Reciprocal IVF is one of the most beautiful examples of what modern fertility care makes possible, allowing both partners in a same-sex or gender-diverse relationship to play a physical role in creating their child. Sometimes called co-IVF or shared motherhood, it’s a treatment option for couples in which both partners have eggs and a uterus, such as lesbian or trans couples.

From the first conversation about who might carry to the moment you’re holding that first positive test, reciprocal IVF is a mix of science, choice, and heart. Understanding how each piece fits together can make the process feel a little less overwhelming and a lot more empowering.

What is reciprocal IVF?

Reciprocal IVF is a fertility treatment where one partner’s eggs are retrieved and fertilized with donor sperm, and the resulting embryo is transferred into the other partner’s uterus. In other words, one person provides the eggs, and the other carries the pregnancy.

This makes reciprocal IVF unique among fertility options for LGBTQ+ couples — both partners are biologically and emotionally involved. The egg provider shares a genetic link to the baby, while the gestational carrier experiences pregnancy and birth.

For many couples, that shared participation is deeply meaningful. It’s not only about genetics but about connection, teamwork, and the experience of bringing life into the world together.

The reciprocal IVF process: Step-by-step

Reciprocal IVF is both a scientific and emotional collaboration. While every clinic and couple’s journey looks a little different, it typically follows seven key steps.

Step 1: Fertility testing for both partners

Both partners start with fertility testing to help determine who’s best suited to provide the eggs and who will carry the pregnancy. Tests look at ovarian reserve (the quantity of eggs), uterine health, and overall reproductive wellness.

Bloodwork like AMH (anti-Müllerian hormone), ultrasounds to count follicles, and uterine assessments for fibroids or polyps help guide next steps and set realistic expectations.

Step 2: Deciding who provides eggs and who carries

Many couples walk into reciprocal IVF already knowing who they want to provide eggs and who wants to carry. But flexibility matters.

“When couples first come in, both partners undergo complete fertility testing. We check their ovarian reserve — their quality and quantity of eggs — and then we also check their uterus and its ability to carry a pregnancy,” explains Dr. Susan Sarajari, MD, Ph.D., a fertility specialist at Pinnacle Fertility in Arlington, VA. “Depending on those results, we usually recommend the person with the ovarian reserve of healthier eggs to be the egg provider and the one with the healthier uterus — no fibroids, no polyps or other uterine issues — to be the carrier. Even if patients come in with their minds made up on who they want to provide eggs and be the carrier, we still run the tests and advise them as best as possible.”

Age often plays a big role, too. Generally, the partner under 35 may have a higher chance of producing healthy eggs, since egg quality naturally declines with age. But ultimately, the right decision balances medical advice with emotional readiness, life logistics, and long-term family plans — especially for couples hoping to have more than one child and take turns.

Step 3: Ovarian stimulation

Once the egg provider is confirmed, the next step is ovarian stimulation — the process of encouraging the ovaries to mature multiple eggs in one cycle.

This involves injectable fertility medications, often a mix of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), taken for about 8–14 days. Another medication prevents the eggs from ovulating prematurely, keeping them safely in the follicles until retrieval.

Throughout stimulation, the egg provider visits the clinic for ultrasounds and bloodwork to track follicle growth and hormone levels. It’s a short but intense phase, often filled with a mix of excitement, nerves, and daily injections that become part of the couple’s routine.

Step 4: Egg retrieval

When the follicles are ready, usually around two weeks after starting medication, the egg provider receives a trigger shot to help the eggs mature fully before retrieval.

The egg retrieval procedure happens under light IV sedation and takes about 15–30 minutes. Using an ultrasound-guided needle, the doctor gently collects the eggs from each follicle. It’s considered a minor procedure, and most people go home the same day, feeling crampy or tired for a short while afterward.

Those eggs are then passed to the embryology lab, where science takes center stage.

Step 5: Sperm selection and fertilization

Once retrieved, the eggs are fertilized with donor sperm, either from a known donor or a sperm bank. In many cases, clinics use a method called ICSI (intracytoplasmic sperm injection), where a single sperm is injected directly into an egg to increase the chances of fertilization.

