Partner-assisted reproduction

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Partner-assisted reproduction, reception of oocytes from partner (ROPA), reciprocal IVF,shared motherhood, partner IVF or co-IVF is a method of family building that is used by couples who both possess female reproductive organs. The method uses in vitro fertilization (IVF), a method that means eggs are removed from the ovaries, fertilized in a laboratory, and then one or more of the resulting embryos are placed in the uterus to hopefully create a pregnancy. Reciprocal IVF differs from standard IVF in that two partners are involved: the eggs are taken from one partner, and the other partner carries the pregnancy. [1] In this way, the process is mechanically identical to IVF with egg donation. [2] [3] Reciprocal IVF offers the highest chance for pregnancy and a lower chance of a multiple births.[ citation needed ]

Contents

This process was first introduced in Spain in 2007 at the CEFER institute. [3]

Process of reciprocal IVF

Reciprocal IVF is a process that involves steps both for the genetic mother and the gestational mother. Below lists the one-by-one steps a couple undergoing this procedure have to go through.

  1. Initial consultation: both partners undergo a health screening to determine their overall health and fertility factors. [4] This information can help a couple decide who will donate the eggs and who will carry the baby.
  2. Sperm sample: a sperm donor is selected and could be an anonymous or known donor. High-quality sperm increases the likelihood of success and is an important factor to consider. [4]
  3. Ovarian stimulation: the partner donating the eggs will undergo an ovarian stimulation cycle and a sequential egg retrieval. [5] Naturally, a woman produces only one egg each month, but, with this hormonal treatment, several eggs are developed. This will allow obtaining several eggs, which can be used throughout several cycles, without the need to repeat this process. [6]
  4. Ovarian Puncture: it is a simple procedure, performed under sedation in which a cannula is inserted through the vaginal cavity, to extract the eggs. This aspirate with the eggs is collected in tubes which are sent to the in vitro fertilization laboratory, where the rest of the process is carried out.
  5. In vitro fertilization: once the egg is obtained it is fertilized with the donor sperm in a laboratory. [7] This can be done by ICSI technique or regular In vitro fertilization. Once the egg is fertilized, embryos are obtained that are kept in the lab for 3 to 5 days, when they develop to blastocysts. [8] For a fresh IVF cycle, both partners will sync their menstrual cycles to allow for the subsequent transition from egg donation to fertilization to implantation to happen smoothly. [4]
  6. Endometrial preparation: the uterine lining of the partner carrying the pregnancy needs to be synchronized with the stage of the embryo development in order for pregnancy to be attained. [9]
  7. Genetic testing : once the fertilized embryos have developed into the blastocyst stage, the embryos undergo preimplantation genetic testing (PGT) to test for the correct number of chromosomes to minimize the risk of genetic mutation. [4]
  8. Embryo transfer: the strongest and genetically correct embryos are selected and the decided number will be transferred to the gestational carrier. [10]
  9. Pregnancy test: after two weeks, a period known as the two-week wait it can be determined if the embryos had been properly implanted and will result in a pregnancy. [11]

Choosing partner roles

The decision to choose which partner is going to be the egg donor and which partner is going to be the gestational carrier can be based on personal reasons or medical reasons. [12] When focusing strictly on medical advantages, the egg donor tends to be the younger partner, the partner with the stronger ovarian reserve, or the partner without known genetic abnormalities.

The gestational carrier tends to be the partner who has previously given birth, is fit for pregnancy, or the partner with the healthiest uterus. [12] These factors can be determined by a full fertility workup by a healthcare provider prior to starting the reciprocal IVF process. [12]

While some couples base their decision on medical reasons, personal reasons may also be a fundamental deciding factor. Many couples base their decision on emotional and/or psychological reasons of who wants to be the donor and who wants to carry the child to term. [12]

Identity reasons may also play a factor in a couple's decision. For instance, some partners who are biologically able may not want to be the gestational carrier because it misaligns with their gender identity or because testosterone regimens may need altering or cessation. [12] However, while the research is limited, successful reciprocal IVF using oocytes from a transgender male who remained on testosterone throughout the entire process has been documented. [13]

