A same-sex couple in Texas, Ashleigh and Bliss Coulter, recently gave birth to a baby boy that they both carried — together, ABC News reports. You might be wondering how exactly this is possible? Thanks to a process called reciprocal in vitro fertilization (IVF), aka "partner-assisted reproduction," same-sex couples like the Coulters are able to take part in the biological creation of their child.
Traditional IVF involves extracting a person's eggs, combining them with sperm outside the body, and then transferring those embryos back into the person carrying the baby's uterus. And typically with a same-sex couple, one partner is artificially inseminated with a donor's sperm, and that person carries the baby. But in this case, Bliss told ABC News that she felt strongly that the child should be biologically hers, but she didn't want to carry the kid. Reciprocal IVF allowed Bliss to provide the egg, through a traditional IVF procedure, and have it inseminated and incubated inside her body. Then, the embryo was transferred into Ashleigh's womb, and she delivered the baby.
In many ways, this process is a lot like donor egg IVF, with the main difference being who carries the embryo and delivers the child, says Alan S. Penzias, MD, reproductive endocrinologist at Boston IVF, and assistant professor at Harvard Medical School. Most of the time, couples choose this path so they can both feel that they had a biological role in the birth of their child, he says. "With partner assisted reproduction, both members of the couple actively participate in the birth of their child," he says.
Reciprocal IVF is becoming more popular, but it tends to be prohibitively expensive, says Briana J. Rudick, MD, fertility specialist at Columbia University Fertility Center. A simple insemination where it's just one person can cost a few hundred dollars, whereas reciprocal IVF can cost $20k, says Deborah Anderson-Bialis, co-founder of FertilityIQ, a startup that provides data about fertility clinics and doctors. "So, it's normally not a flip of a coin, which one are we going to do," she says.
Beyond the cost, figuring out which partner will carry the child and provide the eggs can be an "emotionally fraught" situation, Anderson-Bialis says. Usually, the partner who is younger and has a "more robust ovarian reserve" is the better candidate to go through IVF and egg retrieval, and a partner who has a healthy uterus or has had kids before would be a better fit to carry the pregnancy, says Joshua Klein, MD, FACOG, chief medical officer and reproductive endocrinologist at Expect Fertility. "But sometimes the emotional and psychological dynamics of the couple lead to the opposite preference, which can be medically challenging," Dr. Klein says.
On top of this, figuring out how to get insurance to cover reciprocal IVF can be difficult without a true diagnosis of infertility, Dr. Rudick says. Many insurance companies that cover IVF have rules requiring couples to document infertility, or show that they've tried less-expensive options (like artificial insemination) before they'll cover IVF, Dr. Klein says. "For a same-sex couple interested in reciprocal IVF, these rules very well may preclude insurance coverage for the procedure, even for patients who have an IVF benefit in their insurance plan," he says.
So, while this story is heartwarming, there's a lot to unpack when it comes to reciprocal IVF, and there's also no guarantee that the reciprocal IVF will be successful with all couples, Dr. Klein says. Compared to intrauterine insemination, or IUI (in which sperm is placed inside a person's uterus), IVF is a much more invasive procedure. However, according to data from FertilityIQ, IVF tends to be three-to-five times more likely to succeed than IUI, on a per-cycle basis. But for some couples, the chance to actively participate in the biological creation of their child is worth the financial and emotional cost.