Reciprocal IVF (ROPA): How It Works for Lesbian Couples

Reciprocal IVF — also known as ROPA (Reception of Oocytes from Partner) — is an IVF method in which eggs are retrieved from one partner, fertilised with donor sperm, and the resulting embryo is transferred to the other partner's uterus for her to carry and deliver. Both women have a biological connection to the child: one genetic, one gestational.

The medical protocol involves several stages. The partner donating the eggs undergoes ovarian stimulation (a hormonal protocol lasting 10–14 days), followed by an egg retrieval procedure under anaesthesia. The retrieved eggs are fertilised with anonymous donor sperm in the laboratory. Embryos are cultured for 3–5 days, after which the best one (or more) is transferred to the uterus of the carrying partner, who has prepared her endometrium with oestrogen in the preceding weeks.

Indications and limitations. ROPA suits couples in which both partners wish to participate in the process and neither has medical contraindications to their respective roles: the egg donor to stimulation and retrieval, the carrier to pregnancy. The age of the egg donor is critical: outcomes are significantly better under 35. If one partner is 38–40 or older, the clinic may recommend discussing which role each woman is better positioned for medically.

The cost of ROPA is typically higher than standard IVF with donor sperm, because it involves two medical protocols — stimulation and retrieval for one woman, plus endometrial preparation and transfer for the other. In Spain, where the method is well-established and legal, a full cycle runs from approximately 6,000 to 9,000 euros, not including donor sperm. ROPA is also available in the Netherlands, Belgium, and the UK; it is restricted or prohibited in several other EU countries.

The legal dimension is one of the most sensitive aspects. In countries where same-sex marriage is recognised, the partner who gives birth is automatically recorded as the mother; the other partner adopts the child or is recognised through a specific legal procedure. In countries without such legislation, the situation can be considerably more complex — in some cases, one partner may have no legal parental status at all. A legal consultation before starting treatment is not optional.

The psychological dimension of ROPA is important and frequently underestimated. Couples describe it as a deeply unifying experience: one person provides the genetic material, the other provides the body and the pregnancy. That said, some partners work through complex feelings along the way: the egg donor may feel anxiety about not being the one who is pregnant; the carrier may feel uncertainty about her 'biological role'. Talking through these feelings — before, during, and after the process — matters.

Choosing a sperm donor for ROPA is not fundamentally different from standard IVF with donor sperm. The couple selects an anonymous or identity-release donor from a certified bank, using the medical profile, phenotype information, and, where available, an audio or video message. Confirm that the chosen donor meets the clinic's compatibility requirements for blood type and genetic screening.

Embryo freezing is a standard part of the ROPA protocol. If the retrieval yields several quality eggs, multiple embryos may be created and some frozen for future attempts. Discuss this in advance: what happens to frozen embryos if the couple separates, if one partner dies, or if they decide not to have a second child. These scenarios should be addressed in writing before treatment begins.

ROPA is not the only path for lesbian couples. Alternatives include standard IVF with donor sperm (one partner is both pregnant and genetically connected to the child), IUI (simpler and less expensive when medically appropriate), and co-parenting with a known male donor. The right choice depends on medical data, financial resources, the legal context of the country, and the couple's personal priorities.

For many couples, ROPA is more than a medical procedure — it is a symbolic choice. The ability to share the creation of a child between two bodies, two histories, two women is a feature unique to this method. That is why, despite its complexity and cost, ROPA remains one of the most sought-after paths to parenthood among lesbian couples worldwide.