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A Same-Sex Couple Made History When They Took Turns Carrying Their Baby's Embryo

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 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 the world’s first two women 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 IVF was developed by the doctors at CARE Fertility specifically to help same-sex couples. But it’s a variation of a broader technology—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.

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. 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 Kathy Doody, MD, the Coulters’ doctor at CARE Fertility Clinic in Bedford Texas: It maintains temperature and levels of carbon dioxide and oxygen inside the capsule, and it filters out toxins. “The vagina works as a very good incubator,” she told the Daily News.

The INVOcell stays in a woman’s vagina for five days, after which 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.

The procedure’s name, effortless IVF, 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. It also requires only two or three doctor visits prior to egg retrieval, according to CARE Fertility, compared to eight appointments with traditional IVF.

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.”

What is reciprocal IVF?

The reciprocal IVF method, pioneered by the doctors at CARE Fertility, adds another layer to the effortless procedure. 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.”

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. (Not all of these clinics call the procedure effortless IVF, a trademarked term that involves other requirements, as well.)

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).

Men suffering from severe infertility, however, and women with very low AMH levels, are not good candidates for effortless IVF and may need to seek out other options. Studies also show that couples who exercise, follow a healthy diet, and don’t smoke tend to have better success rates with IVF than those with unhealthy lifestyles.

Dr. Doody says that patients who have thought about traditional IVF but have been discouraged because it’s not financially or geographically feasible should look into effortless IVF as another option. She also says the procedure opens up new avenues for same-sex couples. In fact, USA Today reports that since the Coulters gave birth in June, another lesbian couple has successfully undergone reciprocal effortless IVF and has given birth to a healthy baby girl.

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