IVF and ROPA for lesbian couples

What options do lesbian couples have while building a family? It turns out that there are several techniques in Assisted Reproduction which not only make the dream of becoming parents possible but also allow both partners to become physically involved in the conception and actively share the maternity process.

One of such methods is the ROPA in which one woman contributes with her oocytes and the other woman contributes with her uterus to achieve a full-term pregnancy and a healthy baby at home. How does it work? During this webinar Dr. Carmen Avilés Salas from Phi Fertility Center presents the topic and answers attendees questions afterwards.

What the law says about Lesbian Couples treatment in Spain

ROPA stands for Reception of Oocytes from the Partner. The ROPA method is a variant of in vitro fertilisation treatment. This technique, known as shared biological motherhood, allows a couple formed by two women to share the process of in vitro fertilisation in an active way. One of the women will be the genetic mother who provides the eggs and the other one will be the biological mother who carries the pregnancy.

According to the Spanish law, a woman should be able to benefit from reproductive techniques regardless of her sexual orientation.

Dr. Carmen Avilés Salas reminds us that a lesbian couple have to be married to start the ROPA procedure. It is highly important as both egg and sperm donation in Spain is anonymous. The only exception that is possible is when we talk about married couples. In case of heterosexual couples, a husband can donate sperm to his wife. In case of lesbian couples, one woman can donate her eggs to the other one – without anonymity.

Lesbian shared biological motherhood has been legally recognised in Spain since 2007. Consequently, babies that are born through the ROPA technique within the lesbian married couple have two legal mothers.

Reasons and requirements for lesbian couples

Apart from the legal status of the relationship, another requirement is the positive medical analysis of the couple. Doctors need to know the ovarian reserve, the quality of the eggs and the state of the uterus of both of the women to advise which one of them would be the best donor and which one – the best recipient. Dr. Avilés Salas admits that they usually prefer a younger woman to be the donor. Both women need to perform a blood test in order to be sure that they don’t have any infectious diseases, as well as a karyotype test.

The reasons for deciding on ROPA technique may be different and they do differ from couple to couple. Of course, the main motivation is the possibility for homosexual partners to become active participants in the reproduction process. However, there are also some medical reasons, such as alterations in oocyte quality one of the women suffers from, absence of own oocytes or severe disfunction of own ovarian reserve. Other cases may include a risk of hereditary transmission of any disease, chromosomal or genetic abnormalities and – last but not least – failure of previous fertility treatments.

What ROPA involves

During the ROPA method, one woman undergoes an ovarian stimulation and the other one receives the embryo and carries the pregnancy. Apart from the women involved in the process, there is also a sperm donor needed. Dr. Avilés Salas says that because of donor anonymity enforced in Spain, the women and the donor will not be able to know or meet one another at any point of their life. The sperm donor is selected on the basis of the physical characteristics to ensure maximum similarity with the recipient. The sperm donors should have a normal karyotype and a negative serology. On the couple’s demand, the donor’s semen is checked for recessive diseases (like e.g. cystic fibrosis).

In order for the ROPA technique to work, both women have to be ‘synchronized’. Whilst one of them is being stimulated, the other’s endometrium is being prepared for the reception of the embryo. The woman who provides her eggs undergoes an ovarian stimulation in order to produce follicles in an attempt to obtain an optimal number of oocytes. Such a stimulation involves hormonal injections and takes about 10-12 days. Once the follicles have achieved an adequate size (16-18 millimetres), the egg collection is performed.

The hormonal treatment is also needed to prepare the endometrium of the recipient woman. According to Dr. Avilés Salas, there are various protocols used to achieve this goal, but at Phi Fertility Center they use the one with an increasing dosage of estrogens. When the eggs have been fertilised (with the use of ICSI technique), the recipient starts with progesterone to complete the endometrium preparation.

The embryo transfer day depends on the number of embryos and their development. If there are only two or three embryos, doctors usually perform the embryo transfer on day 3 as the uterus is the best incubator that they have. However, if there are three, four or even more embryos, they will be left to achieve the blastocyst stage and transferred on day 5. 12 days after the embryo transfer, the recipient has a pregnancy blood test performed. If it is positive, 2 weeks later the woman undergoes the first ultrasound scan to make sure the pregnancy is going on.

At this point it is important to mention other possibilities that the ROPA method allows. Dr Avilés Salas talks a little bit about the reciprocal IVF cycle which is, in other words, a simultaneous stimulation. During such a technique, both women are stimulated hormonally at the same time. After the eggs are collected from both women, they are fertilised with the sperm of the same sperm donor. The embryos are cultured and afterwards, the embryos from woman A are transferred to the uterus of woman B and the embryos from woman B are transferred to the uterus of woman A. In that way, both women can be pregnant at the same time. If everything goes according to the plan, both of them will be genetical and biological mothers to their babies.

Probability of pregnancy

Dr. Avilés Salas admits that the probability of pregnancy depends mainly on the egg donor’s age. It is generally known that a woman starts to lose her reproductive capacity in a natural and an irreversible process that tends to intensify from the age of 35 . So if the donor is less than 35 years old, after the first attempt the probability of a pregnancy is about 65% and after all the attempts of the same cycle – about 70%. In comparison, in case of a 40-year old woman, the success rate after the first attempt is only 15% – after all the attempts it is increased slightly to 20%.