Reciprocal IVF explained
Reciprocal IVF or shared motherhood is a unique fertility treatment method for two females who wish to share the experience of pregnancy and motherhood.
Reciprocal IVF in a nutshell
Reciprocal IVF is also referred to as the ROPA method, co-IVF, or shared motherhood.
With reciprocal IVF, both women actively participate: One woman provides the eggs and the other woman carries and delivers the baby.
This method allows both of you to have a close biological connection to your child, as you both contribute to the baby’s creation and development.
The child is genetically related to one mother, while the other provides a nurturing prenatal environment through pregnancy.
Currently, in Denmark, this procedure is only permitted for medical reasons. However, from 1st January 2025, a legal change will to allow reciprocal IVF for all lesbian couples.
What does ROPA mean?
ROPA stands for ‘Reception of Oocytes from the Partner’. It allows a woman to donate her eggs to her female partner who, with the help of IVF treatment with donor sperm, carries the baby during pregnancy and gives birth.
With the ROPA method, both partners have an important role:
- One becomes the genetic mother because she contributes the eggs,
- The other carries the pregnancy to term and becomes the birth mother.
During pregnancy, the latter will be able to contribute to influencing the child’s development via epigenetics.
This process is unique to lesbian pregnancy options as it allows both partners to share the experience of conception and pregnancy equally.
How does reciprocal IVF work?
Reciprocal IVF is a form of IVF (In Vitro Fertilisation) that combines traditional IVF/ICSI treatment with partner egg donation.
Eggs are retrieved from one woman and fertilised with donor sperm outside the body in our laboratory. And the fertilised egg (blastocyst) is then transferred to the partner’s uterus where she carries the baby to term.
Who is reciprocal IVF suitable for?
Reciprocal IVF is specifically for lesbian couples who want to share the whole process of creating a family.
It works best for couples where:
- One woman has healthy eggs, and
- The other woman has a healthy uterus where the embryo can attach (implant) and the pregnancy can develop.
Reciprocal IVF is particularly suitable for:
- Lesbian couples where both partners want to be actively involved in the conception and pregnancy.
- Lesbian couples where one partner does not want to be pregnant, but still wants to be biologically involved in the pregnancy.
- Cases where one partner has a medical condition affecting egg quality or the ability to carry a pregnancy.
How does the reciprocal IVF process work?
Before starting treatment, you’ll both have some tests and examinations following the initial consultation.
After that both of you must prepare your bodies for the process.
The treatment itself is an IVF/ICSI procedure, where fertilisation with donor sperm takes place in the laboratory.
We have extensive experience in freezing all blastocysts for later use in what is called a frozen cycle.
Therefore, ovarian stimulation and egg retrieval can normally be carried out independently of the recipient woman’s cycle, This simplifies the process and avoids the need to synchronise your cycles using hormones.
Here is a step-by-step overview of the process.
Reciprocal IVF – step-by-step
Synchronising menstrual cycles, if needed
If you live abroad and wish to travel to Denmark together for treatment, we can assist with synchronising both your menstrual cycles. This ensures that your bodies are at the same stage in the menstrual cycle, so that the egg retrieval and subsequent transfer of the embryo happen at the optimal time. If it becomes necessary to adjust or reset one or both of your cycles, this can be done with various hormone supplements.
Hormone stimulation and egg retrieval
The partner providing the eggs will undergo hormonal stimulation to encourage the ovaries to produce more eggs. Ultrasound scans will monitor the development of the eggs. When the eggs are ready, a trigger injection is given 36 hours before egg retrieval, which is performed under mild sedation.
Fertilisation with donor sperm
Once the eggs are retrieved, they are fertilised with donor sperm in the laboratory. Read more about finding a sperm donor.
Fertilisation is usually done with a technique called ICSI, where a single sperm cell is injected directly into the egg. The embryos are closely monitored by our embryologists until they reach the blastocyst stage (5-6 days post-fertilisation).
At this stage, a blastocyst is ready to be transferred to the partner’s uterus. Alternatively, we can freeze blastocysts for later transfer in a so-called frozen embryo cycle. If there are multiple viable embryos, we can freeze the extras for future use – for additional attempts or for siblings.
Embryo transfer: Preparation and procedure
Before the embryo is transferred, the partner carrying the baby will be prepared with either hormone injections or medication to ensure the womb is ready for implantation.
Once prepared, the blastocyst is transferred into her uterus through a simple, pain-free procedure.
Pregnancy test
10 days after egg transfer, we measure your HcG level to check if the treatment has been successful.
