Emily Patrick and Kerry Osborn recently made UK history by being the first to give birth to each other’s babies in a process known as simultaneous reciprocal IVF. Ezra was conceived using Emily’s fertilised egg and carried by Kerry, while Elvis, born just a few weeks earlier, was carried by Emily using Kerry’s egg. The same sperm donor fertilised both eggs.

What is reciprocal IVF?

Reciprocal IVF is also referred to as shared motherhood, co-maternity, shared parenthood or intra-partner egg donation. It is a fertility treatment option that allows both partners in a same-sex female relationship to participate in the experience of conception and pregnancy.

If you choose to undergo reciprocal IVF, eggs are collected from one partner and fertilised in our lab using donor sperm. The most suitable embryo is then chosen for transfer into the other partner. Considerations include:

Choosing which partner will be the donor and which will be the carrier

At the beginning of your journey, both you and your partner will undergo a fertility check. The partner donating her eggs should have a good ovarian reserve, which is assessed by an ultrasound scan showing the number of follicles on each ovary, the small fluid-filled sacs that can potentially release an egg. Blood tests are also performed to measure certain hormones, such as anti-müllerian hormone (AMH). Low AMH levels can indicate a low ovarian reserve.

A pelvic ultrasound scan will also be performed to check the health of your and your partner’s uterus to facilitate a successful implantation.

These factors can highlight who is most suitable to be the donor or carry the pregnancy. However, if both of you have no fertility issues, it is up to you to make a personal choice, and we can provide you with our expertise and support when making that decision.

Understanding the risks

Neither role is free of risk as you’ll both be taking fertility medications, and both may experience side effects. Then, one partner will be going through pregnancy and childbirth.

As in the case of Emily Patrick and Kerry Osborn, if you are undergoing simultaneous or concurrent reciprocal IVF, then this may also mean unforeseen challenges as you may have very different experiences of pregnancy and childbirth.

Choosing the right sperm donor 

You can either use sperm from a known donor or from a sperm bank. At Aria, we provide the facility for sperm donors to donate their sperm on a known basis to either a friend, family member or someone else known to them.

We also work with several established sperm banks and can help advise and support you through the process. We will also inform you on when you should order donor sperm in advance of your treatment.

Understanding the legal implications

Understanding the legal implications of using a sperm donor and reciprocal IVF is vital. For example, if you and your partner are married, you are both the legal parents to the child born. However, you must consent to legal parenthood if you are not married before receiving treatment.

If you use sperm through a sperm bank, there are strict regulations regarding donors. A sperm donor can request confirmation of the number of children born, inducing gender and year of birth, but otherwise, the identity of the child and mother will remain anonymous. The donor will have no legal or financial rights or obligations in relation to the child. At the age of 18, your child will have the right to basic information about their sperm donor if they wish.

Using a known donor can be more complicated, so it is vital to obtain legal advice and consider a donor agreement. While they are not legally binding, they record the intentions of all involved.

Our team is here to answer any questions you may have and support you through the process of reciprocal IVF.

International Day of Women and Girls in Science is marked every 11th February as a global celebration of the accomplishments of women in science and to encourage young girls to consider a future career in STEM fields.

Francisca Mora, Senior Clinical Embryologist at Aria, along with clinical embryologist Summer Sorensen and embryologist Kim Hill, share their knowledge and unique insights into the fascinating field of embryology.

What led you to pursue a career in embryology?

“I’ve always known I’d work at something related to obstetrics. My parents say that I was always drawing pregnant women and babies when I was a child, maybe that was a tell?” Francisca reveals.

For Summer, the fascination with fertility started at High School when she attended a Science and Technology Forum and the keynote speaker explained all about the wonderful world of IVF. Kim undertook a Medical Physiology post-grad degree in South Africa that allowed her to be a part of the Reproductive Research Group, where her focus was on male fertility and nutrition.

What education / training did you go through to become an embryologist?

Before working in IVF in the UK, all three of our embryologists first studied in their home countries.

Summer completed a Bachelor of Biomedical Science (majoring in Reproduction, Genetics and Development) before completing a Bachelor of Biomedical Science with Honours, both at the University of Otago in New Zealand. She then completed her Masters of Clinical Embryology at Monash University in Melbourne, Australia.