Timeline

The timeline of reciprocal IVF depends on if a couple chooses to undergo a fresh or a frozen transfer:

Epigenetics

Epigenetics includes the changes that occur in the gene expression, but that does not alter the DNA sequence. These changes may be the result of external or environmental factors. There are multiple studies [15] related to epigenetics that show that the surrogate mother can also play an important role in the development of the embryo. This is because the prenatal environment of the uterus, where the embryo will stay for 9 months, and also the nutrients that reach it, have great relevance in the gene expression. Therefore, it is important that the birth mother have a healthy lifestyle and habits, in absence of toxics such as alcohol or tobacco, among others.

After fertilisation, the endometrial fluid nourishes the embryo and regulates its development, before being replaced in this function by the placenta in the later stages of pregnancy. This embryo-mother communication is finely regulated by numerous cellular pathways, including epigenetic mechanisms. Among the substances transported in the endometrial fluid, extracellular vesicles are one of the most important mediators, especially in relation to their ability to transport ncRNAs. Primary human endometrial endothelial cells were found to internalize miRNAs into vesicles and actively secrete large amounts of exosomes. These are internalized by embryonic trophoblast cells and may influence their epigenetic patterns. Even though the capability of numerous ncRNAs (both maternal and embryo-derived) of being transmitted through endometrial fluid has been clearly established, the role of such molecules in the regulation of pivotal phases of implantation and early embryonic development still requires much needed investigation. [16]

This phenomenon has important implications for patients who have to resort to using the ROPA method. Although the embryo does not carry the genetic information of the gestating mother, her uterus can influence the epigenetic characteristics of her future baby. This can help these women to overcome genetic grief, since they will be able to influence the phenotype of their child even if they do not share DNA. [17]

Similar to reciprocal IVF, partners can choose concurrent IVF or double reciprocal IVF. This method is essentially two simultaneous reciprocal IVF processes, where both partners become pregnant at the same time using embryos from the opposite partner. [18] This process allows both partners to undergo embryo transfers and simultaneous gestational carrying. There are potential considerations for concurrent IVF, including increased costs and potential stress from two childbirth deliveries. [18]

Partners also have the option to choose Effortless IVF. This method of reciprocal IVF uses an FDA-approved capsule (called INVOcell) to combine the donor sperm and egg, rather than reproduction in a lab. [18] The partner who is acting as the egg donor will place the capsule back inside the vagina to incubate for around five days. Once the embryo begins development, it is removed and typically frozen. The partner who is acting as the gestational carrier will then prepare for embryo transfer and carry the resulting child to term. [18]

Costs of Reciprocal IVF

In most states, insurance coverage for IVF is not mandated and varies by state. Insurance providers do not typically cover the costs of reciprocal IVF unless it is medically necessary. [7] Only 25% of Americans have coverage for IVF. [14] On average, the cost of one IVF cycle costs about $12,000, which does not include fertility medications that typically range from $3,000 to $10,000. [7] The average cost of reciprocal IVF in the United States is over $20,000 but varies based on the clinic and medication protocols. [14]

The cost of reciprocal IVF is more than IVF due to additional costs including donor sperm fees, legal fees, and fertility medications. [11]

Success rates

As reciprocal IVF is a fairly new process first established in 2009, one study from 2017 found that 60% of couples undergoing IVF with an average donor age of 32 achieved pregnancy. [19] A study published in February 2018 found a 60% live birth rate in a group of 120 lesbian couples who underwent reciprocal IVF. [20] The subject of the research are European patients only.