What is the success rate of reciprocal IVF?
The success of reciprocal IVF largely depends on the quality of the eggs and the health of the partner carrying the pregnancy.
In particular, the age of the woman providing the eggs plays a crucial role. In general, the younger the woman providing the eggs, the higher the chance of success.
We continuously update our success rates on our website.
What is the main advantage and disadvantage of reciprocal IVF?
The main advantage of reciprocal IVF:
The most important benefit of reciprocal IVF is the sense of togetherness it fosters through the shared experience of creating a child.
Fertility treatment can be an emotional journey filled with both hope and uncertainty.
Many couples find strength in going through this journey together, supporting each other along the way.
The co-IVF method with partner egg donation allows lesbian couples to share this experience, with both partners contributing.
This can strengthen their bond with each other and to their future child.
The main disadvantage of reciprocal IVF:
The main disadvantage of reciprocal IVF is that the treatment is more invasive and expensive than may be necessary to have a child.
The vast majority of women are healthy and have no fertility challenges. So, most lesbian couples can fulfil their dream of having a child through a simple insemination (IUI) with donor sperm.
Advantages of IUI:
- IUI is cheaper and less invasive compared to reciprocal IVF treatment.
- IUI can be performed in your natural cycle – without hormones.
- The insemination treatment where purified sperm is placed in the uterus is a very simple procedure without significant risks.
The epigenetic influence of the birth mother
New research in the field of epigenetics shows that the mother carrying the baby plays a significant role in the child’s development.
While the genetic traits come from the egg and sperm donors, the prenatal environment – including the mother’s nutrition and mental state – impacts how the baby’s genes are expressed.
This means the birth mother has a profound influence on the baby’s early development.
Legal considerations for reciprocal IVF
Legal for everyone from 1 January 2025
In Denmark, reciprocal IVF will become legal for all lesbian couples from 1 January 2025.
Until 31st December 2024, we can only offer ROPA treatment if there is a medical reason for doing so.
From 1st January 2025, this treatment will be available to all our lesbian patients.
No marriage or sperm donor category requirements
In Denmark, there is no requirement to be married to receive the treatment, unlike in many other countries.
There are also no restrictions on the choice of sperm donor in Denmark. You can choose either an open or anonymous sperm donor for the reciprocal IVF treatment.
Co-motherhood
The woman who gives birth to the child will be considered the child’s mother under Danish law.
If both partners are Danish citizens residing in Denmark, the non-birthing partner’s legal parental rights can be secured by completing and signing Familieretshusets Blanket 8 (Family Court Form 8) before treatment.
If you are not both Danish citizens residing in Denmark, we recommend seeking legal advice before beginning treatment to clarify your rights and obligations regarding legal parenthood or co-motherhood.
Frequently asked questions about reciprocal IVF
Can both women be biological mothers through reciprocal IVF?
Yes. One woman provides the eggs, making her the genetic mother, while the other carries the pregnancy and is the birth mother. If the couple later swaps roles, they can both be biological mothers to their own child.
Will I be able to bond with the baby I carry if we are not genetically related?
Yes, the vast majority of women develop a strong bond with the baby they carry, regardless of genetic connection. Pregnancy plays a significant role in building this bond, as you nurture, protect, and give life to the baby. Your body also influences the baby’s development through epigenetics, and the emotional connection naturally deepens during pregnancy and parenthood. It is your care and love that create the unbreakable bond between you and your child.
It is completely natural to have questions or concerns about bonding when undergoing fertility treatment with egg donation. Give yourself space to process your thoughts and feelings, and consider speaking with someone you trust for support.
How long does the reciprocal IVF treatment process take?
The whole process usually takes a few weeks, depending on how the two women’s menstrual cycles synchronise.
Is donor sperm required for the reciprocal IVF treatment?
Yes, a sperm donor is needed to fertilise the eggs. Both open and closed sperm donors are available, and the clinic also offers treatment with a known sperm donor, typically a friend or family member of the couple. You can order donor sperm from us from BORN or LIVIO, or through another sperm bank.
What is the success rate of reciprocal IVF?
Success rates vary and depend on factors such as the age of the woman donating the eggs, the quality of the eggs and the health of the woman carrying the baby.
What are the risks reciprocal IVF?
Research shows that after becoming pregnant through egg donation treatment, there is an increased risk of pre-eclampsia and high blood pressure. Our doctors will explain this in more detail during your consultation. Read more about the risks of IVF with donor eggs here.