Her first job was a trainee position at Fertility Associates in Auckland, New Zealand where she learnt all the necessary skills of being an embryologist.

Kim completed a BSc in Human Life Sciences & Psychology at Stellenbosch University in South Africa, then completed a Master’s Degree in Clinical Embryology at the University of Dundee.

After completing her MSc, she worked as a lab technician before advancing to a trainee embryologist. “I had in-house training, in both private and NHS settings, up to biopsy practitioner, before applying for professional registration. In this time, I also gained accreditation by the European Society of Human Reproduction and Embryology (ESHRE) as a Clinical Embryologist.”

Francisca holds a BSc and MSc Biochemistry from leading Portuguese universities. “I’ve also conducted my master’s thesis on the topic of male infertility. However, I’d say that my training didn’t start until I set foot in an IVF clinic and since then it has been an ever-growing experience, we are continuously learning! Since I’ve moved to the UK, I’ve learnt a great deal through colleagues, workshops, talks and the HFEA. Furthermore, acquiring my professional registration, has also been a key moment in my training.”

How do you stay current with the latest research and advancements in embryology?

“Aria Fertility supports an environment dedicated to improving outcomes through innovations in technology,” Kim explains. “Staying current with scientific advancements and professional recommendations enables us to provide state-of-the-art patient care.

This can come through a variety of sources. “Reading the latest scientific journal articles, attending conferences, LinkedIn, workshops, these are all useful,” Summer adds.

“Moreover, one of the most practical ways is to keep an eye on the embryology hubs that exist online; in that sense, social media has been very helpful in diffusing the latest developments,” Francisca points out.

What is the process or protocol that has most surprised you in terms of development and research?

“I’d probably say that trophectoderm biopsy, used for genetic testing (PGT), has been the process that surprised me the most,” Francisca explains. “Not only because I had not seen it before until I moved to the UK but was well for the level of detail and technical skill that it entails. It’s also a protocol that has evolved quite a lot in the last years, especially the technique used at the genetics lab to detect the abnormalities.”

How have recent advancements in embryology, like genetic screening, affected your work?

Both Kim and Francisca feel that genetic screening has greatly expanded their skill set and how they can guide patients through their treatment. “I became an embryo biopsy practitioner about a year and a half ago so the whole process is still very exciting to me,” Kim explains. “It is a valuable skill set to have, and unique as not all clinics provide genetic testing to their patients.”

“On one hand, such processes have made my work more challenging, in a positive way, since it has raised the bar for my skills and knowledge,” Francisca agrees, “and on the other hand, it has made it easier to guide patients on their treatment, as genetic screening can provide crucial answers.”

Summer feels that the greater awareness of egg freezing has had a huge impact on the fertility sector. “While egg freezing isn’t necessarily a new technology, I have really enjoyed the rise in awareness of this technology in the public space, and how more and more women are thinking about and planning their reproductive futures.”

What are some of the most exciting future possibilities in the field of embryology?

All three embryologists agree that AI will be the big focus in IVF. “It is very interesting to see what avenues are being explored and how this may impact our day-to-day procedures and the positive influence on our patients’ goals,” Summer explains.

“However, there will always be a need for a human embryologist on the other end of the line to support patients through the emotional impact and big decisions involved in IVF,” adds Kim.

Another possibility is creating eggs and sperm from stem cells. “I feel the possibility of creating gametes from other cells of one’s body could be a reality at some point, and this could bring hope to oncology patients,” Francisca expands.

Beyond the lab, what role does communication play in your job?

“As a clinic, we feel communication with our patients is one of the most important aspects of their treatment, for them to understand the process, the risks and to ask any questions they may have,” Summer explains.

“Patient interaction is my favourite part of the job,” Kim agrees. “I love explaining what goes on so that patients don’t feel the lab is a ‘black box’ of unknowns, and the decisions can be made together.”

Communication between team members is also vital. “Considering we all work under a lot of pressure and in a confined space, it’s super important to communicate effectively with colleagues to ensure that everything goes as smooth as possible,” Francisca explains.

“This helps when liaising with patients who can tell there is really good communication amongst the lab and greater team,” Kim agrees.

Is there a ‘typical’ workday at Aria Fertility?