The success rate of reciprocal IVF heavily depends on the age of the birth mother. For women under age 35, there is a 41-43% success rate. For women over 40, there is a 13-18% success rate. [21]

As IVF is not always successful on the first attempt, it is important that couples understand that multiple cycles may be required to achieve a pregnancy. [14]

When choosing to undergo reciprocal IVF, legal issues may need to be addressed based on variations from state to state. [5] One potential issue is the necessity to make sure the partner who donates the egg is a legal parent of the child. [4] This can include getting the name on the birth certificate at the time of birth or may require legally adopting the child. [5] [4] These steps help establish equal parental rights for both the gestational carrier and the egg donor. [4] A legal attorney who specializes in reproductive law can be a useful resource for navigating the specific legal aspects state by state. [4]

In 2023, the Hong Kong High Court ruled that a lesbian who provided an egg but did not carry the baby through reciprocal IVF was a “parent at common law” and that exclusion from parental status was discriminatory. [22] [23]

Related Research Articles

<span class="mw-page-title-main">In vitro fertilisation</span> Assisted reproductive technology procedure

In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova from their ovaries and letting a man's sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.

<span class="mw-page-title-main">Intracytoplasmic sperm injection</span> In vitro fertilization procedure

Intracytoplasmic sperm injection is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of embryos that may be transferred to a maternal uterus. With this method, the acrosome reaction is skipped.

<span class="mw-page-title-main">Infertility</span> Inability to reproduce by natural means

Infertility is the inability of an animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. It is the normal state of a human child or other young offspring, because they have not undergone puberty, which is the body's start of reproductive capacity.

<span class="mw-page-title-main">Artificial insemination</span> Pregnancy through in vivo fertilization

Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment for humans, and is a common practice in animal breeding, including dairy cattle and pigs.

<span class="mw-page-title-main">Assisted reproductive technology</span> Methods to achieve pregnancy by artificial or partially artificial means

Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or the use of fertility medication. When used to address infertility, ART may also be referred to as fertility treatment. ART mainly belongs to the field of reproductive endocrinology and infertility. Some forms of ART may be used with regard to fertile couples for genetic purpose. ART may also be used in surrogacy arrangements, although not all surrogacy arrangements involve ART. The existence of sterility will not always require ART to be the first option to consider, as there are occasions when its cause is a mild disorder that can be solved with more conventional treatments or with behaviors based on promoting health and reproductive habits.

<span class="mw-page-title-main">Embryo transfer</span> Method of assisted reproduction

Embryo transfer refers to a step in the process of assisted reproduction in which embryos are placed into the uterus of a female with the intent to establish a pregnancy. This technique - which is often used in connection with in vitro fertilization (IVF) - may be used in humans or in other animals, in which situations and goals may vary.

<span class="mw-page-title-main">Surrogacy</span> Arrangement in which a woman carries and delivers a child for designated parent(s)

Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman agrees to childbirth on behalf of another person(s) who will become the child's parent(s) after birth. People pursue surrogacy for a variety of reasons such as infertility, dangers or undesirable factors of pregnancy, or when pregnancy is a medical impossibility.

Third-party reproduction or donor-assisted reproduction is any human reproduction in which DNA or gestation is provided by a third party or donor other than the one or two parents who will raise the resulting child. This goes beyond the traditional father–mother model, and the third party's involvement is limited to the reproductive process and does not extend into the raising of the child. Third-party reproduction is used by couples unable to reproduce by traditional means, by same-sex couples, and by men and women without a partner. Where donor gametes are provided by a donor, the donor will be a biological parent of the resulting child, but in third party reproduction, he or she will not be the caring parent.

Egg donation is the process by which a woman donates eggs to enable another woman to conceive as part of an assisted reproduction treatment or for biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third-party reproduction as part of assisted reproductive technology.

Autologous Endometrial Coculture is a technique of assisted reproductive technology. It involves placing a patient’s fertilized eggs on top of a layer of cells from her own uterine lining, creating a more natural environment for embryo development and maximizing the chance for an in vitro fertilization (IVF) pregnancy.

<span class="mw-page-title-main">Human Fertilisation and Embryology Act 1990</span> United Kingdom legislation

The Human Fertilisation and Embryology Act 1990 is an Act of the Parliament of the United Kingdom. It created the Human Fertilisation and Embryology Authority which is in charge of human embryo research, along with monitoring and licensing fertility clinics in the United Kingdom.

