Shared Motherhood

The shared motherhood cycle, also known as reciprocal IVF for same-sex or lesbian couples, involves six steps similar to a standard IVF cycle. However, the difference is that in shared motherhood or reciprocal IVF, the first 4 steps are carried out on one partner, and the remaining 2 steps are performed by the other partner. After assessing both members of the couple, a strategy and treatment plan is put in place. Due to the good survival rate of frozen embryos, and in some cases slightly higher success rates, both members of the couple usually don't need to be under medication. We normally advise creating and freezing embryos first, and then preparing the lining of the uterus of the second partner for embryo transfer (ET) in a second stage. The success rate of a shared motherhood cycle depends on several factors, but the age of the partner providing the eggs and her ovarian reserve are two of the most important. Generally, the success rate of a reciprocal IVF cycle can range from 20-50%. It's best to ask your doctor directly about how it is calculated. It is also important to talk to your doctor and the clinic to understand the legislation behind each country for these kinds of cycles.

Below are the steps involved in the process:

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1. Assessment to determine suitability for treatment.

• It is advisable for both partners to undergo a screening process to determine who would be the most suitable candidate to donate eggs. Blood tests such as AMH, FBC, TSH, and PRL are typically conducted alongside a transvaginal scan to assess the ovaries and uterus. The scan helps determine the accessibility of the ovaries and the number of antral follicles (antral follicular count or AFC), and also ensures that no cysts are present. The blood test helps determine the appropriate medication, dosage, and treatment prognosis in terms of the potential number of collected eggs. The scan also checks the uterus and its lining to ensure that no fibroids or polyps are present. These cycles are usually conducted with donor sperm, and most of the time, the sample is suitable for treatment. Therefore, the key element is the assessment of the same-sex couple.

 

2. Preparation for an in-vitro fertilization cycle

• Sometimes, it is recommended to take certain medications and supplements to optimize the quantity and quality of eggs retrieved during fertility treatments. These medications may include Co-Q-10, a contraceptive pill like norethisterone, DHEA, and Testosterone gel. For females, the preparation process usually takes up to 21 days or 3 weeks. It is important to discuss with your doctor if the preparation is necessary for your specific situation.

 

3. Stimulation of ovaries using gonadotropins.

• During this stage, which lasts for about 10-12 days, the ovaries are stimulated with medications to induce follicle growth. Transvaginal ultrasounds are performed during this time to monitor the ovaries and count the number of follicles and their size. Blood tests are also taken to measure the estradiol level, which helps evaluate ovarian response. When follicles reach a size of 17-22 mm, a trigger shot is administered, and the patient is scheduled for an egg collection procedure typically 34-36 hours after the last injection.

 

4. Eggs are collected and then fertilised using IVF or ICSI.

• The egg collection procedure, commonly known as EC, is a 15-20 minute process carried out in a theatre. The method of performing the procedure varies based on the clinic and country policies and can be done under conscious sedation, local anaesthetics, or general anaesthesia. A transvaginal ultrasound probe is used to access the ovaries and extract as many eggs as possible. Once the procedure is completed, the follicular fluid and eggs are sent to the lab for assessment. This allows the embryologist to provide more feedback to the patients if required. The eggs are then either subjected to ICSI fertilisation or are combined with donor sperm for attempting IVF. The day after the EC the patients are informed about how many embryos were created and the next steps for instance could be an elective freeze on day 5 of all suitable blastocysts.

 

The following two steps are performed on the second partner 

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5. Preparation of the uterus & Embryo transfer procedure (ET)

• In reciprocal IVF or shared motherhood, the embryo transfer procedure is often performed under a medicated cycle. This is also known as Medicated FET. The second partner begins with estrogen (E2) medication on the first day of their menstrual period to prepare the lining of the uterus. Around two weeks after starting the preparation, a transvaginal scan is conducted to assess the thickness and pattern of the lining. If both parameters are good, then the patient is given progesterone administration (P4) to open the implantation window. The patient is then scheduled for an ET after five full days of progesterone. The procedure is conducted in a theatre that is close to the lab. Most of the time, sedation is not required, and the entire process takes only 10-15 minutes. During ET, a vaginal procedure is performed where doctors insert a gynae speculum and an embryo transfer catheter. The embryos are then carefully placed inside the cavity of the uterus. To ensure accurate placement, the majority of clinics perform the procedure under abdominal ultrasound guidance. Most clinics limit embryo transfers to one at a time.

 

6. Pregnancy test 

• The pregnancy test should be conducted normally after 10-14 days following the embryo transfer on the blastocyst stage (day 5). It is recommended to have a determination of B-HCG level in the blood rather than a urine test, as it is more precise. If the result is positive, instructions will be given to return after 4-6 weeks to perform a transvaginal scan to check the viability of the embryo. If the result is negative, the medication intake will stop and a conversation with your doctor will occur in most cases.