“I’d say that each day can be quite different, as there are no equal cases, however there is a main structure that is followed every day,” Francisca explains.

The mornings tend to be busy with fertilisation checks, thawing embryos for embryo transfers later in the day, egg collections, embryo grading and sperm preparation. The afternoons are typically filled with inseminations (either conventional IVF or ICSI -sperm injection into the egg), embryos transfers, preparing for the next day and diagnostic sperm analyses.

What is the hardest part of your job?

Our embryologists all agree on what is the hardest part of their job.

“It’s without a doubt having to give bad news to the patients or to see that their treatment wasn’t successful,” Francisca explains. “Each failed fertilisation, negative pregnancy test, each pregnancy loss really takes a toll on all of us at Aria Fertility.”

“It never gets easier to tell a patient that is hasn’t worked this time,” Summer agrees.

“We want every outcome to be a success, but unfortunately science is not that robust yet, and this is a huge drive to keep developing the research behind IVF so we can better the chances of success,” Kim resolves.

What is your favourite part of your job?

“My favourite lab procedures are egg collections and ICSI. But, overall, my favourite parts are the conversations with patients, and ultimately having a helping hand in our patients realising their dreams of becoming parents,” Summer believes.

“I love it when patients return with a healthy baby for cuddles, after seeing them as a tiny embryo in the lab,” Kim agrees. “This makes every tough day worth it, knowing that so much joy is coming from it. I love speaking with patients and helping to guide them through the difficult decisions they need to make. I love working with the team as we all share common goals, and that is to see each patient journey end in success.”

“I truly value the fact that we can guide patients through their treatment and to be able to explain to them the latest scientific developments that we implement, but I also quite appreciate the fact that each day in the lab is different, each patient is a new opportunity of success,” Francisca adds. “Furthermore, in order to be an Embryologist, one has to have a broad spectrum of knowledge, from Biology to Law, Mathematics to Pharmaceutical Sciences, etc. and personally I enjoy this side of my job.”

A recent article in The Times has focused on the ‘hidden costs of IVF’ and claimed that unexpected charges mean the eventual bill for fertility treatment may be many thousands of pounds more than a clinic’s advertised prices.

In February 2020, the Competition and Markets Authority (CMA) was asked to investigate fertility clinic pricing following consumer feedback. They raised concerns that some clinics provided unclear price information.

The next step was to explore the feasibility of developing a standard approach for a package price for a single cycle of IVF so patients could meaningfully compare clinics.

“The CMA has investigated this and found it is unfortunately not as simple as regulating supermarket pricing,” Aria Clinic Director Rob Smith explains. “Every fertility treatment is unique, and there are so many variables: the medical history of both individuals if you’re treating a couple, the scans or tests required, the medication dosage, whether fresh or frozen embryos are being transferred, or what different treatment add-ons are used.

“There’s no average price because there’s no such thing as an average patient.”

The value of treatment add-ons

The investigation by The Times found that an IVF treatment costs 50% more than advertised at a quarter of private clinics, based on data by Fertility Mapper, a review platform for fertility clinics. Additional costs not included in the initial quote frequently included blood tests, embryo freezing and scans.

Thirty-nine per cent did not include blood test monitoring, which can cost £150-200 for each test.

“Some clinics monitor the life out of patient – sometimes once or twice a day – and throughout an IVF treatment, this can quickly run into the thousands. If you’re not expecting it, this will be a huge shock,” Rob explains. “We make it very clear to patients at Aria that we don’t include the monitoring of bloods in their costs because actually very few patients require it. For those that do require more monitoring, we inform them of this at the very beginning of the treatment and make a small additional charges for these.  Charging for these tests on an ad-hoc basis prevents us from increasing the IVF treatment cost for everyone.”

Another cause for concern was treatment add-ons. When IVF was first invented, the process was collecting the egg, fertilising it and then transplanting an embryo back. This remains the basic IVF cycle. Since then, several refinements to the process have been developed, such as genetic testing or time-lapse imaging of the embryos.

These treatment add-ons are all additional costs, and it is true that there is currently not enough clinical evidence to prove that they are effective at improving treatment results. “At Aria we believe that treatment add-ons can improve the eventual outcome for some patients,” argues Rob, “which is why we offer them. But they are only applicable to certain patients.

