How reciprocal IVF works for same-sex female couples by Dr Inosha Bambaranda

One of the things I value most about working in fertility medicine is being part of the many different journeys people take towards parenthood. For same-sex female couples, the question of how to build a family is one that involves a great deal of thought and planning, and one option that I find many couples respond to with real enthusiasm is reciprocal IVF. 

Also known as shared motherhood, co-IVF, or by its clinical acronym ROPA (Reception of Oocytes from the Partner), reciprocal IVF offers a way for both partners in a same-sex female couple to be physically involved in the creation of their baby. One partner provides the eggs and the other carries the pregnancy, it can be a deeply meaningful arrangement for many couples. 

In this article, I want to explain how reciprocal IVF works, what makes it different from conventional IVF, and what you will need to think about when it comes to choosing a sperm donor, along with a few other considerations that are worth knowing before you begin. 

What is reciprocal IVF? 

Reciprocal IVF is a variation of standard IVF treatment, designed specifically for couples where both partners have female reproductive anatomy. The process splits the roles of genetic parent and birth parent between the two of you. 

One partner, the egg donor, undergoes ovarian stimulation and egg collection. Her eggs are fertilised with donor sperm in the laboratory to create embryos. Those embryos are then transferred into the uterus of the other partner who carries the pregnancy. 

The result is that one partner has a genetic connection to the child, while the other has a gestational and birth connection. Both are the child’s mothers, and in the eyes of UK law, both can be recognised as legal parents from the outset, provided treatment takes place at an HFEA-licensed clinic and the appropriate consent forms are completed before treatment begins 

There's also the option for both partners to undergo ovarian stimulation and egg collection, with donor sperm used to fertilise both sets of eggs. This gives you a larger pool of embryos to choose from, improving the chances of identifying the best quality embryos for transfer. It also means either partner can carry the pregnancy and offers both of you the opportunity to be genetically connected to your child, however you decide to proceed. Click to read Hads & Magenta’s story of their reciprocal IVF journey. 

How does the process work?  

Reciprocal IVF follows the same clinical steps as standard IVF, with the key distinction that two partners are involved at different stages of the process. Here is what to expect: 

Fertility assessment for both partners 

The journey begins with a fertility assessment for you both. For the partner who will be providing the eggs, we are primarily looking at ovarian reserve, which is assessed through a blood test for AMH (Anti-Müllerian hormone) and an ultrasound scan to count the follicles in the ovaries. For the partner who will carry the pregnancy, we assess the uterus and the uterine lining to confirm it is suitable for embryo transfer. Hormone levels will also be checked for both of you. 

Both partners will also complete the required screening tests, including blood tests for infectious diseases such as HIV and hepatitis, which are a standard part of IVF preparation at all licensed clinics. 

Ovarian stimulation and egg collection 

The egg-providing partner begins a course of daily hormone injections to stimulate the ovaries to produce multiple follicles. This typically takes around 10 to 14 days and is monitored closely through a series of ultrasound scans and blood tests. Once the follicles reach the right size, a trigger injection is given to mature the eggs, and egg collection takes place 36 to 40 hours later. 

Egg collection is a minor day procedure carried out under sedation. A fine needle is guided through the vaginal wall under ultrasound guidance to gently retrieve the eggs from the follicles. It typically takes around 20 to 30 minutes and most people feel well enough to go home the same day. 

Fertilisation and embryo development 

The collected eggs are assessed by an embryologist and those that are mature are fertilised with donor sperm in the laboratory. The resulting embryos are cultured for five to six days until they reach the blastocyst stage, at which point their quality can be more accurately assessed. 

Any embryos that develop well but are not transferred in the current cycle can be frozen for future use, whether for a sibling pregnancy or as a safeguard if the first transfer is unsuccessful. 

Embryo transfer 

While the embryos are developing in the laboratory, the carrying partner’s cycle is also being monitored to ensure the uterine lining is at the right thickness for implantation. When everything is ready, the best-quality embryo is selected and transferred into her uterus via a fine catheter, in a straightforward procedure that does not usually require any sedation. A pregnancy test is taken approximately two weeks later.

Why do some couples choose reciprocal IVF over conventional IVF?

For many same-sex female couples, the most straightforward option, and often the first recommendation where there are no known fertility challenges, is IUI (intrauterine insemination) using donor sperm, or standard IVF with one partner’s own eggs. Both are effective options and considerably simpler in terms of what each partner goes through physically. 

Reciprocal IVF is different in that it involves both partners actively in the biological process and are engaged in the creation of their child in a direct and tangible way. 

