What You Need to Know About Reciprocal IVF

Pregnant lesbian couple sitting on a couch together

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Reciprocal IVF, also known as Co-IVF, is one possible option for family building when two women or one cis-woman and one transgender man seek to have a child together. Reciprocal IVF allows both individuals to play an intimate role in the biological development of the baby.

One individual provides eggs (or oocytes) from their ovaries, which are then combined with sperm from a donor to create embryos. The other individual has the resulting embryos transferred to their uterus. If the cycle is a success, they will become pregnant and give birth to the baby. Read on to learn more about the ins and outs of reciprocal IVF.

What Is Reciprocal IVF and How Does It Work?

Reciprocal IVF works in a similar way to when a family uses an egg donor along with a gestational carrier to have a child. What makes reciprocal IVF unique is both the egg donor and gestational carrier are the intended parents, which isn't the case in a typical egg donor or gestational carrier IVF cycle.

During reciprocal IVF, one partner is given fertility drugs (usually injectable hormones) that stimulate egg growth in their ovaries so that more than one egg matures at once. (Typically, the ovaries only mature one egg per month.)

The individual contributing their eggs is also given fertility drugs to prevent the eggs from spontaneously ovulating. (If the eggs ovulate on their own, they will be lost and unavailable to use for IVF.) The egg growth is monitored with sometimes daily blood work and transvaginal ultrasounds.

Once the eggs are mature, they are retrieved using an ultrasound-guided needle. The egg donor is sedated so they are not awake for the process. Once the eggs are retrieved, they are then put into a petri dish with sperm. The sperm comes from a donor that you and your partner will have selected and arranged for earlier. If all goes well, some of the eggs and sperm will come together, and you will get embryos.

In the days leading up to the egg retrieval, the gestational partner will be given different fertility drugs to prepare their uterus for the embryos. Assuming good quality embryos result from the process, one or two of the embryos will be transferred to the other partner's uterus.

Usually, the individuals will have their cycles synced together. This way, when a fertilized fresh embryo is ready, the other partner’s uterus is ready to accept the embryo during transfer.

That said, this is not always the case. If syncing the partners' cycles together isn't possible, your doctor can freeze the embryos. The process of freezing and thawing embryos, however, adds additional cost and may possibly decrease your overall odds for success.

“If the couple uses the fresh embryos created from recently retrieved eggs, then the cycles of both partners will be synchronized through hormonal treatments,” explains Dr. Lisa Hansard, a board-certified reproductive endocrinologist at Texas Fertility Center in Austin, Texas. “This involves preparing the uterine lining in one partner for pregnancy, while at the same time, inducing the egg-contributing partner’s body to mature and release eggs. If the couple is using previously frozen embryos, their cycles don’t need to be synchronized and their treatments will be independent of each other.”

Many fertility specialists recommend using a technology known as preimplantation genetic testing for aneuploidy (PGT-A), or, as it was more simply known in the past, preimplantation genetic screening (PGS). During PGT-A, a few cells are extracted from the growing embryo on the third day or fifth day of development. An embryologist tests the cells and looks at the overall genetic makeup of an embryo.

This technology can be used to rule-out embryos that have genetic defects that may be more likely to lead to a failed treatment cycle or miscarriage. At one time, PGT-A required frozen embryo transfer. However, this is no longer the case. You can have a fresh embryo transfer and still do genetic screening.

Using PGT-A technology may improve the odds of IVF treatment success. However, this increased success rate is based on research on couples with fertility problems. Whether or not PGT-A significantly increases the chances for treatment success for those seeking reciprocal IVF treatment (whose fertility may be normal) is unknown.

How Much Does It Cost and Is It Covered By Insurance?

IVF treatment is already an expensive fertility treatment, but reciprocal IVF costs slightly more. Regular IVF costs anywhere from $10,000 to $12,000. “The average cost [for reciprocal IVF] is over $20,000, and depends on the clinic, medication protocols, and add-on services like genetic testing," says Jane Frederick, MD, a board-certified reproductive endocrinologist at HRC Fertility in Newport, California.

