IVF for Same-Sex Female Couples: ROPA in Portugal

IVF for Same-Sex Female Couples: ROPA in Portugal

For lesbian couples dreaming of starting a family, the Reception of Oocytes from a Partner treatment (ROPA), has been nothing short of revolutionary, offering both partners the chance to share a biological connection with their child. Yet, despite its potential, ROPA remains inaccessible in many parts of the world, hindered by legislation and social mores that fail to recognise or support the diverse pathways to parenthood. 

Against this backdrop of exclusion, Portugal stands out for its inclusivity and progressive laws regarding ROPA treatments. The country’s legal framework is designed to ensure equal parental rights for lesbian couples, making it an appealing option for fertility treatment. In this article, Dr. Vladimiro Silva from Ferticentro delves into the details of ROPA and highlights the advantages of choosing Portugal for lesbian couples seeking to start a family through assisted reproductive technologies.

Dr. Vladimiro Silva, Ferticentro

Dr. Vladimiro Silva, Ferticentro

What is ROPA?

ROPA is a form of In Vitro Fertilisation (IVF) specifically designed for female same-sex couples. This technique allows both partners to have a biological connection to their child. One partner donates her eggs (oocytes), which are then fertilised in a laboratory setting with donor sperm. The resulting embryo is subsequently transferred to the other partner’s uterus, who will carry and give birth to the baby. This unique process ensures that both mothers are involved in the creation and development of their child from the very beginning.

Legal Aspects of ROPA Treatment in Portugal

Portugal has been at the forefront of LGBTQ+ rights within Europe, including the legal recognition of same-sex marriage and parenting. The legal framework governing ROPA in Portugal is inclusive, allowing female same-sex couples (and single women) to access a range of assisted reproductive technologies (ART), while maintaining a strong commitment to the safety, ethics, and rights of all individuals involved. 

However, there are specific criteria and regulations that you may need to be aware of. 

Age requirements for ROPA

In Portugal, the maximum age for a woman who wants to undergo IVF treatment is 50 years old, whether she is in a heterosexual couple, a same-sex couple or a single woman. 

Marital status requirements for ROPA

Your marital status will not impact your ability to access assisted reproductive technologies (ART) in Portugal. Unlike what happens in other destinations (like, for example, Spain, where marriage is required), in Portugal ART is available for single and married couples, without any change in the rights that each member of the couple have over the embryos that are created. 

Non-anonymous sperm donation

In Portugal, egg and sperm donations are governed by a policy that does not allow anonymity. This means that children conceived through these methods have the right to learn about their biological donors when they reach 18. Access to the donor’s information is guaranteed by the Portuguese state and the information is stored for 75 years. This approach gives donor-conceived children the freedom to decide if and when they’re ready to explore their genetic background, without feeling pressured to do so at 18. 

Open-ID donation helps couples making use of these donations to make better-informed decisions, allowing them to know about the donor’s personal and medical background, which could be important for their child’s future. It also simplifies access to the donor’s health information, as donors are usually open to being contacted later. Additionally, this open-identity approach offers donor-conceived children the opportunity to explore their genetic origins in a secure and supportive setting.

Equal parental rights

The adoption of same-sex marriage laws in 2010 and enhancements to transgender rights in 2018 highlight Portugal’s commitment to equal treatment. This inclusive stance extends to ensuring that same-sex couples engaging in assisted reproductive technologies (ART), such as ROPA, are afforded the same parental rights. As a result, in a lesbian couple, both individuals gain legal recognition as parents from the start, irrespective of who contributes the egg or carries the baby to term. 

It is also important to stress that both elements of the couple have exactly the same rights over the embryos that are created, regardless of who donated the eggs or who carries the pregnancy, turning this into a truly shared project, says Dr. Vladimiro Silva, Ferticentro.