There can also be practical or medical reasons to consider it. If one partner has a condition affecting the uterus that makes carrying a pregnancy difficult but has good ovarian reserve, while the other partner has a healthy uterus but fewer eggs, reciprocal IVF naturally aligns those circumstances. 

It is worth being aware that reciprocal IVF involves more for both partners medically. The egg-providing partner goes through ovarian stimulation and egg retrieval, which is a more involved process than if only one partner were treated. This is why a thorough fertility assessment and an honest conversation about what each partner is comfortable with is so important before making any decision.

What does the evidence say about success rates? 

The clinical evidence shows that reciprocal IVF produces clinical pregnancy rates and live birth rates comparable to standard IVF in same-sex female couples. One important factor to also bear in mind is that, unlike standard IVF in the context of infertility, many same-sex couples choosing IVF do not have underlying fertility problems. They are seeking treatment because of their relationship, not because of a medical diagnosis and this can be favourable for outcomes. 

As with all IVF treatment, age plays a significant role. The age of the partner providing the eggs is the most important factor in determining embryo quality and the likelihood of a successful pregnancy. 

Choosing a sperm donor  

Choosing a sperm donor is one of the most personal decisions you will make on this journey. There is no single right answer, and couples approach it in very different ways. What I would encourage is to give it time and thought, and to make use of the support and information available to you. 

What clinics check before a donor is approved 

All sperm donors at HFEA-licensed clinics in the UK are rigorously screened before their sperm can be used in treatment. This includes testing for infectious diseases, semen analysis to assess sperm quality, and genetic screening for conditions such as cystic fibrosis. Psychological assessment and a detailed medical and family history are also part of the process. 

Each donor can contribute to the creation of up to ten families in the UK, a limit set by the HFEA to reduce the chances of donor-conceived half-siblings unknowingly meeting. 

What information is available to you 

When selecting from a donor bank, you will typically have access to information such as the donor’s age, physical characteristics, ethnic background, educational background, occupation, and sometimes a personal statement about why they chose to donate. Some donors also provide a goodwill message for any child born from their donation. 

Identity and donor anonymity in the UK 

It is important to understand how UK law currently works in relation to donor identity. Since April 2005, sperm donation in the UK is not anonymous in the traditional sense. Any child born from a donation made after that date has the right, when they turn 16, to access non-identifying information about their donor. At 18, they can request the donor’s full name, date of birth, and last known address from the HFEA. 

This matters when choosing a donor, because it is worth thinking about how you will talk to your child about their origins as they grow up. Fertility counselling, which is available at every stage of your treatment with us, can be very helpful when thinking through these conversations, both as a couple and in terms of what you want for your child in the future. 

Known donors 

Some couples prefer to use a donor they already know personally. This is possible in the UK and can be arranged through a licensed clinic. If you are considering this route, it is essential that treatment takes place at a licensed clinic rather than through a private arrangement, both for medical safety reasons and for legal reasons. Donors who provide sperm through a licensed clinic have no legal parental rights over any child born. Private arrangements that bypass the clinic carry legal uncertainties that could have significant consequences for your family further down the line. 

Legal parenthood: what you need to know 

Under UK law, the person who gives birth to a child is automatically the legal mother. In the case of reciprocal IVF, for the genetic parent to also be recognised as a legal parent, the right consent forms must be signed before treatment begins. 

If you are married or in a civil partnership at the time of treatment, your partner will automatically be recognised as the second legal parent. If you are not married or not in a civil partnership, you will both need to complete the relevant legal parenthood consent forms at your clinic before treatment starts. 

Our team will walk you through the consent process carefully before treatment begins, and we always recommend discussing legal parenthood with a solicitor who specialises in family law if you have any questions or circumstances you want clarity on. 

So, is reciprocal IVF right for you? 

Reciprocal IVF is not the only path to parenthood for same-sex female couples, and it may not be the most straightforward one for everyone. IUI with donor sperm is a less invasive and less expensive starting point and is the treatment generally recommend first for couples with no identified fertility challenges. Standard IVF with one partner’s eggs is another option. But reciprocal IVF may feel right to you. The right choice depends on your individual circumstances, your fertility health, your ages, and what both of you feel comfortable with. 

Whatever path you choose, we want you to feel supported, informed, and confident in the decisions you make. Reciprocal IVF can be a wonderful way to share the very beginning of your child’s story between you both. For couples where it is clinically appropriate and emotionally right, it is a genuinely special option. 

At TFP Oxford Fertility, we have significant experience supporting LGBTQIA+ families and are here to make sure your journey is as smooth, informed, and personal. If you’d like to talk through your options or have any questions, please don’t hesitate to get in touch.