Over the next few days, embryologists carefully monitor the embryos’ development in the lab. The goal is to grow them for five to six days until they reach the blastocyst stage, when they’re strongest and most likely to implant successfully.

At this stage, some couples may choose to do preimplantation genetic testing (PGT) to check for chromosomal abnormalities before transfer. Whether or not testing is done, the focus is always on selecting the healthiest embryo for transfer to the gestational partner.

Step 6: Uterine preparation for the carrier

While the egg provider is busy with stimulation and retrieval, the other partner begins prepping their uterus to welcome the embryo.

“The carrier undergoes a cycle where they prepare their uterus for the embryo transfer by taking mostly estrogen for several weeks to thicken up the endometrial lining, followed by progesterone before having the transfer done,” says Dr. Sarajari.

This medication protocol mimics the body’s natural cycle, creating the ideal environment for implantation. The clinic monitors progress through ultrasounds to check the lining’s thickness and blood tests to confirm hormone levels. Once the uterus is ready, the big moment arrives.

Step 7: Embryo transfer

The embryo transfer is one of the most emotional steps of any IVF journey.

The procedure is quick and painless, similar to a Pap smear. Using a thin catheter, the embryo is gently placed into the uterine cavity under ultrasound guidance. Afterward, the carrier usually rests for a short time before going home.

Then comes the two-week wait, which, let’s be honest, can feel more like an eternity sometimes. Hormone support continues during this time, and about 10–14 days later, a blood test will confirm whether implantation was successful.

No matter how many times a clinic has done this, every reciprocal IVF transfer carries its own mix of anticipation, love, and possibility — two people sharing in one extraordinary process to create their family.

Fresh vs. frozen embryo transfer: Making the right choice for you

Once embryos have developed in the lab, the next big decision is when (and how) to transfer them. In reciprocal IVF, you and your doctor can choose between a fresh or frozen embryo transfer. Both can lead to healthy pregnancies, but each option comes with its own timing, logistics, and emotional rhythm.

Fresh embryo transfer in reciprocal IVF

A fresh embryo transfer happens in the same cycle as the egg retrieval. That means the partner providing eggs and the partner carrying the pregnancy need to have their menstrual cycles closely aligned — like synchronized swimming, but with more lab work and fewer sequins.

“Fresh embryo transfers require the menstrual cycles of both partners to be synced with each other, which is typically done with birth control pills,” explains Dr. Sarajari. “Because once we have the embryos, the other partner’s endometrial lining inside the uterus needs to be ready to have that transfer done. So, there is that component where the cycles have to be synced in order to use a fresh embryo.”

This option is often chosen by couples who want to move straight from retrieval to transfer without delay, especially if no additional testing (like PGT) is planned and both partners’ cycles are easy to coordinate. It’s a good fit for those who are medically ready and emotionally eager to keep the process moving.

Frozen embryo transfer in reciprocal IVF

A frozen embryo transfer (FET) takes a more flexible route. After fertilization, embryos are frozen and stored for a future cycle. This allows the carrier’s body more time to recover, and gives couples room to schedule the transfer when life (and their stress levels) feel a little steadier.

Frozen transfers are also necessary if you’re planning to do preimplantation genetic testing (PGT), which screens embryos for chromosomal abnormalities before transfer. “Some people choose to do a frozen transfer because they want to have the embryos tested through PGT, where the embryo’s chromosomes are checked before the transfer,” says Dr. Sarajari. “If that’s done, then the embryos need to be frozen because it takes a while to get the results back from those tests.”

There are other practical perks, too. “Couples might also choose a frozen embryo transfer for convenience,” Dr. Sarajari adds. “For example, patients might have a tight schedule and be unable to do a transfer within a certain time frame, so they might choose to freeze the embryos until they are ready. The other time we do a frozen versus fresh transfer is if, for example, the couple has done the reciprocal IVF with a fresh transfer and it failed. Then we usually go to a frozen transfer.”