There are a number of factors that increase the costs for reciprocal IVF. One, donor sperm is needed. This can cost close to a thousand dollars per vial, and you may need multiple vials. Secondly, with reciprocal IVF, you have two individuals taking fertility drugs and having their ovaries and/or uterine linings monitored. This further increases the cost.

Another possible cause for increased expense: donor sperm sometimes requires an IVF process known as ICSI, or intracytoplasmic sperm injection. This is when a sperm cell is individually injected into an egg, instead of placing the sperm in a petri dish with eggs and hoping a few of the eggs will become fertilized. When sperm is thawed, it's not always mobile enough to fertilize an egg by itself. ICSI would be required in these cases and can add a couple thousand more dollars to the price tag.

Some couples may also choose to do genetic testing of the embryos. This is done to increase the odds for success or to screen for deadly hereditary conditions that run in the egg-contributing partner’s family. Some fertility doctors also recommend genetic testing if ICSI is used, because ICSI can increase the risk for some genetic problems. Genetic testing of embryos is another $3,000 to $4,000.

For patients who want to do preimplantation genetic screening, many fertility clinics strongly suggest or require patients to use ICSI for the fertilization process. The reasoning is to avoid genetic “contamination” around the embryo. (Without ICSI, multiple sperm cells have been present around the egg, which may throw off the genetic test results. On the other hand, with ICSI, only one sperm cell has come in contact with the egg—the one used for fertilization.) That said, not all researchers agree that ICSI is required for accurate preimplantation screening.

Unfortunately, reciprocal IVF is rarely covered by insurance. You should plan to pay for most of the cost out-of-pocket. Insurance coverage for IVF treatment is rare in general, though some companies do offer it. Talk to your HR department to find out if your company's insurance covers fertility treatment. Some states mandate employers to include IVF coverage, but reciprocal IVF may not qualify even in these states. The mandated coverage is usually reserved for those facing medical or cancer-related infertility.

Even if your insurance does not cover the full treatment, some monitoring or blood work may be covered. You should also be able to use your HSA or FSA funds to help pay for treatment.

Something to keep in mind: not every treatment cycle will cost $20,000. The good news is that if a cycle produces multiple healthy embryos, you can transfer one or two and freeze the rest. A frozen embryo cycle is just a few thousand dollars. These cycles are less expensive since egg stimulation, monitoring, retrieval, and fertilization already occurred. Frozen embryos may be used to get pregnant now, or you may save some for later and try to have another child in a couple of years. Talk to a healthcare provider about your options.

Deciding Who Provides the Eggs and Who Carries the Baby

You and your partner may already have an idea of who wants to contribute the eggs and who wants to carry the baby. Or, you may be considering taking turns if you know you plan to have more than one child through reciprocal IVF—the first baby, Partner A carries the pregnancy and, for a second child, Partner B carries the pregnancy. 

However, remaining flexible on your plans is best if you want to optimize your odds for success.

“Sometimes patients have a clear idea about what they want the process to look like,” explains Dr. Hansard. “I recommend keeping an open mind and deciding on roles after consulting with a physician and getting a complete fertility evaluation.”

Together with your doctor, you and your partner will make decisions on who will carry the pregnancy and who will contribute the eggs based on overall general health, medical history, family medical histories, and age.

If one partner is significantly younger, your best odds for success may be with the younger partner, according to Dr. Hansard. However, that may not always be the case. Fertility testing and screening—which should be done before starting treatment—can help discover underlying fertility issues.

You might be wondering if a transgender man who takes testosterone supplements could contribute their eggs. Research is lacking in this area, and there’s no clear right answer. Most fertility doctors prefer to have the transgender man temporarily stop taking testosterone supplements during treatment. However, in one case study, successful pregnancy has occurred even when the transgender man continued their hormones.

Talk to a healthcare provider about all your options, and don’t be afraid to shop around for a fertility doctor that best listens to your concerns and gives you good odds for success.

The Legal Intricacies of Reciprocal IVF

Something you may not have thought about yet is the legal implications of reciprocal IVF. You might assume that since one of you will be genetically related, and one will give birth to the child, there should be no problems in establishing legal parenthood for the two of you. Unfortunately, the process is not always straightforward.