<span class="mw-page-title-main">Oocyte cryopreservation</span> Procedure to preserve a womans eggs (oocytes)

Oocyte cryopreservation is a procedure to preserve a woman's eggs (oocytes). This technique has been used to postpone pregnancy. When pregnancy is desired, the eggs can be thawed, fertilized, and transferred to the uterus as embryos. Several studies have shown that most infertility problems are due to germ cell deterioration related to aging. The procedure's success rate varies depending on the age of the woman,, as well as depending on health and genetic indicators. In 1986, the first human birth of oocyte cryopreservation was reported.

Poor ovarian reserve is a condition of low fertility characterized by 1): low numbers of remaining oocytes in the ovaries or 2) possibly impaired preantral oocyte development or recruitment. Recent research suggests that premature ovarian aging and premature ovarian failure may represent a continuum of premature ovarian senescence. It is usually accompanied by high FSH levels.

Fertility tourism is the practice of traveling to another country or jurisdiction for fertility treatment, and may be regarded as a form of medical tourism. A person who can become pregnant is considered to have fertility issues if they are unable to have a clinical pregnancy after 12 months of unprotected intercourse. Infertility, or the inability to get pregnant, affects about 8-12% of couples looking to conceive or 186 million people globally. In some places, rates of infertility surpass the global average and can go up to 30% depending on the country. Areas with lack of resources, such as assisted reproductive technologies (ARTs), tend to correlate with the highest rates of infertility.

Sperm donation is the provision by a man of his sperm with the intention that it be used in the artificial insemination or other "fertility treatment" of one or more women who are not his sexual partners in order that they may become pregnant by him. Where pregnancies go to full term, the sperm donor will be the biological father of every baby born from his donations. The man is known as a sperm donor and the sperm he provides is known as "donor sperm" because the intention is that the man will give up all legal rights to any child produced from his sperm, and will not be the legal father. Sperm donation may also be known as "semen donation".

Religious response to assisted reproductive technology deals with the new challenges for traditional social and religious communities raised by modern assisted reproductive technology. Because many religious communities have strong opinions and religious legislation regarding marriage, sex and reproduction, modern fertility technology has forced religions to respond.

Unexplained infertility is infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman. It is usually an exercise in excluding all possible causes before making a diagnosis, however the age of the female partner as well as the duration of infertility are often the most scrutinized characteristics of any infertility case.

Cryopreservation of embryos is the process of preserving an embryo at sub-zero temperatures, generally at an embryogenesis stage corresponding to pre-implantation, that is, from fertilisation to the blastocyst stage.

Repeated implantation failure (RIF) is the repeated failure of the embryo to implant onto the side of the uterus wall following IVF treatment. Implantation happens at 6–7 days after conception and involves the embedding of the growing embryo into the mothers uterus and a connection being formed. A successful implantation can be determined by using an ultrasound to view the sac which the baby grows in, inside the uterus.

<span class="mw-page-title-main">Use of assisted reproductive technology by LGBT people</span>

Lesbian, gay, bisexual, and transgender people people wishing to have children may use assisted reproductive technology. In recent decades, developmental biologists have been researching and developing techniques to facilitate same-sex reproduction.

