Expert's Perspective

Family-Building Options for Transgender People

If you are a trans person and think you may want to become a parent one day, you may have questions about how your transition may affect your fertility and what your options are for having a genetically-related child. We encourage you to discuss your concerns with a fertility specialist familiar with caring for trans patients.

Can transitioning affect my fertility?

Yes. Hormone therapy can affect both sperm and egg production. Sometimes these effects are reversible upon discontinuation of the hormones. But, sometimes the effects can be permanent. You shouldn’t however, rely on transition hormones for contraception if you are at risk for pregnancy. Surgical removal of the ovaries, uterus, or testes may also permanently affect your fertility.

What are my options to preserve my fertility?

Fertility preservation options include sperm banking for transwomen and egg or embryo freezing for transmen. Ideally these are performed prior to transition. In some cases it may be possible to stop hormones temporarily in order to allow sperm and egg production to resume for banking purposes. It is unclear how long you need to be off hormones for your fertility to recover. Similarly, it is also unknown whether hormone exposure has any long term side effects on eggs, sperm, or resulting children. Discontinuation of exogenous hormones, even temporarily, can be distressing for many people. Egg freezing involves ovarian stimulation (taking injectable fertility medications for a couple of weeks) and a transvaginal surgical procedure to retrieve the eggs.

What are the reproductive options for transwomen?

If you are a transwoman who has banked sperm, your sperm can be used to inseminate a partner or for assisted-reproduction with insemination of partner or donor eggs. The resulting embryos can be transferred to a partner’s uterus or to a gestational carrier.

What about uterine transplantation?

Although there have been recent reports of successful uterine transplantation into a cis-gender woman and subsequent successful birth, this option is not likely to be a viable option for trans women in the near future.

What are the reproductive options for transmen?

Transmen can discontinue testosterone therapy and undergo insemination with donor or partner sperm or assisted reproduction with the resulting embryo being transferred into their own uterus, a partner’s uterus, or to that of a gestational carrier. If a transman has frozen eggs or embryos, those eggs can be thawed and inseminated with partner or donor sperm and pregnancy established by transfer of an embryo to a partner’s uterus or to that of a gestational carrier. The pregnancy success rate of egg and embryo freezing is largely dependent on the age of the egg provider at the time at which the eggs were harvested.

Are there any special considerations for children and adolescents?

If a child has undergone puberty and is able to assent, it is possible to freeze sperm or eggs as discussed above. If puberty is suppressed with medication, it is currently not possible to freeze eggs or sperm without discontinuing the medication and allowing puberty to progress first. Perhaps in the future, it may be possible to successfully freeze testicular or ovarian tissue prior to puberty and to mature eggs and sperm in vitro (in the petrie dish).

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