IVF with donor sperm: what lesbian couples need to know

In 1978, Louise Brown was born — the first person conceived through IVF. Her story felt like science fiction. Today, more than 10 million people alive in the world were conceived the same way. The technology has become so routine that many clinics use the word ‘protocol’ with the same matter-of-fact tone as ‘blood test.’ For lesbian couples, IVF with donor sperm is the most direct path to biological parenthood. Direct — but not simple. Between the first clinic appointment and a birth, there’s a chain of decisions, each with a medical, legal, and emotional dimension. This article is a map of that chain. Three protocols: a choice to make at the start The first question most couples face isn’t ‘when’ — it’s ‘how.’ There are three main approaches to conception with donor sperm, and they differ significantly in complexity, cost, and success rates. Intrauterine insemination (IUI) Prepared donor sperm is placed directly into the uterine cavity around the time of ovulation. It’s the least invasive method: no general anaesthesia, the procedure takes a few minutes, and it can be done in a natural cycle or with mild ovarian stimulation. Success rate per attempt: 10–20% depending on age and fertility profile. Most clinics recommend up to three IUI attempts before moving to IVF, unless there’s a specific medical reason to start with IVF. Best suited for: couples with no identified fertility issues, generally under 35–38, who want to start with the least invasive option. IVF with donor sperm Eggs are retrieved after ovarian stimulation, fertilised in the lab with donor sperm, cultured for 5–6 days to the blastocyst stage, and then transferred. More involved and more expensive than IUI — but with higher success rates. Success rate per transfer: 35–50% using the patient’s own eggs in women under 35; declines with age. For women over 40, donor eggs are typically the recommended option. Best suited for: couples who have had unsuccessful IUI cycles, those with identified fertility factors (tubal issues, etc.), women over 38–40, or those who want to include preimplantation genetic testing. Reciprocal IVF (RIVF) A protocol unique to female couples: eggs are taken from one partner, fertilised with donor sperm, and the resulting embryo is transferred into the other partner’s uterus. One woman is the genetic mother; the other carries the pregnancy. Medically, this is standard IVF with donor eggs — except the donor is the partner rather than an anonymous third party. Legally, the situation varies: in several countries (Spain, the Netherlands, the UK), the protocol is recognised and both mothers can be named on the birth certificate under specific conditions. In others, the genetic mother’s legal status requires additional steps. Best suited for: couples for whom it matters that both partners have a biological connection to the child; also when one partner has medical reasons not to be stimulated but wants to carry the pregnancy. Choosing a protocol isn’t just a medical decision. For many couples, it also carries meaning: who will be the genetic mother, who will carry the baby, and how that story will be told to the child. Choosing a donor: what’s actually involved Sperm banks offer thousands of profiles. On the surface, it looks like a catalogue: height, weight, eye colour, education, profession, sometimes an audio recording and childhood photos. On closer inspection, it’s one of the most significant decisions you’ll make. Anonymous vs open-identity donor This is the central distinction — and not just an ethical one. An anonymous donor’s identity is never disclosed — to you or to the child. In some countries (Spain), this is the only permitted model. In others, legal anonymity is guaranteed but practically vulnerable to commercial DNA tests (23andMe, AncestryDNA): children conceived with donor sperm increasingly find biological half-siblings — and, through them, the donor himself. An open-identity (identity-release) donor is one whose identifying information the child can request upon turning 18 (or earlier, depending on country and bank). The donor isn’t obliged to respond to contact — only to be identifiable. Most banks in the UK, Netherlands, Sweden, and Denmark operate on this model. Research consistently shows: children conceived via donor conception who were told from an early age and had access to information about the donor show better psychological wellbeing in adulthood than those who found out later or had no access to that information. This is from a Swedish longitudinal study published in 2021. What to look for in a donor profile Genetic screening: what panel was run? Does it include expanded carrier screening (ECS), karyotyping, FMR1 testing? The broader the panel, the more you know Number of families already using this donor: different banks set different limits. In Denmark, the cap is 25 families per donor. In the US there are no limits — some donors have more than 100 biological children Education and profession: not because these affect genetic material (they don’t), but because they’re part of the information your child may one day want to have Photos and voice recordings: many banks provide childhood photos and audio clips — subjective, but meaningful to many couples CMV status (cytomegalovirus): a technical but important point. If the recipient is CMV-negative, a