12 Things We Wish We Knew Before Starting Reciprocal IVF
We are a same-sex lesbian couple so it’s important to explain reciprocal IVF. For heterosexual couples, just the female may be going through most of the clinical procedures but for us, it’s split. Sarah was up to bat for the first inning. We retrieved her eggs, the clinic mixed them with our donor sperm, and once we had a good quality embryo, we implanted it into Elizabeth in hopes of her becoming pregnant and carrying the baby throughout the pregnancy. That made it sound way easier than the reality!
This is also referred to as co-maternity IVF. Different clinics use different terminology but at our clinic Sarah is the maternal parent and Elizabeth is the gestation parent.
Note: Part of this article discusses female bodily functions so proceed with caution. We are not health professionals and are not here to give medical advice, just to share what worked for us.
1) Research
Do your own research along the way because your clinic will not tell you everything. Even the best of clinics do not have time to tell you every little detail. There are so many possibilities, so many side effects, so many pro-tips and it’s all available online. It can be a lot at once but you don’t know what you don’t know. We discovered tips and tricks as we went along and as we messed up. These are just our tips but everyone’s path is different.
2) Clinic Selection
What they won’t tell you online. Sarah did a lot of research before we chose our clinic and before we even chose what city to do treatment in. We were lucky that for our age, our clinic in Atlanta had a high success rate. BUT, if you are looking to carry multiples (twins, triplets, etc.) or to choose the sex of your embryo, make sure you ask ahead of time. Many places do not advertise as both of these topics are controversial in the fertility world. We did not know this and only discovered it midway through our first consultation appointment with our doctor.
Multiples
Our clinic’s goal is for you to have a healthy baby. Twins often do not carry to term, arrive early, and spend time in the NICU. For this reason our clinic will only implant 1 embryo at a time. We weren’t looking for twins so this was completely ok with us.
Sex Selection
Again, the clinic wants each pregnancy to result in a healthy baby, therefore selecting the sex is not allowed. You just want a baby right??? This one took us by surprise at first but after our doctor explained it, we understood. We always thought we could choose but turned out, nope, not this time, and we’re ok with that. Our doctor also advised us against having our embryos tested due to our age and lack of medical history issues. Again, testing the embryo when it’s not needed could compromise the embryo so why would we chance that just to find out the sex? We have heard that only 1 clinic in Atlanta openly discloses that they sex select and many will not tell you over the phone. This topic may be less controversial depending on which state you live in too.
3) Supplements & Vitamins
There is a lot of information out there on this topic so we encourage you to do your research based on your medical background. Based on Sarah’s age (33 at the time of retrieval) and health, our doctor did not advise us to do anything special for her egg retrieval. While we had a successful egg retrieval (15 eggs collected) we would have liked for Sarah’s egg quality to be have been better. We researched this afterwards and if we could do it again, we would have started her on CoQ10 supplement that improves egg quality. As for Elizabeth, we started her on a prenatal vitamin (suggested by our doctor) after our first consultation visit. As always, consult with your doctor before taking anything.
4) Period Mapping
Get used to tracking your period and the flow (spotting, light, full flow, etc.) Everything about this process is focused around your period start dates. Many procedures, ultrasounds, and appointments must happen within “X” number of days from your period start. Our clinic considered your start day your first day of full flow but for some this might happen on the second or third day of your period. This concept took some adjusting on our part. In our shared calendar Elizabeth started making detailed notes i.e. “SL Period light spotting PM”. It can get exhausting discussing your period so much but you will get used to it.
5) Fertility Drugs
Do not assume that your fertility drugs will be available at your local pharmacy. You (or your clinic) will need to check with your insurance company for coverage details. Some insurance companies will cover drugs at local Specialty Drugstores (i.e. CVS and Walgreens have these but only at select locations) and others require you to use mail order pharmacies. This will require overnight shipment. Not a big deal as long as you know this in advance and you’re not under the wire with your timeline…..It was also our responsibility to keep track of our drug quantities. We didn’t realize we were low on Cetrotide (an important drug that kept Sarah’s eggs from releasing before the retrieval) until Sunday and we needed double the amount on Monday! We couldn’t wait for overnight shipping (our mail order pharmacy does not ship over the weekend) but fortunately our clinic called in more of the drug to a local specialty pharmacy. We had to pay full price but at least we got it.
6) Egg Retrieval Drugs
Menopur Pro Tip - This drug stings like a mofo going in but there is a trick! After you mix the drug, let it sit for 15 minutes before you administer it. Something about letting the drug sit after mixing lessens the stinging. The first time we did the Menopur shot Sarah said it felt like little ants crawling around under her skin. After we found this trick, the discomfort was much more manageable.
