A lesbian couple in Texas is making headlines for something that, until recently, would have been considered impossible: Before giving birth to their baby boy in June, both women took a turn carrying their baby’s embryo.
The feat was made possible by a procedure called reciprocal effortless in vitro fertilization (IVF), in which a fertilized embryo is transferred, very early in the pregnancy, from one woman to another. According to the Center for Assisted Reproduction (CARE Fertility) in Bedford, Texas, where the procedure was performed, Ashleigh and Bliss Coulter are one of the world’s first same-sex couples to share a pregnancy in this way.
The Coulters have shared their success story with People, the New York Daily News, and other media outlets in hopes that more people take advantage of this option. “We know that there are a lot of same-sex couples out there who want to do the same thing,” Ashleigh told People. “We want to publicly be out there and let the LGBTQ community know that they do have options and it’s possible.”
Reciprocal effortless IVF was developed by the doctors at CARE Fertility specifically to help same-sex couples. But it’s a variation of a broader technology—simply called effortless IVF—that can be helpful for heterosexual couples, as well. Here’s what you should know about these procedures, especially if you’re considering fertility treatments yourself.
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What is effortless IVF?
In traditional IVF, a woman’s ovaries are stimulated with hormones and her eggs are harvested in a clinic. Those eggs are then fertilized by sperm—either her male partner’s or a donor’s—in a laboratory setting, outside of the body. The fertilized egg is implanted back into the woman, where it grows and develops for nine months.
Effortless IVF is different in a few major ways, says Kevin Doody, MD, a physician at CARE Fertility Clinic. (Dr. Doody and his wife Kathy are the developers of effortless IVF.) Instead of the egg being fertilized outside of the body, doctors place the egg and sperm in a plastic capsule called an INVOcell, which is then implanted back into the woman’s vagina.
This is where the egg is fertilized, and the embryo begins to develop. A woman’s body provides a favorable environment for fertilization, says Dr. Doody: It maintains temperature and levels of carbon dioxide and oxygen inside the capsule, and it filters out toxins.
“When we started working with the INVOcell, we noticed that embryos seemed to be advancing and dividing more quickly in the vaginal incubator than in the laboratory incubator," Dr. Doody tells Health. "We were seeing fully hatched embryos on day five, compared to embryos that had expanded but hadn't yet started to hatch at all."
After five days, the INVOcell is removed from the vagina, and the fertilized embryo(s) is retrieved. For heterosexual couples, one of those embryos is then implanted into the woman’s uterus, where it continues to develop for nine months.
In clinical trials, IVF with the INVOcell device was shown to have similar pregnancy and implantation rates as traditional IVF performed in a laboratory, "at a reduced cost for the patients."
The name "effortless IVF," which Dr. Doody and his wife have trademarked, comes from the idea that the woman’s body naturally regulates the environment in which the egg is fertilized. In a lab, that environment has to be recreated, which costs money and requires time, space, and equipment.
That’s one of the reasons why effortless IVF typically costs about half of what traditional IVF costs. Effortless IVF also uses a woman's weight and hormone levels to personalize her treatment, which cuts down on tests and doctor's visits. Only two or three appointments are usually required prior to egg retrieval with effortless IVF, compared to eight with traditional IVF.
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What is reciprocal IVF?
The reciprocal IVF method adds another layer to the effortless procedure. Traditionally, reciprocal IVF refers to a procedure in which eggs are harvested from one female partner, fertilized in a lab, and implanted into a second female partner. But with effortless IVF, the partner who donates the eggs also gets a chance to carry the embryo.
Here's how it works: One partner—in the case of the Coulters, this was Bliss—has her ovaries stimulated and her eggs harvested, and doctors use the INVOcell to place one (or more) of her eggs, along with donor sperm, back into her vagina.
After five days, the embryo(s) is retrieved and frozen. Meanwhile, the other female partner (that was Ashleigh, for the Coulters) begins taking estrogen and progesterone supplements when her next menstrual cycle begins.
The couple works with an IVF coordinator to schedule an embryo transfer, during which the frozen embryo is implanted into the non-biological parent. She then carries the developing fetus for nine months.
In this procedure, the biological mother provides the egg and the environment in which it’s fertilized, and her partner then carries their baby for the duration of the pregnancy. “We kinda joke around about how both of us got to carry the baby and it’s special for both of us,” Ashleigh said in a video on CARE Fertility’s website. “I think that was a huge, huge deal for us, for sure.”
The doctors at CARE Fertility learned this week that Bliss and Ashleigh Coulter were not actually the first couple to undergo reciprocal IVF with the INVOcell device, as was originally reported. A doctor in Virginia who was trained by the Doodys actually used this method to deliver a healthy baby to another lesbian couple back in March, says Dr. Doody. And since the Coulters gave birth in June, another lesbian couple has successfully undergone the procedure and given birth to a healthy baby girl.
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Who will this process work for?
Reciprocal and effortless IVF won’t work for everyone, and there are certain requirements patients must meet before undergoing the procedures. Furthermore, the INVOcell technology that makes these procedures possible is only available at select clinics across the United States. (These other clinics do not use the term effortless IVF, which involves more than just the INVOcell device, although Dr. Doody says he and his wife are training other facilities to adopt their method.)
Women who want to provide eggs and carry an INVOcell device during fertilization must weigh less than 190 pounds and have a body mass index (BMI) below 35, with no significant medical issues. Her tests results for anti-mullerian hormone (AMH) must be 0.8 or greater on two separate occasions, and her antral follicle count must be 8 or greater. Both of these numbers can be indicators of how many eggs a woman has left.
For same-sex couples, the partner who will carry the embryo after the initial five days should have a BMI less than 40, with no significant medical issues that would interfere with pregnancy. She must also undergo a uterine evaluation, including a transvaginal ultrasound, hysteroscopy, and hysterosalpingogram.
Heterosexual couples may benefit from IVF (the traditional or the effortless variety) if the male partner has low sperm count or low sperm motility, or if the female partner has blocked or damaged fallopian tubes, or ovulatory problems such as polycystic ovary syndrome (PCOS).
Dr. Doody says that patients who have thought about IVF but have been discouraged because it's not financially or geographically feasible should look into effortless IVF as another option. "If you don't live within a few hours of a clinic—or even if you do—the cost and the number of visits required can really make traditional IVF difficult," he says.
Although IVF has "improved tremendously over the last three decades," says Dr. Doody, it has also become increasingly complex, which has translated into higher costs. And while some states have mandated that health insurance plans cover IVF, most Americans still have to pay out-of-pocket.
"We are working hard to make sure those patients aren't left out in the cold, and that they have some way of accessing a very good treatment that has a good success rate," he says. "I would love to see this take off and make IVF more accessible to those patients."
This post was updated on October 31 with new reporting.
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