As society becomes more aware and accepting of transgender individuals, the health care industry is increasingly focused on providing inclusive and supportive medical care. One essential aspect of this care is fertility preservation counseling for transgender persons.
These patients often undergo gender-affirming treatments such as hormone therapy or surgery, which can affect their ability to have children. Sometimes, these treatments partially reduce or even completely remove the ability to have biological children.
Before starting gender transition, transgender patients should receive counseling about options to preserve their fertility — the ability to have children in the future. Unfortunately, there isn’t a lot of research available on fertility preservation specifically for transgender individuals. Many of the methods we use are adapted from techniques originally developed for people undergoing cancer treatment.
This article aims to review the current approaches to fertility preservation for transgender patients and discuss the available options.
The importance of fertility preservation counseling
Fertility preservation counseling is a vital step for transgender individuals considering hormone therapy or gender-affirming surgeries. Understanding the potential impacts of these treatments on reproductive health and exploring transgender fertility options can empower individuals to make informed decisions about their future family-building possibilities.
Why fertility preservation matters
- Impact of hormone therapy
Hormone treatment, such as testosterone for transgender men and estrogen for transgender women, can have significant effects on reproductive organs. Those undergoing hormonal treatment for a female-to-male transition can find that testosterone suppresses ovulation.
Alternatively, gender-affirming hormone therapy for a male-to-female transition involves estrogen, which can reduce sperm production. These changes can be temporary or permanent, emphasizing the need for early fertility counseling.
- Surgical interventions
Gender-affirming surgeries, such as hysterectomy to remove the ovaries and uterus or orchiectomy to remove the testicles, are often irreversible and can lead to permanent infertility. Discussing fertility preservation before surgery allows individuals to explore options for preserving their reproductive potential and pursuing fertility treatment later on.
- Family planning aspirations
Many transgender individuals desire biological children, either now or in the future. Fertility preservation counseling helps them consider these aspirations alongside their transition goals.
Fertility preservation options for transgender individuals
There are various fertility preservation options available for transsexuals, each with unique benefits and considerations. Counseling with a knowledgeable healthcare provider is essential to understanding the fertility options for transgender individuals and making informed choices.
Options for transgender women
- Sperm cryopreservation
Transwomen can opt for sperm cryopreservation before starting hormone therapy or undergoing surgery.
Sperm cryopreservation involves collecting and freezing sperm samples from the testes for future use in assisted reproductive technologies (ART). Sperm banking can be beneficial for those who want to pursue treatment options like in vitro fertilization (IVF), intrauterine insemination (IUI), or surrogacy.
Transgender women may freeze sperm, which can later be utilized by a female partner or gestational carrier. For those seeking a direct referral for sperm storage only (typically people with no history of hormone use), we can perform the necessary tests and then refer you to the proper provider.
- Testicular tissue freezing
For prepubescent transgender youth or those unable to produce a sperm sample, testicular tissue cryopreservation is an experimental option. This involves preserving testicular tissue that may later be used to generate sperm.
Options for transgender men
- Oocyte (Egg) cryopreservation
Transgender men can preserve their fertility by freezing eggs before starting testosterone therapy or undergoing gender-affirming surgeries. The oocyte cryopreservation process involves ovarian stimulation to produce multiple eggs, retrieving them, and then freezing them for future use.
- Embryo cryopreservation
This option involves fertilizing the retrieved eggs with sperm (from a partner or donor) to create embryos, which are then frozen for future implantation.
- Ovarian tissue freezing
An emerging option for transgender men is ovarian tissue cryopreservation, where ovarian tissue is surgically removed and preserved for future use. This option is particularly useful for those who wish to begin testosterone therapy during adolescence before reaching reproductive maturity.
Challenges and considerations highlight the importance of counseling for fertility preservation
While fertility preservation offers hope for many gender nonconforming and transgender individuals, there are several challenges and considerations to keep in mind.
Emotional and psychological considerations
- Gender dysphoria
The process of fertility preservation, especially for transmen, may exacerbate gender dysphoria due to the focus on reproductive organs. Counseling and mental health support are crucial during this time.