Success rates: Fresh vs. frozen in reciprocal IVF

While there was once debate about whether fresh or frozen embryos led to higher success rates, today’s research shows that both options are equally promising, especially in cases like reciprocal IVF, where both partners are typically fertile.

According to Dr. Sarajari, “Fresh and frozen transfers in that kind of setting with reciprocal IVF are similarly successful.” That means the choice often comes down to personal preference, medical recommendations, and timing, but not necessarily better odds.

Recent studies back this up, showing comparable pregnancy and live birth rates for both methods. So whether you go the fresh route for immediacy or the frozen route for flexibility and testing, both paths can lead to the same beautiful outcome: a shared pregnancy built on teamwork, trust, and a whole lot of love.

Understanding PGT (preimplantation genetic testing) in reciprocal IVF

Preimplantation genetic testing, or PGT, is one of those optional steps in the IVF process that can feel both fascinating and intimidating, especially if you’re hearing about it for the first time. At its core, PGT is designed to give you and your doctor more insight into your embryos before transfer, helping to identify which ones are most likely to lead to a healthy pregnancy.

PGT involves taking a few cells from each embryo once it reaches the blastocyst stage (around day 5 or 6 after fertilization). Those cells are then analyzed for chromosomal abnormalities, such as missing or extra chromosomes that could prevent implantation or cause miscarriage. The embryos themselves remain safely frozen while results come back.

For many couples, especially when the egg provider is over 35, PGT offers peace of mind. As we age, the number of eggs with normal chromosomes naturally decreases, which can affect embryo quality and success rates. Testing can help identify embryos with the best chance of developing into a healthy baby, reducing the risk of failed transfers or early pregnancy loss.

“Some people choose to do a frozen transfer because they want to have the embryos tested through PGT, where the embryo’s chromosomes are checked before the transfer,” explains Dr. Sarajari. “If that’s done, then the embryos need to be frozen because it takes a while to get the results back from those tests.”

In other words, PGT is the reason most reciprocal IVF cycles involving genetic testing use frozen embryo transfer. The waiting period for results might feel long, but it gives doctors more information to work with, and can make the next step of your shared motherhood journey that much more confident.

Who should provide eggs and who should carry?

Going into reciprocal IVF, you and your partner might already know how you want to share the responsibilities of making your baby. You might even plan to take turns if you want more than one child. Remaining flexible, however, is really important during the family planning process, and reciprocal IVF is no exception. You just never know what will be the best option for your success rate.

Factors that determine the best approach

When it comes to deciding who provides the eggs and who carries the pregnancy, there’s no single “right” answer, just the one that gives you the best chance of success while honoring both partners’ needs and goals.

Doctors look at several factors before making recommendations:

  • Ovarian reserve: Blood tests like AMH (anti-Müllerian hormone) and FSH (follicle-stimulating hormone), along with an antral follicle count via ultrasound, help estimate how many eggs each partner has and their likely quality.
  • Uterine health: The carrier’s uterus is assessed for fibroids, polyps, or scarring, as well as the shape and thickness of the endometrial lining, which is all-important for implantation.
  • Age: Fertility tends to decline after 35, especially in terms of egg quality. If one partner is younger, it might make sense for them to provide the eggs.
  • Lifestyle and timing: Careers, health considerations, and personal comfort with the physical demands of treatment can also play a role.
  • Future family plans: Many couples hoping for more than one child plan to take turns, with one partner providing eggs for the first pregnancy and the other for the next.

Medical factors matter, but so do emotions, timing, and the sense of connection each partner feels to their role. Some couples come in knowing exactly how they want to share the process, while others make that decision together after learning more about their bodies.

Remaining flexible in your family-building plan

Even if you and your partner have your hearts set on who will provide eggs and who will carry, being open to adjustments can make a big difference.

“When couples first come in, both partners undergo complete fertility testing,” says Dr. Sarajari. “We check their ovarian reserve — their quality and quantity of eggs — and then we also check their uterus and its ability to carry a pregnancy. Depending on those results, we usually recommend the person with the ovarian reserve of healthier eggs to be the egg provider and the one with the healthier uterus — no fibroids, no polyps or other uterine issues — to be the carrier. Even if patients come in with their minds made up on who they want to provide eggs and be the carrier, we still run the tests and advise them as best as possible.”

