For more sex education resources during the COVID-19 outbreak, check out our Better Sex Ed guide.  

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

A couple in Texas made fertility history recently when they each carried their fetus during different stages of its development, though only one of them actually became pregnant. The technology involved is not new, but this couple used it in an innovative way that allowed them both to be involved in incubating the embryo and carrying the fetus.

Many lesbian couples use reciprocal in vitro fertilization (IVF). In that procedure, eggs are harvested from one woman, fertilized with sperm from a known or anonymous donor, and the resulting embryo(s) are then implanted into the egg donor’s partner’s uterus or frozen for future use. Couples often see this as a way for both parents to have a biological or physical connection to their child before birth.

The Texas couple—Ashleigh and Bliss Coulter—took it one step further by using an FDA-approved device called the INVOCell. In standard IVF treatments, harvested eggs are fertilized in a test tube and incubated in a lab for the first five days before being frozen or deposited into a woman’s uterus. With the device, the harvested eggs and sperm spend the first five days in the small, plastic device inserted high in a woman’s vagina. If fertilization is successful, the resulting embryo is frozen and then implanted, usually into the same woman’s uterus.

But in this case, the eggs were harvested from Bliss, who also carried the INVOCell in her body for five days. The embryo was then transferred to Ashleigh, who became pregnant and ultimately gave birth to the couple’s son, Stetson, now 5 months old.

INVOCell has roughly the same success rates as standard IVF transfers, but advocates for this procedure cite advantages including lower cost (about $8,000 per attempt compared to $15,000) and less risk of pregnancy with multiples (twins, triplets, or more). They also say that there is less risk of being implanted with the wrong embryo, though this is actually very rare.

Dr. Kathy Doody, a fertility specialist who worked with the Coulters, told the Daily Beast: “I think the twist—so to speak—with [this] approach is that it allows that bonding early on. I think it opens up an exciting option for our same-sex couples.”

When INVOCell was approved in 2015, many expected it to become a popular first choice for couples turning to fertility treatments. But that has not happened; the manufacturer says that the procedure has led to “several hundred babies being born” in the last three years.

To put that in perspective, according to the Centers for Disease Control and Prevention (CDC) there were more than 76,000 babies born using all assisted reproductive technologies in 2016 alone. But INVOCell is pretty new in most states; it was only in 2017 that the first babies conceived by this method were born in California.

Dr. John Couvaras, a Phoenix fertility expert who was not involved with the Coulters’ pregnancy, offers INVOCell in his practice. He told LiveScience that he wonders if some of his colleagues may be skeptical because it’s less precise than laboratory fertilization—instead of sperm being placed on or even injected into individual eggs by an embryologist, sperm and egg are just put together in the INVOCell and left to their own devices. It is also possible that patients themselves are leery of any new procedure.

Still, he thinks it ought to be a first choice: “But if I could be the czar of infertility, I’d say we should do more low-cost approaches up front, and if not successful, then move to” traditional IVF.

Start-Ups Look for New Models to Pay for Fertility Treatments

Getting pregnant the old-fashioned way is free, but it’s only an option for heterosexual couples with no fertility problems. Same-sex couples and those who have trouble conceiving for any number of reasons (such as advanced age, low sperm count, or scarring from an untreated sexually transmitted infection or STI), quickly realize that getting pregnant can be a very expensive undertaking and traditional insurance covers very little.

Today, there are a number of start-up companies dedicated to helping couples pay for assisted reproductive technologies in a variety of creative ways, many of which have been started by women who faced these out-of-pocket expenses themselves.

Tammy Sun started Carrot after paying $35,000 to freeze her eggs. Her health insurance wouldn’t cover it, and her employer provided no assistance (only eight states require employers to provide coverage for infertility treatments).

She told Forbes that she realized the current system was only set up to provide limited coverage for those who fit neatly into one box. “The entire medical system is really designed around a very old-school understanding of what infertility means—two people of the opposite sex failing to conceive for a year.” She went on to say, “What we’re still missing, is the piece of the conversation acknowledging all of the different ways that people experience fertility.”

Her company works with employers who are interested in providing coverage for fertility treatments to all interested employees regardless of sex, gender, or sexual orientation. Employers choose how much they are willing to cover, and Carrot implements the plan by providing employees with advice, referrals, and ultimately reimbursements for the treatments they use. Sun says that offering this kind of a package makes employers more competitive and allows employees to plan treatments without wondering how much insurance will cover.

Future Family, founded by Claire Tomkins and Eve Blossom, takes a different approach to helping people pay for assisted reproductive technologies. The company allows individuals to buy packages that cover all expenses using a monthly payment plan. Tomkins became interested in fertility financing after needing six rounds of IVF to become pregnant with her daughter. She found the process overwhelming and isolating, and she realized that people like her—women who had put off having children into their 30s and 40s to concentrate on their careers—needed help navigating the system.

In addition to providing assistance paying for treatments, the company pairs each client with a fertility nurse who acts as a concierge, helping them find the right providers and answering questions along the way.

The CDC estimates that 12 percent of U.S. women of reproductive age have fertility issues. The likelihood of experiencing such problems goes up as women age. Add to that more same-sex couples having children, and the popularity of reproductive technologies is likely to rise even more. Given how expensive IVF is and that there’s no guarantee of success, these new payment options are a welcome advance for many families-to-be.

Could Blood Tests Help Plan Fertility Goals? 

Future Family, one of the start-up fertility financing companies discussed above, also offers a blood test designed to help women plan their families by “predicting” if they might have fertility issues. And it’s not the only company taking this tactic.

A company called Modern Fertility recently released an at-home version, which requires only a few drops of blood from the tip of a woman’s finger. The companies believe that these tests can help women avoid the pain of infertility or at least be prepared for what might be coming, but some experts think they show only a partial picture and may raise unnecessary anxieties.

The blood tests checks levels of a number of hormones involved in ovulation. They also check thyroid functioning, which can factor into fertility. Both companies have nurses who will go over the results with women and explain if their hormones are within normal range and whether—based on these results—they may have an average or worse than average chance of facing fertility issues in the future.

In theory, women would be able to plan around the results they got either by considering having a family earlier or taking proactive measures like freezing their eggs for future use.

But some experts think the information is so incomplete as to not be useful. Dr. Alexis Greene, a reproductive endocrinologist in Westchester, New York, told Vogue, “Fertility is not just numbers; it’s a big spectrum that encompasses a lot of different things beyond lab work, such as age, prior history, if you’ve ever been pregnant before, and what your ovaries look like on an ultrasound.” Greene worries about these tests: “If anything comes back out of the average or normal parameters, it may cause unnecessary angst.”

The truth is that all women become less fertile as they age. Instead of using a blood test to rank how you compare to your peers, there are some simple steps you can take to protect your fertility. Maintaining a healthy weight and avoiding tobacco, excessive alcohol, and too much caffeine can be the first line of defense against future fertility issues. Keeping up with regular check-ups with a gynecologist is also an important way to stay ahead of potential health issues.

In addition, many fertility problems stem from undetected or untreated STIs. Using condoms can help people avoid STIs, and the CDC recommends that all sexually active women under 25 be screened for chlamydia and gonorrhea at least once a year. Older women should also be screened based on their risk factors including whether they or their partner has multiple sex partners. And, if you do get diagnosed with an STI, make sure you follow all treatment instructions.