“If you have unsuccessfully undergone multiple rounds of IVF, then it is vital that your clinic attempts to boost the chances of a successful treatment by utilising these advances in technology and techniques. We always discuss these options beforehand and make sure patients make an informed decision about their treatment.

“However, if you are under 38 and embarking on your first round of IVF, then genetic testing, for example, is just not required. Unfortunately, some clinics try to recommend these treatment add-ons when unnecessary.”

The Aria ethos

“We set up Aria because we wanted to create something unique in the industry,” Rob explains. “We aim to be as transparent and clear on costs as possible from the outset. We do not advertise a headline ‘from’ price on our website, and we include our complete pricing guide with every treatment clearly listed.

“After the initial consultation with one of our fertility experts, the doctor will send a list of what is required to our patient care team. They then provide the patient with a bespoke quote that includes exactly what is included in the treatment package.”

“Another thing that I think is quite unique is that you pay for a package and there are no surprises afterwards. It happened to me, at other clinics, to pay for packages and then to have to pay for countless ‘non-included’ extras. For example, ‘the first scan is not included’. You probably would not expect the medicines to be included but the scans? At Aria you pay once, and no further surprises.”

“If the patient wishes to discuss any aspect of the quote, they can come into the clinic and go through it line by line with one of the team.

“We are always striving to improve our patient experience, and gathering feedback is vital to this process,” continues Rob. “In our most recent data collected, almost 88% of our patients reported that they had paid exactly what they had expected.”

Call +44 (0) 203 263 6025 to speak to one of our team about fertility treatment costs at Aria Clinic.

Women have a complex, interconnected hormone network that can impact fertility.

Hormones are chemicals primarily produced in the endocrine glands, and they act as messengers that control and influence different bodily functions, including conception and pregnancy.

A hormonal imbalance is when your body produces too much or too little of a particular hormone. Conception relies on a carefully choreographed mix of hormones produced in a specific sequence during the menstrual cycle so that a small change can disrupt the hormones and fertility process.

In our latest blog, we discuss the 7 major fertility hormones that are at play when trying to conceive:

Hormones and fertility

1 Oestrogen

Oestrogen is the primary female hormone; it kickstarts puberty and continues to regulate the menstrual cycle, among many other essential bodily functions. Produced by the ovaries and placenta, it maintains the uterine lining and regulates other key fertility hormones.

2 Progesterone

Mainly made in the ovaries, progesterone helps regulate your menstrual cycle, and after ovulation, it helps the uterine lining to become receptive to the implantation of a fertilised egg. It also prevents the uterine muscles from contracting so the egg is not rejected. Low progesterone levels are thought to play a role in recurrent miscarriage.

3 Follicle stimulating hormone (FSH)

The pituitary gland in the brain makes this hormone and signals the ovaries to grow eggs. It also stimulates oestrogen production at this stage, which is necessary for the body to produce a surge of luteinising hormone (LH), leading to ovulation. This also has an impact on the cervical mucus. When ovulating, the cervical mucus changes from thick and white or creamy to stretchy and clear, which helps the sperm survive and fertilise the egg.

4 Luteinising hormone (LH)

Another hormone produced by the pituitary gland, LH works in concert with FSH. LH levels must rise just before ovulation to trigger the release of the egg from the follicle. An imbalance in LH is often a cause of irregular menstruation.

5 Human chorionic gonadotropin (hCG)

Often known as the pregnancy hormone, hCG is only produced by the body when you’ve conceived. hCG levels rise just after conception until about ten weeks in pregnancy, and it’s this chemical that pregnancy tests detect and measure. It tells the body to stop menstruation and helps thicken the uterine lining to support the growing embryo

6 Prolactin

Made by the pituitary gland, prolactin is a critical player in regulating your menstrual cycle. An imbalance in prolactin, especially if produced in excess, can cause menstrual and fertility problems.

7 Anti-Müllerian Hormone (AMH)

AMH is produced in the ovarian follicles and is responsible for maintaining your body’s immature eggs and regulating the number of growing follicles and their selection for ovulation. If you’re undergoing IVF, measuring the levels of AMH can be used to estimate your ovarian reserve

AMH remains consistent throughout your menstrual cycle, whereas other hormones fluctuate. For this reason, we can test your AMH level at any point during your process and this will provide us with an indicator of your current reproductive potential. If the level of your AMH is low, this does not necessarily mean you will not be able to conceive.

