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Medical Transition

Preserving Parental Dreams: Fertility Options During Gender Transition

Kayle Gishen

— 5 min read
Preserving Parental Dreams: Fertility Options During Gender Transition

For transgender individuals, particularly those undergoing gender-affirming treatments like hormone replacement therapy (HRT) or surgeries, fertility preservation can be an important consideration. Whether you’re a trans man (assigned female at birth, transitioning to male) or a trans woman (assigned male at birth, transitioning to female), understanding your options for preserving fertility before starting medical transition can help you make informed decisions about your reproductive future.

The following guide explores fertility preservation options, explains why it’s important to consider these options early, and provides helpful resources for those seeking reproductive choices.

Why Consider Fertility Preservation?

Transitioning, whether through HRT or surgery, can have an impact on fertility. Hormone therapy, in particular, can affect sperm and egg production. For trans men, testosterone therapy may significantly lower or stop sperm production, while for trans women, estrogen and anti-androgen therapy can decrease sperm production as well.

It's important to note that these effects are not always reversible. If you may want to have biological children in the future, fertility preservation is an option to consider before beginning HRT or surgery.

Fertility preservation allows transgender individuals to retain the possibility of biological children through assisted reproductive technologies (ART) in the future, should they choose to do so.

Safeguarding Reproductive Potential: Fertility Preservation Options

Fertility preservation options generally involve either freezing sperm or eggs before starting hormone therapy or undergoing surgeries that may affect fertility. These options differ between trans men and trans women, as the reproductive anatomy and process of preservation vary based on gender identity.

1. Sperm Banking (for Trans Men)

For trans men who wish to preserve their fertility before starting testosterone therapy, sperm banking is one of the most common methods. Sperm banking involves collecting and freezing sperm, which can later be used for in vitro fertilization (IVF) or other fertility treatments.

How it works:

  • The process of sperm banking typically involves visiting a fertility clinic where you provide a sperm sample (usually through masturbation).
  • The sperm is then frozen and stored in a cryobank until you are ready to use it.
  • In cases where a person is unable to provide a sperm sample on their own (e.g., due to dysphoria or other reasons), some clinics may offer support options, including sperm retrieval procedures under anesthesia.

Considerations:

  • Sperm banking is most effective when done before starting testosterone therapy, as testosterone can lower sperm count and fertility.
  • It’s important to discuss the storage fees, which may vary depending on the clinic and storage duration. Most clinics offer storage options ranging from a few months to many years.
  • You may also want to consider how long you intend to store the sperm, as long-term storage can be costly.

Resource:

  • American Society for Reproductive Medicine (ASRM): Provides guidelines on sperm banking and fertility preservation (www.asrm.org).

2. Egg Freezing (for Trans Women)

For trans women, egg freezing is an option to preserve fertility before undergoing hormone therapy or gender-affirming surgery. Egg freezing (also known as oocyte cryopreservation) involves stimulating the ovaries to produce multiple eggs, which are then harvested and frozen for future use.

How it works:

  • Before freezing eggs, the ovaries must be stimulated with hormones over the course of about 10-14 days. This involves a series of injections that help produce multiple eggs.
  • Once the eggs have matured, they are retrieved in a minor surgical procedure, typically done under sedation.
  • The eggs are then frozen and stored until you are ready to use them, usually in conjunction with IVF.

Considerations:

  • Egg freezing is most effective for individuals who are younger, as egg quality and quantity decrease with age.
  • The process can be costly, both for the hormone stimulation and the egg retrieval procedure. Most clinics offer financing options, but it’s important to be aware of the expenses involved.
  • Egg freezing also involves some risks, including the potential for ovarian hyperstimulation syndrome (OHSS), which is a condition caused by excessive stimulation of the ovaries.

Resource:

  • Fertility Preservation for Transgender Individuals: The Fertility Preservation Project (www.fertilitypreservation.org) offers information on egg freezing and other preservation methods for transgender individuals.

3. Embryo Freezing (for Trans Women in Relationships)

For trans women who are in a relationship with a partner with ovaries, embryo freezing is another option. Embryo freezing involves fertilizing eggs with a partner’s sperm (or with donor sperm) before freezing the resulting embryos.

How it works:

  • Similar to egg freezing, the ovaries are stimulated with hormones to produce eggs. However, in this case, the eggs are fertilized before being frozen, and the embryos are then stored.
  • Embryos have a higher success rate for implantation than eggs alone, making this an option for those in relationships who want to preserve the potential for a biological child.

Considerations:

  • This option requires the involvement of a partner’s sperm or donor sperm, making it an ideal choice for trans women who are in relationships with men or who are open to using donor sperm.
  • Embryo freezing tends to be more expensive and complicated than egg freezing due to the involvement of fertilization and embryo storage.
  • Like egg freezing, embryo freezing has risks and considerations related to hormonal stimulation and potential side effects.

Resource:

  • Fertility and Sterility Journal: The journal offers research and studies on embryo freezing and related fertility options (www.fertstert.org).

4. Ovarian Tissue Freezing (for Trans Women)

Another fertility preservation option for trans women is ovarian tissue freezing, which involves removing and freezing ovarian tissue. This procedure is less common and more experimental, but it may be an option for trans women who want to preserve fertility but are unable to undergo egg freezing due to time or financial constraints.

How it works:

  • A portion of ovarian tissue is removed and frozen before starting hormone therapy or surgery.
  • The tissue can later be re-implanted or used for egg retrieval, though the technique is still being refined and is not as widely available.

Considerations:

  • This is an experimental procedure and may not be widely offered at all fertility clinics.
  • Success rates for ovarian tissue freezing are still under research, and it may not be as reliable as other methods like egg freezing.

Resource:

  • The American Society for Reproductive Medicine (ASRM): Offers more details on experimental techniques like ovarian tissue freezing (www.asrm.org).

5. Testicular Tissue Freezing (for Trans Men)

In some cases, trans men who cannot provide a sperm sample may consider testicular tissue freezing. This involves removing small pieces of tissue from the testes, which can later be used for sperm retrieval or other fertility treatments.

How it works:

  • The testicular tissue is frozen and stored, and future advancements in reproductive technology may make it possible to retrieve viable sperm from the tissue in the future.

Considerations:

  • This procedure is experimental and is not as widely available as other fertility preservation methods.
  • Like ovarian tissue freezing, testicular tissue freezing is an emerging technique that is still being researched.

Resource:

  • Transgender Fertility Preservation Guide: This guide from RESOLVE: The National Infertility Association provides information on tissue freezing and other fertility preservation options (www.resolve.org).

When to Consider Fertility Preservation

Ideally, fertility preservation should be considered before starting hormone therapy or undergoing gender-affirming surgeries, as these treatments can affect fertility. If you’re thinking about fertility preservation but are unsure when to begin the process, here are some key considerations:

  1. Before Starting Hormone Therapy: For trans men, testosterone therapy can stop sperm production. For trans women, estrogen and anti-androgens can lower sperm count.
  2. Before Surgery: Certain surgeries, such as hysterectomy (removal of the uterus) or orchiectomy (removal of the testes), can eliminate the possibility of biological reproduction.
  3. As Early as Possible: The earlier you can freeze eggs or sperm, the better your chances are of preserving healthy, viable reproductive cells. Age plays a significant role in fertility, so starting earlier is often better.

Consulting with a fertility specialist who is knowledgeable about the unique needs of transgender individuals is crucial to ensuring you understand all your options and make the best choice for your future. While the process can be costly and emotionally challenging, it offers peace of mind that you have the ability to explore your reproductive options in the future.

Resources

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