IVF in Portugal

ROPA Treatment Process

The ROPA treatment process is a journey that both partners undertake together, involving several steps:

  1. Preparation: Both partners undergo medical and psychological evaluations to ensure they are ready for the process. This includes discussions about the emotional implications of ROPA and  health screenings which may include  bloodwork and ultrasound scans of the uterus and ovaries, applicable to both partners.
  2. Confirmation: After receiving the test results, the couple will have another meeting with their doctor to go over the findings and finalise the treatment approach. Before proceeding to select a donor, it’s necessary to agree upon the proposed treatment plan, including strategies and anticipated costs. These details will be outlined by an assigned Patient Coordinator, ensuring the couple has all the information needed to move forward confidently with treatment.
  3. Qualification: In the qualification stage for ROPA treatment, both partners undergo thorough evaluation to identify their roles within the process—either as the egg donor or the gestational carrier. This involves assessing medical, psychological, and sometimes genetic criteria to ensure that one partner is capable of producing healthy eggs, while the other has a uterus that is suitable for carrying a pregnancy to term. These assessments are crucial to maximising the chances of a successful pregnancy and ensuring the health and safety of both the baby and the mothers.
  4. Stimulation Process: Once the couple has approved the costs and agreed on the roles of each mother in the process, they are ready to begin treatment. A doctor will prescribe specific hormonal treatments to stimulate the donor partner’s ovaries to produce several mature eggs. Monitoring the treatment’s progress ensures that the follicles grow to a size and number that indicate the eggs are viable for retrieval.
  5. Egg Retrieval: Egg retrieval is carefully conducted under ultrasound guidance by an experienced IVF doctor, usually taking about 15 minutes while the patient is under sedation, ensuring comfort and safety. Shortly after this procedure, arrangements for the next critical phase, the embryo transfer, are made, involving the partner slated to carry the pregnancy. The eggs retrieved during this process are immediately placed into a specially formulated culture medium, designed to support their development until they are ready for fertilisation.
  6. Donor Sperm Selection and Matching: In Portugal, the approach to sperm donation emphasises transparency and choice. Couples can select a donor from comprehensive profiles offered by some clinics or have a donor matched to their preferences at others, with the option for approval. This system ensures that children conceived via donor sperm have the right to learn about their biological origins at 18, fostering a connection with their heritage in a supportive setting. For broader options, international sperm banks are also available, with rigorous screening for genetic conditions and the opportunity for detailed compatibility assessments between donors and recipients. Genetic matching programs are also available, allowing to exclude up to 2200 recessive genetic diseases, thus making this a very safe process.
  7. Fertilisation and IVF Lab Procedures: The frozen sperm sample is then treated and optimised in the laboratory, in order to select the strongest, most motile spermatozoa. In classical IVF treatments, eggs are then placed overnight with a sample of more than 100,000 spermatozoa, to enable fertilisation. Alternatively, embryologists may use a more efficient technique to maximise fertilisation rates: they inject every mature egg with a pre-selected sperm. This technique is called Intracytoplasmic sperm injection (ICSI).
  8. Embryo Culture: Once created, embryos are put in culture for 5 or 6 days, inside a special incubator that allows them to be evaluated 24/7. The way that embryos are developing is assessed through artificial intelligence algorithms, thus allowing for a very precise and informed embryo selection. In certain cases embryos can also be submitted to PGT-A, in order to screen them for chromosomal abnormalities. The most viable embryos are either frozen (in the case of deferred cycles or PGT-A treatments) or transferred into the womb at day 5 or 6 (in the case of fresh synchronised cycles).
  9. Preparing for an embryo transfer: The individual designated to carry the pregnancy must undergo a cycle of endometrium preparation, varying from natural, slightly modified, or fully medically supported cycles to ensure optimal implantation conditions. Natural cycles utilise the body’s rhythms with minimal intervention; modified cycles introduce minor medical support to enhance natural processes, and fully supported cycles involve comprehensive medication regimens to prepare the endometrium thoroughly. Tailored to individual needs, this process is crucial for achieving successful embryo implantation and pregnancy. This can be done in a synchronised way with the ovarian stimulation process or at a different moment (where the endometrium preparation will only start after embryos are created and frozen).
  10. Embryo Transfer: One embryo is carefully transferred into the womb with the help of a small, very thin cannula. This is a very quick and painless procedure that normally does not require sedation. Following the embryo transfer, there’s a waiting period of 12 days before taking a pregnancy test to check for success. While the process is carefully managed for the best possible outcome, it’s helpful to know that sometimes multiple transfers might be needed to achieve pregnancy. This aspect of the journey, while requiring patience, holds the promise of eventual success with continued attempts.
  11. Embryo Cryopreservation: Remaining embryos not used in the initial transfer can be kept cryopreserved for future use, whether for a second child or if another attempt is needed. Both partners have equal rights over these embryos, allowing for their use in subsequent transfers. This flexibility is a key aspect of treatments like Reciprocal IVF/Shared Motherhood/ROPA, emphasising the shared path to parenthood.