7) Trigger Shot
This shot signals your ovaries to release your eggs and is typically the last shot you have during your retrieval process. Your doctor will tell you exactly what hour to do the shot (typically 36 hours before your egg retrieval procedure but follow your doctor’s orders). Make sure to check and see if your trigger shot is subcutaneous or intramuscular well before your trigger shot day. It is unlikely that you can change the type of shot but we made the mistake of not finding out until the evening we had to administer and it was a shit show. Up until that point all of Sarah’s shots had been administered in her stomach. Pretty easy. It wasn’t until the evening of the trigger shot that we watched the how-to video and found out that this very important shot had to be administered in her butt, in the muscle and with a much larger needle than we were used to. All of Elizabeth’s progesterone in oil shots are intramuscular so now we are pros at them but this was our first one and we were scared out of our minds. Had we had a little bit more time to mentally prepare for this our night might have gone a little smoother. Instead we spent the evening freaking out, demanding that our nurse change our trigger shot (which they didn’t), and looking for an at home nurse service that would come over and administer. (We found one by the way and she was amazing. We highly recommend Takera with Preferred Fertility Concierge if you’re in the Atlanta area.)
8) Egg Retrieval Bowel Movement
Yep, you read that correctly. This is probably our most important tip. Make sure you have a bowel movement the day before your egg retrieval. Medicine used during the procedure can make you constipated. Sarah is normally pretty regular so we didn’t think much of this until she was in the fetal position and in the worst pain the evening after her procedure. Her cramps were so bad she could barely move. We are lucky to have an amazing friend who is also a doctor who instructed Sarah to drink magnesium citrate. Elizabeth rushed to the local pharmacy to grab one and after Sarah drank it she had to painfully move her body. Movement was necessary in order for her to have a bowel movement. So we moved in little intervals. We literally walked laps around the sofa (one lap at a time with rest in between) with Elizabeth holding her up and gliding her as she shuffled across the floor. I wish we were exaggerating but this was excruciating.
Magnesium Citrate Tips
If you do drink this, make sure you stay close to a bathroom and put a pad on. It will keep you from having to change your underwear in case you have an accident.
Don’t drink sparkling water, it will only make your pain worse.
9) Organization
Stay on top of things and as best you can. This really applies if you’re expecting insurance to cover any/some of your treatments. Things may fall through the cracks. Call and ask for status updates if you’re waiting on approvals. Do not assume that no news is good news. No news normally means someone used the wrong fax number, your doctor isn’t returning calls to the drug company or your drug order is just sitting idle somewhere awaiting who knows what. Always take notes: date, time, company, and who you spoke with. It is always helpful to start a conversation and will give you backing when you can give detailed information. Chances are you will always be talking to someone new when speaking with insurance. If you’re not getting answers from the insurance representative, ask to speak to a supervisor or to a fertility care coordinator. Infertility is so common that many companies now have a separate team for fertility and these people will be much more knowledgable. Elizabeth found that the front line, customer service insurance employees are privy to very little information.
10) Cash Money (or other forms of payment)
Be prepared to pay the cash price for treatment if you’re a same sex couple. We went into this prepared to pay out of pocket. We were then pleasantly surprised when our clinic told us our insurance would cover a huge portion of it….yay! But that was just based on their research and when the claims started coming in we were quickly denied. While Elizabeth did have good infertility coverage, her insurance did not cover surrogacy (many do not) and due to this being reciprocal IVF, Elizabeth is considered a “host uterus.” All insurance companies are different so we recommend doing your research before hand if you do not want surprises. But let’s be real, IVF is nothing but surprises!
Insurance Note: Our coverage was with United Healthcare and we had an IVF max that our clinic believed would cover Sarah’s egg retrieval. What we did not know is that the fertility drugs were also part of this max allowance and since those costs went through before the clinic bills, the drugs took the coverage max and left little to nothing for the egg retrieval costs. We had no idea that the drugs would be included in this max since our drug coverage was with a different company and neither did our clinic so make sure you ask ahead of time. Had we known, we might have done more research to understand all cost savings when comparing cash pricing.
Timeline Note: We started this process in 2019 and we hope that this topic will improve for same sex couples as time goes on.
11) Sexual History
Be prepared to talk about your medical and sexual history at your consultation with your doctor. Your clinic will probably send you plenty of information to fill out prior to the visit but be prepared to discuss it. You don’t need to have stuff memorized but you will probably be asked questions like, Have you ever had sex with a male? Have you been in a relationship with a male? Have you ever tried to get pregnant? Have you ever terminated a pregnancy? These questions might seem normal to a heterosexual couple (and some do not have to be asked at all) going into an infertility appointment but it might catch a pair of lesbians off guard. For a heterosexual couple of course we are having sex, of course we are trying to get pregnant - you’re there to discuss your relationship and how to get pregnant together. For a same sex lesbian couple, discussing important sexual history may mean discussing past relationships with male partners. Sarah and Elizabeth have always been open with each other about their pasts but just keep this in mind going in. Just remember that it is all important information for your doctor to know in order to give you the correct protocol.
12) Fertility Support Group
Make sure you find a support group. Friends and family are great but it’s important to have others that have been through the process. You might have friends that have done IVF. If so great! Use them as a resource. If not, find a community online. Elizabeth found a huge IG community that was very helpful during our transfer process. She found other females on similar protocols that were just weeks ahead of her. It was helpful to see what was coming and to ask them questions. This eased a lot of anxiety and definitely helped with administrating shots. Many women film their shot administration and it was helpful to watch someone in real life do it, not just a model on a how-to video.
That’s all for now! We hope this has helped. Best of luck on your IVF journey. If you have questions or comments leave them below!