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What is reciprocal surrogacy and how does the process work?

The world of fertility medicine has come a long way and the many procedures and options out there can be exciting, though confusing. You may have heard of reciprocal surrogacy, but exactly what is it? Perhaps even more confusing, how does reciprocal surrogacy work?

Individuals and couples looking to have children are able to do no matter the biology or fertility of the partners involved thanks to donors and surrogates. Reciprocal surrogacy, also called reciprocal IVF, is a specific type of fertility option that does not involve a stranger or friend as a surrogate, but is actually an option for same-sex female couples. Read on to learn about what it entails.

What is reciprocal surrogacy?

Reciprocal surrogacy is when one person’s fertilized egg is implanted in another person’s uterus. The person whose uterus the embryo was implanted into carries the baby to term as long as the embryo successfully implants and grows.

This is almost always done in couples of two women so that one woman carries the baby that comes from the other woman’s egg. While only one woman can have a genetic connection to the child, this way they can both have a physical connection to the process. While this involves two women, people of any gender who have an egg and a uterus can use reciprocal surrogacy.

Reciprocal surrogacy is most often referred to as reciprocal IVF. It is sometimes also called co-maternity.

Alena Popova/Shutterstock

How does reciprocal surrogacy work?

Unlike fertility treatments that try to get a person pregnant by inseminating them, reciprocal surrogacy must be done with in vitro fertilization (IVF) because the goal is not to inseminate the egg in the person trying to get pregnant. Any other method like intrauterine insemination (IUI) won’t work.

The first step is to find a fertility clinic to work with. They will guide the couple through the process, recommend and prescribe fertility drugs, and perform all of the steps along the way.

The basic steps are:

  1. Collect eggs from Partner 1.
  2. Inseminate donor eggs from Partner 1 with donated sperm in petri dish at fertility clinic.
  3. Allow fertilized eggs to develop in a lab for about five days.
  4. Transfer the embryo(s) into Partner 2’s uterus.

There is more detail than that along the way, of course.

To get to step 1, Partner 1 needs to take fertility medications to increase the number of eggs she produces so as many as possible can be collected in the procedure. The partners may both take hormones to sync up their cycles so that the embryos can be transferred without being frozen while waiting for Partner 2’s uterine lining to be ready for implantation.

The couple also needs to choose a sperm donor and procure the sperm donation. They could choose an anonymous donor and have the sperm shipped from a sperm bank, or they could choose a known donor like a friend and have him make a donation at the clinic and have the donation frozen for when it is needed for step 2.

After step 3, the couple could choose to run genetic tests on the embryo(s) to see if they have any abnormalities that may make them not want to go on to step 4. Depending on how many of the eggs were successfully retrieved and how many of those were successfully fertilized and how many of those successfully grew for five days and how many of those had no serious issues in their testing, the couple then chooses how many to implant. Sometimes an embryo develops into a baby and sometimes it doesn’t. Implanting one embryo could give you zero, one, or two babies. Implanting two embryos could give you zero, one, two, three, or four babies. It’s a matter of odds, luck, and fate, or whatever your beliefs are how many babies develop.

How much does reciprocal surrogacy cost?

Every embryo transfer costs thousands of dollars and chances are less than 50% that a transfer will be successful, which is why so many couples choose to transfer more than one embryo at once. It ups the chances of not having to try again, but it also gives a chance of multiples.

The average cost of the total process of getting pregnant with reciprocal surrogacy is between $4,000 and $30,000. Costs vary by how many times the couple needs to try, which could be one month or many months on end, with no way of knowing at the outset. Location, clinic choice, fertility needs of the partners, and other factors all play a role in where the cost will end up. The average is around $20,000.

When embarking on this journey, make sure your legal, financial, physical, and emotional bases are covered and cared for throughout. It can be taxing, but the prize waiting at the end is the best possible.

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Sarah Prager
Sarah is a writer and mom who lives in Massachusetts. Her writing has appeared in The New York Times, The Atlantic, National…
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