Sometimes, swapping roles or rethinking the plan leads to a higher chance of success and less physical or emotional stress. Reciprocal IVF is already a shared act of love; being open to change only deepens that partnership.

Choosing a sperm donor for reciprocal IVF

Choosing a sperm donor is one of the most personal parts of reciprocal IVF, where science meets something deeply emotional. You can use a known donor, like a friend or family member, or select an anonymous donor through a licensed sperm bank. A known donor offers familiarity but requires clear legal agreements to define boundaries and parental rights, while sperm banks provide medical and genetic screening, legal protection, and options for open-ID donors (who can be contacted when the child turns 18).

When choosing, consider the donor’s medical history, genetic screening results, and personal background, along with any physical traits or characteristics that matter to you. Always work with a reputable, FDA-regulated sperm bank or a fertility clinic that can guide you through safe, ethical options.

In the U.S., sperm donors from accredited banks relinquish all parental rights, but laws vary by state, so consulting an LGBTQ+-friendly attorney can help ensure everything’s clear from the start. Whether you go with someone you know or an anonymous donor, what matters most is finding the option that feels right for your family and your vision of shared motherhood.

Legal considerations for reciprocal IVF

The legal side of reciprocal IVF isn’t as romantic as embryo transfers or baby name lists, but it’s just as important. In the U.S., laws around parental rights for LGBTQ+ families can vary widely from state to state, so taking time to understand them early on helps protect your family from future complications.

Parental rights for both mothers

In most cases, reciprocal IVF creates two parents: one genetic (who provides the egg) and one gestational (who carries the pregnancy). But even when both partners are legally married, not every state automatically recognizes both parents at birth.

That’s because U.S. parentage laws often still default to biological connections, meaning the gestational parent is automatically listed on the birth certificate, while the genetic parent’s rights may depend on where you live and whether your state recognizes non-biological same-sex parents.

This lack of consistency can lead to heartbreaking legal gray areas, especially when families move or travel across state lines. That’s why many LGBTQ+ family lawyers recommend going a step further.

Second-parent adoption requirements

Even if both partners are listed on the birth certificate, a second-parent adoption (also called a confirmatory adoption) offers an extra layer of legal protection. It ensures that the non-gestational parent’s rights are recognized everywhere, not just in the state your child was born.

Each state handles the process differently. Some require a home study and court hearing, while others are simpler, with minimal paperwork and lower costs (usually ranging from a few hundred to a few thousand dollars). The timeline can take a few months, but once finalized, it grants equal legal parentage, meaning no one can challenge your rights, even if laws change.

It might feel redundant, especially when both parents contributed biologically, but it’s one of the most important steps you can take to protect your family long-term.

Legal planning before starting treatment

Before starting reciprocal IVF, it’s worth having an open conversation about the legal logistics. Many couples create co-parenting or donor agreements before conception — especially if using a known sperm donor — to clearly define roles and responsibilities.

Working with an LGBTQ+-friendly family law attorney can help you:

  • Review state laws on parental rights and adoption
  • Draft any necessary pre-conception agreements
  • Ensure both parents are fully protected from day one

Taking care of these details upfront may not be the most exciting part of your journey, but it’s one of the most empowering. Because when your baby arrives, you’ll know your rights — and your family — are fully recognized and secure.

Is reciprocal IVF covered by insurance? Navigating coverage

Insurance coverage for reciprocal IVF can be hit or miss, and often depends on where you live. Some states now mandate fertility coverage, but many still define infertility in outdated, heteronormative terms that exclude LGBTQ+ couples. Because of this, claims are sometimes denied unless a couple can prove “medical necessity,” usually defined as a year of unprotected heterosexual intercourse without conception.

When reviewing your plan, check how it defines infertility, whether donor sperm or eggs are covered, and if same-sex couples are explicitly included. If you’re denied coverage, you can appeal — letters from your doctor, state nondiscrimination laws, and documentation of inclusive mandates elsewhere can all strengthen your case.