Reciprocal IVF - Portugal

Reciprocal IVF and Sperm Donor Matching in Portugal

For couples undergoing ROPA in Portugal, the sperm donor pool is large and diverse, including thousands of donors spanning various races and ethnicities. The actual donor selection process prioritises health and psychological compatibility but also allows couples to find a donor who closely matches their physical preferences, such as race, hair, and eye colour. 

Donor contributions are also closely monitored to maintain high ethical standards and protect all parties involved in the donation process. Egg donors are allowed to donate up to four times in their lifetime, while sperm donors can contribute to a maximum of eight families, ensuring that each donor’s contributions are limited, preventing overuse and promoting genetic diversity. 

Donations are recorded in the national ART authority’s database, ensuring clarity and fairness. Additionally, the compensation for donors is legally set at 1021€ for egg donors and 51€ per sperm collection, uniformly across both public and private centres. This ensures everyone has fair and inclusive access to sperm and egg donations.

In Portugal, fertility clinics often include genetic compatibility testing as part of their services. This testing looks for common recessive gene mutations between the donor and the recipient, covering a wide range of genetic disorders (up to 2200 diseases in the most differentiated programs). 

Frozen Embryos after Reciprocal IVF: Legal Aspects

After completing ROPA treatment, you might have extra embryos. These embryos can be frozen and stored at the clinic, giving you time to decide on their future use, donation, or disposal. Portuguese law outlines clear guidelines for the storage of frozen embryos, ensuring your options are well-defined and legally sound.

  • Storage Duration: In Portugal, viable embryos can be frozen and stored for a period of three years, which can be renewed for another three years. 
  • Surplus Embryos: Should you choose not to proceed with the embryo transfer, you have the option to offer them to other couples seeking fertility treatment. As alternatives, the embryos can be contributed to scientific research endeavours or appropriately disposed of, depending on your decision.
  • Recipient Rights: It is important to remember that any decisions about the use or disposal of frozen embryos require the agreement of both original beneficiaries to ensure that rights and responsibilities are shared equally. Frozen embryos obtained from a ROPA treatment can be transferred either to the same person that received the first embryo transfer or to the other element of the couple – it is a couple’s decision to define who tries to get pregnant at every moment.

Success Rates of ROPA

A woman’s age plays a significant role in determining the success of in vitro fertilisation (IVF). Especially after reaching the mid-30s, and more so after turning 40, IVF success rates tend to decrease. This decline is influenced by the natural ageing process, which leads to a reduction in both the quantity and quality of eggs as women grow older.

In initial statistics for 2021, the Society for Assisted Reproductive Technology (SART) provided figures indicating the number of live births per planned egg retrieval, categorised by age groups ranging from under 35 to over 42 years old:

  • Aged under 35 – 44.5% 
  • Ages 35 – 37 – 32.4%
  • Ages 38 – 40 – 20.2%
  • Ages 41 – 42 – 9.6%
  • Aged over 42 – 2.9%

Like all IVF treatments, it’s essential to keep in mind that achieving a live birth may require more than one or two cycles. This will help you mentally and emotionally prepare for the journey ahead, says Dr. Vladimiro Silva, Ferticentro.

IVF for Same-Sex Female Couples: ROPA in Portugal

Frequently Asked Questions About ROPA

In ROPA, who is the mother of the baby?

You are both the mother of your child. In reciprocal IVF (ROPA), both partners in a female same-sex couple play crucial roles in the conception and upbringing of the child. One partner provides the eggs, while the other carries the pregnancy. Therefore, both partners are considered mothers to the baby born through ROPA. The child will have a biological connection to the partner who provided the eggs and was genetically linked to the embryo, as well as a gestational connection to the partner who carried and gave birth to them. This unique arrangement fosters a shared parental bond between both partners in the ROPA process. 

