Lesbian Moms Can Each Carry Their Baby: New Frontiers in LGBTQ+ Reproduction
There is a great story of rainbow family creation coming out of Spain, where a lesbian couple just gave birth to their son after each mom carried him during the pregnancy (1).
I wanted to write an article about this because all rainbow families are important to the BabyMoon Family community, and this is a great story for female same-sex couples embarking on their family building journey. Also, this is a novel technology that has some interesting benefits and differences compared to the more traditional in vitro fertilization (IVF).
The process by which two women each carry a portion of a pregnancy is called ‘shared motherhood’ or ‘reciprocal IVF.’ The technology that makes this possible is from a company and product called INVOcell (https://www.invocell.com/). INVOcell is the first FDA-cleared (for the U.S.) and CE-marked (for Europe) medical device for fertility treatment through intravaginal culture (IVC).
IVC is an innovative approach where a woman’s body acts as a natural incubator for fertilization. Compared to IVF, where the eggs are fertilized by the sperm and allowed to develop in a lab, IVC allows mothers-to-be to carry the embryos in their bodies until they are ready for implantation.
IVC involves 5 steps:
Eggs are retrieved from the donor/mother. I wrote a previous BabyMoon Family article on what is entailed in egg donation (https://www.babymoonfamily.com/original-articles/egg-donation-procedure and https://medium.com/@babymoonfamily/what-is-it-like-to-undergo-egg-donation-8ecb4a9f3f60). This process would be the same for IVF and IVC.
Sperm is collected and tested. I also wrote a previous BabyMoon Family article on what it was like to leave a sperm sample at the clinic from my own experience (https://www.babymoonfamily.com/original-articles/clinic-masturbation and https://medium.com/@babymoonfamily/masturbating-in-a-clinic-as-a-queer-dad-to-be-44e81dbf7b25). This process would also be the same for IVF and IVC.
The eggs and sperm are placed in the INVOcell for fertilization. This is where the process differs from IVF, as with IVF, fertilization and embryo development occur in a lab. While some patients may be recommended to undergo ICSI (Intracytoplasmic sperm injection), this can be done for either IVF or IVC cycles, if needed.
The INVOcell device is placed in the vaginal canal for incubation of the embryos.
5. The INVOcell is removed after incubation and then an embryo is selected for implantation into the other mother.
An interesting aspect of the IVC process is it is meant to mimic the natural process as much as possible. During a natural cycle, fertilization of the egg by the sperm occurs, and then there is a delay of about 6 days until the formation of a blastocyst. This blastocyst then implants into the uterine wall for continued maturation, as shown in the drawing below.
In IVC, these 6 days of maturation to form a blastocyst occur in the INVOcell device in one of the mothers, so the timings and early embryo development stages are aligned.
Some other aspects to consider with this process include the size and comfort of the INVOcell device as well as the efficacy compared to traditional IVF.
Per the company website, the outer chamber is approximately 2.5 cm wide and 4.5 cm tall. The retention device, which is similar in size to a diaphragm, is 7.0 cm in diameter. They have conducted some user research that suggests that the INVOcell was ‘well tolerated and did not cause irritation.’
In terms of efficacy, there have been several company-sponsored studies. One study was conducted in 2016 and titled, Comparing blastocyst quality and live birth rates of intravaginal culture using INVOcell™ to traditional in vitro incubation in a randomized open-label prospective controlled trial (2). The study demonstrated the following results:
IVF produced a greater percentage of total quality embryos as compared to IVC (50.6 vs. 30.7 %, p = 0.0007, respectively).
There was no significant difference between in IVF and IVC in the percentage of quality blastocysts transferred (97.5 vs. 84.9 %, p = 0.09) or live birth rate (60 % IVF, 55 % IVC).
This last result is important because even though IVC produced fewer embryos than IVF, this did not affect the end result, which is live births.
Another more recent study was published in 2021. This was a real world evidence study in the U.S. that demonstrated average live birth plus ongoing pregnancy rates for IVC ranged from 29% to 53% per cycle start and 40% to 61% per transfer. Because these rates are similar to IVF, the authors concluded the following: ‘This study of IVC using INVOcell as an alternative model for infertility treatment confirms its utility as a viable alternative to standard incubator-based in vitro fertilization’ (3).
For BabyMoon Family, a huge win for this technology is that it is really targeting same-sex female couples with its offering. Being able to share the gestational experience in this way is groundbreaking for mothers-to-be. Although no formal cost-effectiveness analysis with this technology is yet to be published, there is the possibility that this could provide a cost-savings over IVF, as the cost of incubating the embryos in a lab is removed. Reproductive experiences for LGBTQ+ people are always layered with costs, with some in the U.K. claiming current IVF procedures for same-sex couples amount to a ‘gay tax’ (4). So, any portion of the journey that can result in savings would be very welcomed by queer intended families.
As I have written before, more rainbow families have the possibility to make the world a better place (https://www.babymoonfamily.com/original-articles/rainbow-families-impact and https://medium.com/@babymoonfamily/will-more-queer-parents-and-their-children-make-the-world-a-better-place-777056021564), so any technology that facilitates and encourages this is a step in the right direction.
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