Lacey & Crystal's Reciprocal IVF Story

Background & Assessment

• Two partners (Partner A & Partner B), both in their early 30s, presented desiring to build a family with shared biological connection.

• Neither had known fertility issues; both had regular menstrual cycles, normal ovarian reserve testing (AMH, AFC), and no uterine or tubal anomalies on imaging.

• The couple opted for reciprocal IVF, with Partner A designated to provide the eggs and Partner B to carry the pregnancy.

Key early steps included:

1. Pre-treatment evaluation for both partners

   • Infectious disease screening

   • Genetic carrier screening

   • Hormonal panels (FSH, LH, estradiol, TSH, prolactin)

   • Uterine evaluation (ultrasound or sonohysterogram)

   • Ovarian reserve assessment

2. Legal & psychological counseling

   • A specialized fertility attorney drafted agreements clarifying genetic parentage, gestational roles, consent, and future rights.

   • Both partners engaged in counseling to discuss expectations, roles, and potential emotional implications.

Stimulation, Retrieval & Synchronization

Ovarian Stimulation (Partner A):

• Partner A underwent a standard IVF stimulation protocol with gonadotropins, monitored via serial ultrasounds and estradiol levels.

• When follicles matured, ovulation was triggered with appropriate hCG (or GnRH agonist) as per protocol.

Egg Retrieval & Fertilization:

• Under sedation, Partner A had egg retrieval via transvaginal ultrasound aspiration.

• Retrieved oocytes were assessed for maturity (MII).

• Using donor sperm, fertilization was performed (via conventional IVF or ICSI as required).

• Embryos were cultured to blastocyst stage (day 5/6).

Endometrial Preparation (Partner B):

• Concurrently, Partner B’s uterus was prepared with an estrogen + progesterone protocol to provide an optimal receptive environment at the time the embryo would be ready.

• Hormone levels and endometrial thickness were monitored to ensure adequate lining prior to transfer.

Embryo Transfer, Outcome & Follow-Up

Embryo Transfer:

• A single, high-quality blastocyst was selected for transfer into Partner B under ultrasound guidance to minimize the risk of multiples.

• The transfer procedure was straightforward and well tolerated.

Luteal Support & Monitoring:

• Partner B received progesterone support (vaginal, intramuscular, or combined) during the luteal phase.

• Serum β-hCG testing ~10–14 days post-transfer confirmed pregnancy.

• Subsequent early pregnancy ultrasounds confirmed intrauterine gestation and heartbeat.

Cryopreservation:

• Remaining viable embryos were vitrified (frozen) for future use, offering the couple flexibility for siblings or subsequent embryo transfers without full restimulation.

Follow-up & Obstetric Management:

• The pregnancy proceeded with standard obstetric care, special monitoring given the gestational context, and prenatal screening.

• Delivery was managed per obstetric best practices for a single gestation.

Key Decision Points & Best Practices Illustrated

1. Which partner provides eggs vs carries

   • Decisions guided by ovarian reserve, medical history, psychological preference, and logistical factors.

2. Synchronization logistics

   • Precise coordination of stimulation and uterine preparation is critical to align embryo readiness with uterine receptivity.

3. Embryo selection and transfer policy

   • Elective single embryo transfer (eSET) is preferred to minimize multiple risks.

   • Use of PGT-A may be considered (especially in older patients) to optimize transfer of euploid embryos.

4. Legal framework and consents

   • Clear contracts from the start prevent future disputes regarding parentage, rights, and roles.

5. Cryopreservation strategy

   • Banking embryos provides future options without requiring new stim cycles.

6. Counseling and psychosocial support

   • Address emotional dynamics of co-maternity: how each partner adjusts to egg vs carrier roles, communication, and expectations.

Lessons Learned & Best Practices Summary

• Reciprocal IVF allows both partners in a female couple to take active biological roles: one genetic, one gestational.

• Success hinges on rigorous medical coordination, legal safeguards, and mutual emotional preparedness.

• Selecting the partner with stronger ovarian reserve to be egg provider often optimizes success.

• Elective single embryo transfer is preferred to reduce multiple pregnancy risk in otherwise healthy couples.

• Embryo cryopreservation gives flexibility for future family planning.

• Legal and psychological support from the outset helps prevent later conflicts and ensures clarity in roles and expectations.