References

  1. ↑ "Shared motherhood: The amazing way lesbian couples are having babies". Cosmopolitan. 14 February 2018. Retrieved 21 March 2018.
  2. ↑ Klatsky, Dr Peter (22 June 2017). "Co-Maternity And Reciprocal IVF: Empowering lesbian parents with options". Huffington Post. Retrieved 21 March 2018.
  3. 1 2 Marina, S.; Marina, D.; Marina, F.; Fosas, N.; Galiana, N.; Jove, I. (9 February 2010). "Sharing motherhood: biological lesbian co-mothers, a new IVF indication". Human Reproduction. 25 (4): 938–941. doi: 10.1093/humrep/deq008 . PMID   20145005.
  4. 1 2 3 4 5 6 7 8 "Reciprocal IVF | LGTBQ Families | Reproductive Science Center NJ". Reproductive Science Center of New Jersey. Retrieved 2021-12-02.
  5. 1 2 3 "Reciprocal IVF". RESOLVE: The National Infertility Association. 27 August 2021. Retrieved 2021-12-02.
  6. ↑ "What is ovarian stimulation? - Process, medications and symptoms". inviTRA. 2022-02-21. Retrieved 2022-03-11.
  7. 1 2 3 "Reciprocal IVF – What Lesbian Couples Need to Know | WINFertility". www.winfertility.com. 2 March 2016. Retrieved 2021-12-05.
  8. ↑ "Intracytoplasmic sperm injection (ICSI) | HFEA". www.hfea.gov.uk. Retrieved 2022-03-11.
  9. ↑ "Reciprocal IVF for Lesbian Couples". www.gayivf.com. Retrieved 2021-12-08.
  10. ↑ "Embryo Transfer". American Pregnancy Association. 2018-04-25. Retrieved 2022-03-11.
  11. 1 2 "Reciprocal IVF - Northern California Fertility Medical Center". Northern California Fertility Medical Center - Sacramento IVF. 2019-06-04. Retrieved 2021-12-07.
  12. 1 2 3 4 5 Fertility, C. N. Y. (14 June 2021). "Reciprocal IVF: What It Is, How It Works & What It Costs" . Retrieved 2021-12-02.
  13. ↑ Greenwald, Phoebe; Dubois, Bethany; Lekovich, Jovana; Pang, John Henry; Safer, Joshua (2021-06-16). "Successful In Vitro Fertilization in a Cisgender Female Carrier Using Oocytes Retrieved From a Transgender Man Maintained on Testosterone". AACE Clinical Case Reports. 8 (1): 19–21. doi:10.1016/j.aace.2021.06.007. ISSN   2376-0605. PMC   8784719 . PMID   35097196. S2CID   236315482.
  14. 1 2 3 4 5 Fertility, C. N. Y. (14 June 2021). "Reciprocal IVF: What It Is, How It Works & What It Costs" . Retrieved 2021-12-07.
  15. ↑ Vilella, Felipe; Moreno-Moya, Juan M.; Balaguer, Nuria; Grasso, Alessia; Herrero, Maria; Martínez, Sebastian; Marcilla, Antonio; Simón, Carlos (2015-09-15). "Hsa-miR-30d, secreted by the human endometrium, is taken up by the pre-implantation embryo and might modify its transcriptome". Development. 142 (18): 3210–3221. doi: 10.1242/dev.124289 . ISSN   0950-1991. PMID   26395145. S2CID   10407069.
  16. ↑ Zuccarello, D., Sorrentino, U., Brasson, V. et al. Epigenetics of pregnancy: looking beyond the DNA code. J Assist Reprod Genet 39, 801–816 (2022). doi:10.1007/s10815-022-02451-x
  17. ↑ "▷ Epigenetic Inheritance in the ROPA Method: What you should know". 6 April 2023.
  18. 1 2 3 4 "Reciprocal IVF". RESOLVE: The National Infertility Association. 27 August 2021. Retrieved 2021-12-07.
  19. ↑ "What is reciprocal IVF, and how can it benefit LGBTQ couples?". Extend Fertility. 2019-06-20. Retrieved 2021-12-08.
  20. ↑ Bodri, D.; Nair, S.; Gill, A.; Lamanna, G.; Rahmati, M.; Arian-Schad, M.; Smith, V.; Linara, E.; Wang, J. (February 2018). "Shared motherhood IVF: high delivery rates in a large study of treatments for lesbian couples using partner-donated eggs". Reproductive Biomedicine Online. 36 (2): 130–136. doi: 10.1016/j.rbmo.2017.11.006 . ISSN   1472-6491. PMID   29269265.
  21. ↑ PFCLA. "Reciprocal IVF: Success Rates and Outcomes". www.pfcla.com. Retrieved 2021-12-02.
  22. ↑ "NF v R [2023] HKCFI 2233". HKLII. Retrieved 28 August 2024.
  23. ↑ Tsang, Frances (9 October 2023). "Lesbian Couple's Victory in Recent IVF Case in Hong Hong". Hugill & Ip Solicitors. Retrieved 28 August 2024.
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