AMH levels strongly correlate with the antral follicle count (AFC), and when combined, we can provide you with a clearer understanding of your fertility. Get in touch to arrange your Female Fertility Investigation at Aria Clinic.

Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk.

The practice of reflexology dates to Ancient Egypt, India and China but was first introduced into the West in 1913 as ‘zone therapy’. The concept behind reflexology is that specific points or reflex areas on the feet and hands are linked to other areas and organs of the body.

Reflexology aims to restore or maintain the body’s natural equilibrium by applying gentle pressure to these reflex points, and it has been shown to be effective in treating various conditions, including arthritis, digestive disorders, migraines and insomnia. It is also gaining popularity for those experiencing infertility issues.

“Scientifically, we can’t explain exactly how reflexology works, but we can demonstrate it has a positive effect on treating not only symptoms but also the causes of symptoms,” Reproductive Reflexologist Barbara Scott explains.

Barbara’s interest in this area was sparked by her first reflexology client, who was struggling to fall pregnant. As Chair of the Association of Reproductive Reflexologists and author of Reflexology for Fertility, Barbara is committed to furthering research in this field. She is currently a doctoral student at the University of Wales Trinity St David.

The Association has developed structured protocols to support couples struggling to conceive and those undergoing IVF or other fertility treatments, allowing them to measure outcomes beyond the anecdotal evidence from patients.

Reflexology and fertility

“We take a patient-centred integrative approach. It is important for us to see both parties, as men often get overlooked in fertility treatment,” Barbara details.

“During the initial consultation, which can last up to two hours, we focus on where they are in their fertility journey and how they have got there. It doesn’t matter if they have just started trying or have already had a complex journey. We often advise further testing as there may be something they haven’t considered exploring.

“Then we devise a treatment programme. For women, we ensure their menstrual cycle is functioning as effectively as possible, even if they are about to embark on IVF.

“For both parties, three months is the optimum timeframe. Men produce millions of sperm cells every day, but from when sperm is first produced in the seminiferous tubules until they are ready to ejaculate, this takes about 12 weeks. Sperm are delicate single-cell organisms susceptible to damage, so you can improve both quantity and quality.

“Women are born with every egg they are going to have, so you can’t change the number, but you can change the environment. So we don’t just focus on ovulation but also the luteal phase from ovulation to bleed. This can be a question of whether you are producing the right kind of cervical mucus at the right time or are your levels of progesterone fluctuating.”

Your reproductive reflexology plan

“We devise a programme of weekly sessions based on specific protocols that are designed to support each stage of your cycle – or each key stage of your IVF treatment. This can be supported by patients working on reflexology points on their hands between each session. We also ask women to take their temperature each morning or use the OvuSense fertility tracker, and we use this data to monitor the effectiveness of our sessions.

“We work on specific reflex points on the feet. The first session can feel very strange for patients, but most usually find it incredibly relaxing. Often, they can experience sensations in the body depending on what we are treating. If they are in the stimulating phase of IVF, it is possible to feel the dominant ovary  or the thickening of the uterine lining.

“Once your IVF treatment begins, we like to know what you’ll be taking and when so we can design protocols to mimic and support each key stage of the IVF programme, whether that’s stimulation or sedation.

“Men can often feel sidelined during the fertility treatment pathway, but the sperm quality must be as good as possible whether you are undergoing IVF or ICSI. I often advise the TestHim website, which has a helpful health questionnaire. Men are often the biggest converts as they feel they are making a positive contribution.

“The Association of Reproductive Reflexologists expect our practitioners to stay up to date with current reproductive health developments. We also suggest that anyone who trains with us undergo maternity reflexology training so they can support patients beyond week 12 of their pregnancy.”

For more advice on Reproductive Reflexology, visit Barbara’s website Seren Natural Fertility. Or visit the Association of Reproductive Reflexologists to find a practitioner.

Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk for advice on preparing for IVF. For more information on the individual practitioners and organisations offering support, advice, and information to those undergoing fertility treatment, please visit our Support Hub.