CMV-negative donor is generally recommended How much to store Standard clinic advice is to purchase several straws from the same donor upfront — typically three to six. The reasons: multiple attempts may be needed; if you want a second child from the same donor in a few years, that donor may no longer be donating or his samples may be gone. Storage has an annual cost (usually €200–500), but the possibility of biological siblings from the same donor matters to many families. What it costs Cost depends on country, clinic, and protocol. Rough figures for IVF with donor sperm in Western Europe: - Donor sperm (one straw): €600–1,500 - Ovarian stimulation medication: €800–2,500 - Monitoring ultrasounds and blood tests: €400–900 - Egg retrieval: €1,500–3,000 - Fertilisation and embryo culture: €1,000–2,000 - PGT-A (if performed): €1,500–3,500 per batch of embryos - Embryo transfer: €800–1,500 - Embryo cryostorage (per year): €300–700 Total for one full IVF cycle with donor sperm: roughly €6,000–15,000 depending on country and clinic. Spain and the Czech Republic are typically at the lower end; the UK and Scandinavia at the higher end. For reciprocal IVF, add the stimulation of the second partner — approximately €2,000–4,000 on top of the base cost. Worth noting: in a number of countries, some of these costs are covered by public health insurance or partially reimbursed. Spain, France, and Belgium all offer lesbian couples access to state-funded IVF — check the specific conditions in your country. What happens if the first attempt doesn’t work This is one of the most important conversations to have before you start, not after. An unsuccessful embryo transfer is a medical fact — and an emotionally heavy experience. Research shows that couples who discussed a contingency plan in advance cope with a failed attempt significantly better. What ‘discussing in advance’ means in practice: how many attempts are we prepared to make? At what point do we pause and reassess the protocol, or the decision itself? How do we support each other through it? Statistically: around 40% of couples achieve a pregnancy on the first transfer (using PGT-A tested embryos). Among those who try three times, more than 70% eventually succeed. Not a guarantee — but not a lottery either. ‘We agreed: three tries, then a break and a proper conversation. It gave us the feeling that we were running the process — not the other way around.’ — from an interview with a participant in an Australian study on the psychological experience of lesbian couples in IVF, 2022. The legal side: who is a parent The answer depends on country — and on protocol. Standard IVF with donor sperm If the couple is married, in many European countries (Spain, Netherlands, Belgium, France, UK, Portugal, Denmark, Sweden), both partners are automatically recognised as legal mothers. If not, additional steps are required. For the details, see our article on legal parenthood in Europe. Reciprocal IVF The situation here is more nuanced. The genetic mother (whose egg was used) and the birth mother both have a biological connection to the child — just of different kinds. Legal recognition of both depends on the specific country: in Spain and the UK, it’s explicitly provided for by law when the procedure takes place at a licensed clinic. In Germany, it currently isn’t. The donor’s legal status When sperm from a licensed bank is used, the donor is not a legal parent under any European law — and has no parental rights or obligations. This is distinct from a ‘known donor’ (a friend or acquaintance), where the legal situation is considerably more complex and requires its own formal arrangement. Talking to your child: where to start The professional consensus in child psychology and reproductive medicine has shifted significantly over the past twenty years. The old guidance was to ‘wait until the child asks’ or ‘tell them at the right moment.’ The current guidance is: tell them from early childhood — before they’re old enough to remember finding out. The logic: if a child has always known, it’s simply part of their story — not a secret, not a revelation. If they find out at twelve or at forty, it can feel like a profound disruption and a breach of trust. Practically: children’s books about families with two mums and a donor dad exist in many languages and are a good starting point. Then, in simple age-appropriate language: ‘We really wanted you, and a kind person helped us by sharing a part of themselves.’ That’s the version for a three-year-old. At seven, more detail. In adolescence, an honest conversation about what it means to know — or not know — the donor. This isn’t one conversation. It’s a series of conversations across a whole childhood. One last number In 2023, the Danish sperm bank Cryos International — one of the largest in the world — published its client data: more than 60% of their customers globally are single women and lesbian couples. Not an exception, not a niche. The majority. A technology that began as an experimental solution to infertility has become one of the primary tools for building families in the twenty-first century — in the fullest sense of that word. This article is for educational purposes only and does not constitute medical advice. Success rates and costs vary by clinic, country, and individual medical profile. Consult a fertility specialist before beginning any protocol.