set of details, head to our comprehensive guide to IVF here.
A woman is usually given injectable hormones to make her ovaries develop as many eggs as they can (say 8 to 20) instead of the usual 1 - 2 that would be matured each month. This continues for an average of 10 days, until a “trigger shot” is taken to start the ovulation process where eggs become mature.
Eggs are surgically retrieved from the ovaries, and typically general anesthesia is used during the procedure. A doctor usually uses a vaginal ultrasound to guide a needle that suctions out each egg.
Over the next 3 - 7 days, a fertility clinic’s laboratory will take all of the collected, mature eggs and try to grow them into healthy embryos.
First, they fertilize the eggs with sperm either by surrounding an egg with sperm in a petri dish, or using ICSI, a micro-procedure where a single sperm is injected into an egg. If you’re using frozen donor sperm there’s a good chance your doctor will want to use ICSI.
Then they try to grow the embryos into either Day 3 “cleavage stage” embryos or heartier Day 5, 6, or 7 “blastocyst stage” embryos.
Once embryos have reached the blastocyst stage, there is an option to remove a few cells and have them sent out for genetic testing, sometimes referred to as PGT or PGS screening. This testing can either test for a single genetic disorder that you have a family history of, or testing can predict if an embryo is likely or unlikely to lead to a healthy pregnancy.
After developing embryos, whether or not genetic screening has been done, more clinics and patients are using the option to freeze all their embryos. Then embryos will be transferred later on.
An embryo will be transferred into the uterus, with the hopes that it implants and leads to a healthy pregnancy. The safest option is to transfer one embryo at a time.
Any embryos of reasonable quality that were not transferred will be frozen and can be used later, either in the event that the transfer doesn’t work, or if it does work, for more children in the future.
In some senses, you can think of IVF like a funnel. Unfortunately every developed ovarian follicle won’t contain a mature egg, and every mature egg won’t necessarily lead to a healthy embryo or a baby. At each stage throughout the process, you’ll lose something. That’s why the goal is to have a high number of eggs to start off with.
Reciprocal IVF, also referred to sometimes as “co-maternity” or “shared motherhood,” is the process where one partner’s eggs are retrieved in an IVF cycle, and a resulting embryo is placed in a partner’s uterus, so that partner will carry the pregnancy.
Reciprocal IVF creates an opportunity for both partners to play a biological role in a pregnancy.
The advent of a field called epigenetics reveals that a woman who carries a pregnancy has a role in altering the genetic makeup of the embryo and fetus. Her lifestyle during that pregnancy plays a role in which genes are ultimately expressed.
There are many personal factors that will play into the decision of who provides eggs and who carries a pregnancy in Reciprocal IVF.
That said, it’s important to understand some key issues when it comes to egg quality and the ability to carry a pregnancy.
The age of a woman’s eggs determine whether an IVF cycle will work to a much greater extent than the age of a woman’s uterus.
To illustrate this point, here’s data showing the difference between a 42-year-old doing IVF using her own eggs, versus women of the same age who use donor eggs from younger women (if IVF with donor eggs is of interest, see our dedicated course here). In a single cycle, this 42-year-old woman has five times the likelihood of conceiving when using younger, donor eggs.
Why is this relevant? If a lesbian couple wants to have just one child, they may be better off using the eggs from the younger partner, and having the older partner carry the pregnancy.
If a couple wants multiple children, and both partners want a chance to provide eggs and carry, then it might make sense to start with eggs from the older partner first.
Let’s look at the case of a couple where one partner is 34 and the other is 39. Let’s presume they want two children with a gap of about 2 years. As you can see below, whether the 34 year old uses her eggs now, or in 2 years (at age 36), the odds of IVF success using her eggs are relatively high. Thus, she is in a position to wait on using her eggs and an in a better position to carry first.
On the other hand, the 39 year old partner is teetering on the age where IVF using her eggs is less likely to work and in two years the odds of IVF success using her eggs will drop into the teens or lower. Thus, as you can see below, she’s in less of a position to wait 2 years and would be the better candidate to use her own eggs now and to carry the second child.
Different states view parentage differently and so it’s important to talk with a lawyer in the state where you live (and will give birth, if they’re different) if you’re going to pursue Reciprocal IVF.
Just remember, adding a second parent’s name to a birth certificate is not enough to establish legal parental rights on its own.
Many states do not automatically recognize the rights of the mother who contributed her eggs to the pregnancy — some only recognize the rights of the birthing mother.
In this case, the mother who contributed her eggs might need to get a court order during the pregnancy, or go through a second parent adoption. Getting legal advice early in this process is key to avoid deeply unpleasant surprises.
Typically IVF costs around $20,000 per cycle, often significantly more than the prices clinics advertise. That’s because marketed prices seldom include the cost of (non-optional) medication (~$5,000 per cycle) or costly add-ons the clinic will eventually insist upon in the future.
In the US generally, it’s somewhat rare to have IVF covered by an employer’s insurance plan. For lesbian couples, though, it’s truly rare.
That’s because most employers who cover IVF specifically have plans that have a “pre-authorization” requiring that someone meet the medical definition of infertility — that means having heterosexual sex for six to twelve months without success. Since most lesbian couples won’t meet that definition, they’ll be paying for IVF and other fertility treatments out of pocket.
If you’re looking for our list of companies that cover fertility treatments, including those that offer inclusive policies that don’t require medical infertility, check out our workplace index here.