No matter the gender that we identify with, we are all created to want to have offspring.  Unfortunately, fertility and the treatment of reproductive disorders have been a significant concern recently, with many people facing challenges in that area. 

This issue is even more important for transgender people or those who are about to change their gender. Gender-affirming treatment usually affect fertility so it’s important to consider all the fertility preservation options for transgender individuals before making that decision.  

Luckily, medicine is advancing in every field, including fertility preservation options for transgender individuals.  

Fertility Preservation Options

Fertility preservation is when you save your eggs, sperm, or reproductive tissue so that you can have biological children in the future. Scientifically it’s called cryopreservation; where human reproductive tissues/gametes are frozen using a process called vitrification. While it can be beneficial for anyone, people who are about to transition benefit from this option a great deal. 

The different fertility preservation options for transgender individuals support different needs.

Sperm Preservation

Sperm preservation is the process of saving sperm cells. The most common method for this is sperm banking, which basically means collecting and freezing sperm samples for future use. The process of sperm banking is very straightforward. You go to the fertility clinic, provide a sample of your sperm and the clinic stores it frozen (cryopreserved) in a specialized holding tank.

If you are about to undergo gender-affirming surgery or start hormone therapy, you should do this beforehand since these procedures can diminish sperm count and quality.  

Egg Preservation

Egg freezing, or oocyte cryopreservation, is a popular way to maximize the chance of  childbearing in individuals born female. The first human birth from a frozen egg was achieved in 1986, and we have come a long way since then. In 2012, egg freezing was no longer considered “experimental” as implantation and pregnancy rates using frozen eggs are similar to pregnancy rates using fresh eggs.  

For transgender men, this means getting hormone-based therapy, which will result in the stimulation of multiple eggs. The more eggs that are stimulated, the more can be frozen. The retrieval process lasts, on average, two weeks and includes hormone injections and frequent, near-daily, monitoring. When the eggs are mature, a doctor retrieves them via minor outpatient surgery. The eggs are then frozen (cryopreserved) and stored for future use.  

If you are about to undergo a gender-affirming surgery, it is best to do oocyte cryopreservation beforehand for the best results and peace of mind.  

Embryo Preservation—One of The Most Popular Fertility Preservation Options for Transgender Individuals

This type of fertility preservation involves eggs obtained in the same manner as with oocyte cryopreservation and fertilizing them with sperm to create an embryo. The embryo is then frozen and preserved for future use. Choosing this fertility preservation option for transgender individuals is great if you have a partner or are using donor sperm or eggs.  

This method is the most reliable approach since the fertilization has already taken place and the number of available embryos is known. Many people preserve several embryos. However, it must be considered that not all of the embryos created will be used. There are multiple options for unused embryos – like donating them to others or donating them for research. That choice will depend on you.

Ovarian and Testicular Tissue Preservation

Unlike the previously mentioned preservation methods, which have been used for decades, ovarian and testicular tissue preservation is rather innovative. Doctors remove and freeze the reproductive tissue of male or female patients. In the case of transgender patients, this should occur before the gender change. Later, this preserved tissue can be re-implanted in the individual to restore fertility.  

Ovarian tissue cryopreservation is no longer experimental, but testicular tissue cryopreservation still is.  

Choosing the right fertility preservation option is vital.

In Vitro Maturation (IVM)

IVM is a less invasive and quicker way to retrieve eggs than other procedures we’ve listed above. IVM involves retrieving immature eggs from ovaries and maturing them in a lab. While newer, this approach can be great for individuals who don’t want to undergo daily hormone treatments. Since it was first used in the 1990s, in-vitro maturation has been showing promising results. It is still not as widely available as the other methods, but it does offer a fair share of benefits.  

Psychological and Emotional Considerations

Fertility preservation is a great thing to do for your reproductive future and peace-of-mind, but it can be emotionally draining. The support you get during your fertility treatment journey or fertility preservation process makes all the difference. Support groups and counseling groups can be of great use and are easily available. Thanks to this, you will find many like-minded people who can offer support to each other during difficult times. 

Mental Health Considerations

Even with all the medical advancements in the world, fertility treatments do not always work out how we want. Naturally, we all get disappointed when things don’t go as planned. Seeing as fertility treatment and preservation can greatly impact one’s future, it is only natural to be sad and discouraged when that happens.  

Some even experience depressive episodes due to the stress and emotional strain of the process. If you find yourself in this situation, please know that seeking depression treatment is encouraged and a sign of strength—not weakness. Let professionals help you so that you can be mentally ready to grow your family in the future.  

Legal and Ethical Considerations

Fertility preservation comes with its fair share of legal and ethical dilemmas. Laws regarding almost every part of the process vary by region, so you should investigate the laws in your area. The same goes for ethical considerations, as some areas are more conservative.  

To counter this, a reproductive attorney should be part of your family-building team. Not only do they specialize in fertility, but they know the local laws and ethical implications of this choice. 

How to Choose a Fertility Clinic?

When looking for fertility preservation options for transgender individuals, the right clinic will make all the difference. As a transgender patient, you should look for available services for each clinic, proximity of the clinic, and factor in recommendations from other transgender people.  

When choosing a clinic for your needs, look for: 

• Clinics that have worked with transgender individuals 

• Facilities that offer mental health support for those struggling 

• Places that offer financial assistance and insurance 

Final Thoughts

Fertility preservation options for transgender individuals offer different ways for people to plan their future families. By understanding all the methods available, you can make an informed decision. It is a big step that will greatly impact your future, so don’t take the decision-making lightly—put time and thought into it! 

Resources: 

https://www.uclahealth.org/medical-services/obgyn/fertility/egg-freezing 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913892/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/ 

https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/fertilitypreservation