While technology has advanced and opened up pathways to parenthood that did not exist before, the law has not always kept up. For example, while the partner who gave birth is typically automatically granted parenthood status in most states, the partner who contributed their eggs may need to go through an adoption process to claim parental rights.

If you decide to use a known sperm donor, then speaking to a lawyer as soon as possible (before you make any decisions or begin treatment) is even more important. Without careful preparation and contract writing, a known sperm donor may be able to claim parental rights. Talking to a lawyer also protects the sperm donor, who may be held liable to pay child support if certain legal steps aren't taken before conception.

The law will depend on where you live. “Consult a reproductive attorney in your state to understand your state’s rules regarding reciprocal IVF,” explains Dr. Hansard. “In some states, the laws can be complex. This is best done before you get the [treatment] process started.”

What Providers Offer Reciprocal IVF?

A reproductive endocrinologist at a fertility clinic is the medical professional you need to carry out reciprocal IVF. A regular gynecologist or midwife can not conduct IVF treatment.

While looking for a fertility clinic, consider both the clinic’s overall IVF success rates and how LGBTQ+-friendly the clinic is. A clinic where you and your partner feel welcome and accepted will lead to a better experience for both of you. One way to know if a clinic is LGBTQ+ friendly is to look at their website. Do they mention fertility treatment for LGBTQ+ people? Do they directly indicate they have an LGBTQ+ friendly office?

Another way to find a clinic open to LGBTQ+ individuals is to ask people in your community.

“Get recommendations from family and friends," recommends Dr. Hansard. "After you’ve narrowed down the list, visit the prospective clinics and ask about their history working with couples seeking reciprocal IVF, how often they have performed reciprocal IVF, and what the process is like.”

Depending on where you live, you may have an abundance of LGBTQ+-friendly fertility clinics, or you may find yourself needing to travel for treatment.

Ideally, a clinic that has experience with reciprocal IVF will make the process smoother for everyone. However, if that’s not available, a clinic that at the very least is experienced with gestational carrier arrangements can also be a good choice. (Gestational carrier arrangements are similar to reciprocal IVF cycles.)

How Long Can It Take to Get Pregnant?

While it’s possible to get pregnant during your first treatment cycle, this isn’t guaranteed, and it isn’t unusual for the process to take time. Depending on the fertility health and age of the partner who supplies the eggs, and a variety of other fertility factors in both individuals, you should plan to spend an average of three cycles trying to achieve pregnancy success. 

However, taking up to six months—or not seeing any success, sadly—is also a possibility, especially if there are fertility roadblocks for either partner.  

“Success rates will depend on the age of the donor egg, with one study showing 60% achieved pregnancy with an average age of donor at 32 years old," explains Dr. Frederick. “The actual success rate 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." In other words, most fertility research has been done on couples who can't get pregnant due to medical infertility. With reciprocal IVF, most of the time, the people involved have good fertility.

Many fertility specialists recommend PGT-A screening of embryos to increases your chances for success. In one study, for women over age 38, PGT-A screening of embryos increased the live birth rate per transfer significantly—from 31.7 percent to 62.1 percent. However, this increase was not seen for younger patients. Also, this study included couples with fertility challenges and may not apply to individuals seeking reciprocal IVF, who may have excellent fertility health.

Keep in mind: each cycle does not usually require full ovarian stimulation and a new sperm donor contribution. If all goes well, your fresh cycles should yield some frozen embryos that can be transferred in a subsequent cycle, if the fresh cycle isn’t a success.

This means your overall costs will vary for each cycle. Frozen embryo transfer cycles will be significantly less expensive—on average, a few thousand dollars—compared to fresh embryo cycles, which cost closer to the $20,000 mark or higher.

A Word From Verywell

Reciprocal IVF is an exciting way for two women or one cis-gender woman and a transgender man to share in the biological process of having a baby together. If you’re young and otherwise have good fertility, your odds for IVF success are much better than those based on studies of couples with infertility.

“Most couples will successfully conceive via reciprocal IVF,” says Dr. Hansard.

However, reciprocal IVF is not guaranteed and is only one possible way to build your family. Foster care, adoption, surrogacy, intrauterine insemination with a sperm donor, or co-parenting (having and raising a child with the help of a friend with whom you do not live with) are other wonderful options.

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