“It is super important to all our patients and the LGBTQ+ community to keep all these options — standard IVF, reciprocal IVF, IUI, etc. — open and accessible,” says Dr. Sarajari. “We go down to the Capitol each year to talk to senators and representatives to make sure that the laws protecting fertility care for all families are preserved and passed. We actively lobby for our patients.”

Patients can help, too, by sharing their stories and supporting advocacy groups like Family Equality and Resolve that fight for inclusive fertility coverage nationwide.

When insurance doesn't cover reciprocal IVF

If your plan doesn’t cover treatment, there are still ways to manage costs. Many couples use HSAs or FSAs for eligible expenses or explore financing options offered by fertility clinics. Several nonprofits, including Journey to Parenthood and Family Equality, offer grants for LGBTQ+ families. Some couples also turn to crowdfunding, which can make a meaningful difference in covering out-of-pocket costs.

However you fund your journey, remember: access to family-building is a right, not a privilege, and the more people who push for equitable coverage, the closer we get to making that a reality.

The emotional journey: Mental health and reciprocal IVF

Reciprocal IVF is as emotional as it is medical. Between the hormones, the logistics, and the endless waiting, it can feel like part of your heart is right there in the lab beside those embryos.

What to expect emotionally

Even when everything goes smoothly, reciprocal IVF can take you on a rollercoaster. There’s the hope of seeing those first follicles growing, the anxiety of waiting for results, and the weight of knowing how much this means to both of you. Hormonal changes can add another layer, especially for the partner taking stimulation meds or prepping for transfer.

It’s completely normal to feel exhausted, emotional, or disconnected at times. The process can also put stress on your relationship; not because you’re doing something wrong, but because you’re both so deeply invested in the same dream. Sharing that emotional load, rather than trying to protect each other from it, can make a world of difference.

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If a cycle doesn’t go as planned — if fertilization fails, embryos don’t develop, or a transfer doesn’t lead to pregnancy — the heartbreak can be intense. You might feel grief, guilt, anger, or even shame, especially if one partner feels responsible for their role in the process. None of those emotions mean you’ve failed; they’re signs that you care deeply about what you’re building together.

Take time to process before deciding what comes next. Some couples try again with a new cycle, others explore alternative paths like IUI, adoption, or embryo donation. There’s no single “right” way forward, only the one that feels sustainable for your emotional and physical well-being.

Supporting each other as partners

Reciprocal IVF is a team effort, but that doesn’t mean both partners experience it the same way. One may be dealing with daily injections and procedures, while the other feels helpless watching from the sidelines. Talk openly about how each of you is coping and resist the urge to compare whose role is “harder.”

Simple things help: taking turns managing appointments, scheduling time for non-fertility-related dates, or setting boundaries around when you talk about IVF at home. If guilt, resentment, or disconnection starts to creep in, couples counseling, especially with a fertility-trained therapist, can help you reconnect and reset.

Finding community and support

You don’t have to go through this in isolation. LGBTQ+ couples often find comfort in fertility support groups, online communities, and therapists who understand the unique dynamics of shared motherhood.

Connecting with others on a similar path, even just reading their stories, can remind you that your feelings are valid and your journey is shared. Whether it’s a virtual group, a local LGBTQ+ family organization, or a space like Rescripted’s own community, finding people who truly get it can turn a lonely process into one filled with solidarity and hope.

Finding the right fertility clinic for reciprocal IVF

Choosing the right clinic is about more than success rates. For LGBTQ+ couples, an affirming environment can make the difference between feeling like “just another patient” and feeling seen, supported, and celebrated throughout treatment.

What to look for in an LGBTQ+-friendly practice

Start by paying attention to how inclusive a clinic feels from the first interaction. Do their intake forms reflect all genders and family structures? Are you both acknowledged as equal partners in care?

Look for clinics with:

  • Experience in reciprocal IVF and other LGBTQ+ fertility treatments
  • Inclusive language on their website and during consultations
  • Staff training in supporting same-sex and gender-diverse couples
  • Transparent success rates, including data on LGBTQ+ patients when available

An affirming clinic will make both partners feel equally involved at every stage, not just the one undergoing the procedure.