- Decisional conflict
Some individuals with a transgender gender identity may face conflicting feelings about fertility treatment versus starting hormone therapy or undergoing surgeries for reassignment. Fertility preservation counseling can help navigate these complex emotions and prioritize personal goals.
Financial and accessibility barriers
- Cost of preservation
Fertility preservation procedures and future reproductive options can be expensive, and insurance coverage is often limited. Financial counseling and exploring available resources can help alleviate this burden.
- Access to specialists
Finding healthcare providers knowledgeable about transgender health and fertility preservation can be challenging. Building a supportive medical team is essential for successful preservation efforts.
Can it be too late to preserve fertility?
Yes, it can be, which is why fertility preservation counseling is so important for transgender individuals. By exploring fertility preservation options and providing compassionate support, healthcare providers can empower transgender individuals to make informed decisions about their reproductive future. However, there are options for individuals who have already undergone some forms of gender-affirming medical care.
One study found that trans women who were undergoing gender-affirming hormone therapy had restored sperm cell development (spermatogenesis ) and viable spermatozoa recovered after a discontinuation of hormone therapy. Another study reported that transmen undergoing testosterone therapy long-term could experience a breakthrough ovulatory event, illustrating the potential to resume ovulation if hormonal treatment was discontinued.
While using hormones can make family building more challenging, it doesn’t make it impossible. However, gender-affirming surgeries often lead to irreversible infertility. The good news is that as awareness and acceptance of transgender healthcare continue to grow, so does accessibility to fertility preservation counseling and options for transgender individuals.
Considering LGBTQ+ Fertility Preservation Options? Consider Dr. Aliabadi
Dr. Aliabadi creates a safe and inclusive environment for all her patients where they can feel empowered in a collaborative decision-making process about their fertility future. Dr. Aliabadi and her caring, supportive staff are available to support you. We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
FAQs
Can you reproduce after gender-affirming surgery?
Gender-affirming surgery can irreversibly affect an individual’s ability to reproduce. Because gender-affirming surgery can lead to infertility, the American Society for Reproductive Medicine advises all individuals considering gender reassignment to receive counseling on the effect of treatment on their fertility as well as fertility preservation options.
Can you get pregnant if you’re on hormone blockers?
Traditionally it was assumed that a transman or non-binary individual could not get pregnant while on hormone blockers or during hormone therapy. However, recent studies have reported breakthrough ovulation in individuals using hormonal therapy long-term, which could result in pregnancy, making contraception use important.
What percentage of transgender adults have utilized fertility preservation?
An older study conducted in 2016 found that 2.8% of transgender youth and young adults who were post-puberty utilized fertility preservation services.
Sources
Access to fertility services by transgender and nonbinary persons: an Ethics Committee opinion. Fertility and Sterility
https://doi.org/10.1016/j.fertnstert.2021.01.049
Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873819/
Fertility preservation legislation in the United States: Potential implications for transgender individuals | LGBT health
https://www.liebertpub.com/doi/abs/10.1089/lgbt.2019.0017
Perceptions and Motivations for Uterus Transplant in Transgender Women
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775302
Modeling of live-birth rates
https://academic.oup.com/humrep/article/32/10/2049/4085112
Research priorities for gender nonconforming/transgender youth: gender identity development and biopsychosocial outcomes. Curr Opin Endocrinol Diabetes Obes. Olson-Kennedy J, Cohen-Kettenis
https://journals.lww.com/co-endocrinology/abstract/2016/04000 research_priorities_for_gender.15.aspx
Sexual and reproductive health considerations among transgender and gender-expansive youth. Curr. Probl. Pediatr. Adolesc. Health Care
https://www.mdpi.com/2673-4397/3/4/24
Pregnancy Outcomes After Fertility Preservation in Transgender Men. Obstet. Gynecol.
https://journals.lww.com/greenjournal/abstract/2017/06000/pregnancy_outcomes_after_fertility_preservation_in.10.aspx
Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: Qualitative responses to an international survey. J. Assist. Reprod. Genet.
https://pubmed.ncbi.nlm.nih.gov/30604136/
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.