Are you a transgender man or woman that would like to understand more about your fertility options? Of course, many of the same issues that affect cisgender (people who identify with the gender they were assigned at birth) also affect transgender people. But there are some more specific things that trans men or women need to know about fertility and pregnancy - we go through eight of them below.
I’m about to transition. What are my options to have genetic children in the future?
At this stage, your physician will recommend that you look into preserving your future fertility to allow you the option of children at a later point in your life. This is prior to you beginning any hormone therapy treatment, as we do not know the long-term effects of these on egg production or ovarian function.
To preserve your fertility, you need to freeze your eggs or sperm. A trans woman can use banked sperm with an IUI conception method if she is in a relationship with a woman, or she can use an egg donor or gestational carrier if she is single or in a relationship with a man. A trans man who has frozen eggs can use a donor or partner sperm if they are in a relationship with a man, or if they are with a woman, they can use reciprocal IVF where the woman is inseminated with an embryo from donor sperm and the frozen eggs.
What if I have already started hormone therapy and did not freeze my eggs or sperm prior?
If you have already begun taking hormone therapy treatment, this can be paused to potentially allow for natural conception. There is no guarantee that fertility will be restored, however there have been cases of conception whilst still on hormonal therapy, therefore it is not an effective birth control method either.
Although it can be psychologically distressing to stop hormonal therapy, the chance of conception is much higher when not taken. If you are a trans man and would like to carry a baby, you can in theory, as long as you still have a uterus, fallopian tubes and ovaries.
I’ve had surgery to remove my ovaries or testicles. Can I still have biological children?
If you have had genital reconstruction surgery and did not have your eggs or sperm frozen, the short answer is no. If you have had your ovaries removed, you’ll no longer produce eggs, and if you have had your testicles removed, you’ll no longer produce sperm. You can look into using a surrogate with egg and sperm donation as alternative ways to start your family, read more about how we can help you here.
If I transition under the age of 18, what can I do to preserve fertility?
Transition during adolescence can be difficult, however, it’s important that fertility options are considered even though it might not be what you want to think about at such a young age. Most cases will have to be reviewed on an individual basis due to issues with consent of a minor. If a child is post-puberty, they can have their eggs or sperm frozen. However, if they have begun taking puberty suppressing medication and then straight to hormone replacement therapy, this may render them infertile as they have never undergone a natural puberty.
Do other fertility issues still apply?
Yes - from age-related factors to lifestyle choices, all the same issues can affect a transgender person’s fertility. Egg quantity and quality declines with age, smoking will still harm your egg. So it’s still just as important to maintain a healthy diet and weight to maximise your chances of conception.
If me or my partner are trans, is it guaranteed that we will have infertility issues?
It’s important to remember that just because you or your partner are trans, this does not mean you will necessarily have infertility issues or need to use advanced reproductive technology such as IVF. Most commonly, the issue tends to be a lack of access to a uterus, eggs or sperm, rather than infertility for either partner involved, so donors and surrogates are an alternative solution.
Am I entitled to NHS funding for fertility preservation?
There is no distinct answer to this as it can depend on where you live and individual Clinical Commissioning Groups (CCGs). There are funding options available, but it is advisable that you speak directly to a practitioner as every case is different. Currently, there are no guidelines around fertility preservation for people with gender dysphoria. There are calls from the British Fertility Society to review the guidelines around NHS funding specifically for transgender people whose fertility is effectively destroyed through the gender reassignment process.
Where can I find transgender-friendly fertility doctors?
Referrals from trusted sources are a great place to start, as it’s important that you find a centre that is culturally sensitive to your situation. Treatment can be a challenging and emotional experience for anyone, making it vital that you get the right support during and after treatment. Gendered Intelligence work with young trans people in particular to raise awareness and offer support, while the British Infertility Counselling Association provides counselling to people of all ages looking into fertility treatment.
Here at The Hewitt Fertility Centre, we treat a number of transgender patients and other members of the LGBT community, with success rates among the best in the UK. Whatever your situation, we’ll work with you to find the best possible solution to help you reach your dreams of starting a family.