Questions to ask during your consultation

Once you’ve narrowed down your options, use the first consultation to learn how the clinic approaches reciprocal IVF specifically. Some good questions include:

  • How much experience do you have with reciprocal IVF for lesbian couples or trans patients?
  • Do you generally recommend fresh or frozen transfers, and why?
  • How do you ensure both partners are included throughout treatment?
  • What are your costs, financing options, and insurance partnerships?

These conversations can also reveal how well the clinic communicates, which is just as important as the medicine itself.

Red flags to watch for

Trust your instincts. If a clinic seems uncomfortable discussing your relationship, avoids using inclusive language, or makes assumptions about your family structure, that’s a sign to walk away.

Other red flags include:

  • Limited or no experience with LGBTQ+ patients
  • Outdated or heteronormative assumptions about fertility
  • Vague communication or lack of transparency about pricing and protocols

You deserve a team that treats your journey with respect, not as an exception.

Fertility clinics leading in LGBTQ+ care

Some fertility clinics are leading the way when it comes to making reciprocal IVF truly inclusive — not just in name, but in practice. Pinnacle Fertility, where Dr. Sarajari practices, is one standout. Beyond offering expert care and guidance for LGBTQ+ couples, Dr. Sarajari and her team actively advocate for equal access to fertility treatment, even taking that fight to Capitol Hill to help protect reproductive rights for all families.

Other clinics across the U.S., like CNY Fertility, Kindbody, Boston IVF, and RMA of New York, have also built reputations for supporting same-sex and gender-diverse couples with sensitivity, transparency, and experience.

Ultimately, the “right” clinic is the one that makes you feel seen, supported, and safe, where every step of your shared motherhood journey is treated with the same respect and care as any other path to parenthood.

Is reciprocal IVF right for you and your partner?

Reciprocal IVF can be one of the most meaningful ways for LGBTQ+ couples to grow their family, but it’s also a deeply personal decision. What feels right for one couple might not be the best fit for another, and that’s okay.

When reciprocal IVF makes sense

Reciprocal IVF may be a great option if:

  • Both partners have viable eggs and a healthy uterus
  • You both want to share a biological connection to your child
  • You’re drawn to the idea of sharing the physical experience — one creating the embryo, the other carrying it
  • You have the financial resources to support IVF, since it can be more expensive than other family-building routes

For many couples, this path is about equality, connection, and teamwork, with two people contributing in different but equally vital ways to the same baby’s story.

Other family-building options to consider

If reciprocal IVF doesn’t feel like the right fit (or isn’t possible medically or financially), there are still many valid ways to build your family:

None of these paths are “less than.” Each one is a valid, beautiful way to grow a family — it’s just about what aligns with your circumstances and values.

Making the decision together

Reciprocal IVF is as much about communication as it is about science. Before starting treatment, take time to talk through:

  • What each of you values most: the biological connection, the pregnancy experience, or simply becoming parents
  • How you’ll manage the timeline and emotional ups and downs
  • The financial realities, including potential insurance coverage, grants, or payment plans

It’s okay if you don’t have all the answers right away. Some couples decide instinctively, while others talk it out over weeks (or months). The key is to make the choice together, with honesty and empathy. However you get there, your path to parenthood should feel like a shared decision — one that reflects both your hearts and your hopes for the future.

Reciprocal IVF as an act of love

Reciprocal IVF is one of the most beautiful expressions of shared love: two people both contributing to the creation and growth of their child in different, deeply connected ways.

“It is super important to all our patients and the LGBTQ+ community to keep all these options — standard IVF, reciprocal IVF, IUI, etc. — open and accessible,” says Dr. Sarajari. “We go down to the Capitol each year to talk to senators and representatives to make sure that the laws protecting fertility care for all families are preserved and passed. We actively lobby for our patients.”

Her message says it all: this path deserves to remain open to everyone who dreams of building a family. If reciprocal IVF feels right for you and your partner, start the conversation with your doctor, and know that your journey is part of something bigger.

Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.