In addition to both partners being recognised as mothers to the child, reciprocal IVF in Portugal ensures equal parental rights for both individuals. This legal framework grants both partners in the female same-sex couple equal rights and responsibilities concerning the child’s upbringing, healthcare, education, and overall welfare.

What happens to the genetic material if the eggs are sourced from the female partner in reciprocal IVF?

In reciprocal IVF, each partner’s genetic material remains distinct and unique. One partner provides the eggs, while the other serves as the gestational carrier. This ensures that both partners contribute their own genetic makeup, with no mixing of genetic material between them. Additionally, the sperm donor contributes genetic material that combines with the egg donor’s DNA, further diversifying the genetic composition of the child. However, it’s worth mentioning that although the genetic material remains separate, the carrier’s biological environment can influence how genes are expressed. This fascinating process, known as epigenetics, showcases the intricate interplay between genetics and environmental factors, potentially influencing the traits and characteristics of the child.

What will the baby’s appearance be like in reciprocal IVF? Will the baby resemble the egg donor or the gestational parent?

In reciprocal IVF, the baby’s appearance is shaped by a wonderful mix of genetic factors from both the egg donor and the gestational parent who provides the intrauterine environment where the baby will grow. While some traits may come from the egg donor, others may resemble those of the partner who carries and delivers the baby. It’s important to remember that each baby is beautifully unique, often displaying a delightful blend of features from both genetic contributors.

How many cycles will it take to get pregnant?

The number of treatment cycles required for pregnancy success can greatly differ among individuals and couples. It hinges on several factors such as the woman’s age, underlying causes, response to treatment, embryo quality and lifestyle considerations. While some may achieve pregnancy after a single cycle, others might require two or more attempts. It’s crucial to have a personalised discussion with your fertility specialists to receive tailored guidance based on your unique circumstances.

How long does a treatment cycle last?

The duration of your treatment varies depending on the specific procedure involved. Generally, doctors aim to align the treatment timeline with a natural physiological cycle, which typically lasts about the same duration. However, there may be instances where treatments cannot commence immediately due to the need for preceding medical procedures. Your fertility specialist will offer a detailed explanation of the timeline for each treatment. It’s worth noting that treatments typically have minimal impact on your daily routine, with only a few necessary appointments. Procedures like egg retrieval or embryo transfer often allow for same-day discharge.

What side effects can I expect from the medication?

The impact of IVF medication can vary significantly among people and depends on the particular treatment administered. Please note that nowadays, with the modern ovarian stimulation protocols, the overall incidence of serious side effects (like the ovarian hyperstimulation syndrome – OHSS) is extremely rare, affecting less than 1% of the patients. Typical side effects may include bloating, mood swings, hot flashes, breast tenderness, headaches, and nausea. In rare instances, ovarian hyperstimulation may occur. However, these side effects are generally temporary and tend to subside once treatment is completed. Your medical team will closely monitor your progress throughout the process and will make adjustments to the medication regimen as necessary to mitigate side effects while optimising the likelihood of a successful IVF cycle. 

What is the average cost of the reciprocal IVF in Portugal?

Navigating the financial aspects of reciprocal IVF treatment can be a significant consideration for couples embarking on their journey to parenthood. Here’s a broad range of costs you can expect:

Item Cost
1 complete cycle including 1 embryo transfer €4,500 – €6,000
Medication €400 – €600
Storage for 3 years €600 – €800
Consultation fee €0 – €110
Additional embryo transfers €1,500 – €2,000
Purchase of sperm €500 – €800
PGT testing 0f 3 embryos €1400 – €1600 

In conclusion, reciprocal IVF, or ROPA, presents a groundbreaking opportunity for lesbian couples to fulfil their dream of parenthood while maintaining a biological connection to their child. Despite existing barriers in many parts of the world, Portugal stands out as a beacon of inclusivity, offering progressive laws and a robust legal framework that prioritise equal parental rights for same-sex couples. 

Ultimately, by choosing reciprocal IVF in Portugal, lesbian couples can embark on a transformative journey to parenthood with confidence, knowing that they are supported by a legal framework that values equality, inclusivity, and the profound bond between parent and child.