Trans patients often face unique challenges when it comes to fertility preservation. For many, the process of transitioning can have a negative impact on their fertility, making it difficult or even impossible to have children later on. Gender-affirming surgeries can also impact the possibility of having children in the future.
While it is possible for transgender individuals to have normal pregnancies post their transition before gender-affirming surgeries, due to the changes in hormone levels, infertility is a real challenge. Fortunately, there are fertility preservation options available for trans patients.
This blog post will explore some of these options and what they involve. We will also discuss the challenges that trans parents face when it comes to fertility preservation and how best to overcome them.
Why Fertility Preservation is Important for Trans Patients
Fertility preservation remains to be a viable option for trans patients because of the impact that HRT and other gender-affirming care have on their reproductive health. Fertility preservation methods have advanced today because of the advancements in assisted reproductive technology. This has been especially helpful for cisgender people who are choosing to have children later in life and thus need ways to preserve their fertility. These methods have also helped cancer patients who are undergoing radiation therapy and other forms of treatments. Issues such as breast cancer and cervical cancer are quite common and radiation treatment and chemotherapy can impact fertility. These methods have helped cancer survivors have biological children once they are out of cancer therapy.
For transgender patients, similar approaches to fertility preservations are important in ensuring that they have a chance to have children of their own later in life. If you are choosing to undergo only hormone replacement therapy and not undergoing gender-affirming surgery, then it may be possible for you to have normal pregnancies. But the dysphoria as well as the impact of hormone treatment can make it hard and hence fertility preservation is preferred.
There are other experimental procedures that are being explored currently including uterine and ovarian transposition where a trans woman may be able to receive a uterus and ovaries from another woman and can give birth using this. However, this has only been successful in cisgender women so far and is still a long way away from being a valid option for trans women. Gestational surrogacy or normal pregnancy after stopping their hormone therapy are the only ways in which trans patients can have children today and both these methods would need some fertility preservation methods for success.
The Different Methods of Fertility Preservation
There are a few different methods of fertility preservation for trans patients. One is sperm freezing, which can be done before or after the transition. Another is egg freezing, which requires hormone therapy to stimulate egg production. Lastly, there is ovarian tissue freezing, which can be done before or after the transition. All of these methods are considered equally effective and have similar success rates. The choice of method may depend on individual circumstances, such as whether the person has had surgery or not.
Sperm freezing is the most common method of fertility preservation for trans women. It is a simple and quick procedure that can be done at any fertility clinic. The sperm is collected in a sterile container and then frozen in liquid nitrogen. Sperm samples can be stored for many years, and thawed when needed. Sperm cryopreservation should be done before the hormone therapy begins for the best results. Sperm samples can also be obtained surgically in case normal ejaculation is not possible or preferred. In the case of pre-pubescent transitions, there are experimental procedures by which testicular tissue is collected and preserved in the hopes that spermatogenesis can happen via these samples. In case the patient is already undergoing HRT, this will have to be stopped temporarily for almost 3 months before collecting the sperm samples.
Egg freezing is the chosen method of fertility preservation for trans men. This requires ovarian stimulation and egg retrieval. The eggs are then frozen and stored for as long as the patient desires. Since ovarian suppression is common in transgender individuals, collecting oocytes from the follicles of the ovaries is a great option to preserve fertility.
Ovarian tissue cryopreservation is a new method of fertility preservation that is still being researched. It involves removing a small piece of ovarian tissue and freezing it. The tissue can then be transplanted back into the body at a later date, where it will hopefully start producing eggs again. This method has the potential to be used by trans women who have not had surgery, as well as those who have had surgery but still have some ovarian tissue remaining.
In some cases, embryo cryopreservation is also used for fertility preservation. In the case of transgender individuals with partners, embryo freezing can be done where the egg is fertilized using the partner’s sperm or donor sperm and the embryo is frozen and stored. This embryo can then be thawed and implantation can be done in the uterus or that of a gestational carrier.
What to Expect When undergoing Fertility Preservation
When undergoing fertility preservation, trans patients can expect to receive comprehensive care from a team of fertility specialists. This care may include counseling on fertility options, testing to assess reproductive potential as well as any genetic issues, and procedures to collect and store eggs, sperm, or embryos.
Trans patients who elect to undergo fertility preservation should be prepared to make decisions about their future fertility treatments. They will need to consider whether they wish to use their stored gametes (eggs, sperm, or embryos) themselves, or donate them to another person or couple. It is also important to consider the costs of fertility preservation and treatment, as well as the potential risks and side effects.
Fertility preservation can be a complex and emotionally- charged process for trans patients. However, with careful planning and support from a team of experts, it can be a successful way to preserve reproductive potential and give trans patients some peace of mind about their future fertility options.
Alternatives to Fertility Preservation
There are many ways to have children as a transgender person. Some trans people choose to get pregnant and give birth, while others use alternative methods such as adoption, surrogacy, or donor insemination.
Adoption is another option for trans people who want to become parents. Adoption can be a great option for those who do not wish to undergo fertility treatments or who are not eligible for them. There are many wonderful children in need of homes, and there are also many LGBTQ-friendly adoption agencies that can help match you with a child who is right for your family.
Surrogacy is another option for trans parents-to-be. A surrogate is somebody who carries and gives birth to a child on behalf of another person or couple. This can be an option for those who cannot carry a pregnancy themselves or who do not want to go through the experience of pregnancy and childbirth.
However, in the case of surrogacy or for normal pregnancy, having a good-quality egg and sperm is necessary for successful in-vitro fertilization (IVF). Hormone replacement therapy can significantly impact reproductive function and hence egg and sperm banking for future use is a way to have a backup plan in case they are not able to produce viable eggs or sperm when they are trying to build a family.
Fertility preservation is an important step for trans patients who want to have children later in life. It allows them to have the option of using their own eggs or sperm to conceive, rather than relying on a donor. There are many different ways to preserve fertility, and each has its own benefits and risks.
It’s important to understand the impact that the various treatment options you are going to undertake on your fertility. Ask your healthcare provider for advice and more information before you begin the process of transitioning.
Fertility preservation gives you options as a trans person to have biological children at a later date. Even if you are not sure about having children today, it makes sense to store your eggs or sperm for future use. It may be useful for you if you decide to have kids or it may be of use to others in case you choose to donate it at a later stage!
Want to know more about your fertility preservation options? Talk to us at Dreams Fertility. Our fertility specialists will take you through all your options and be with you every step of the way as you make your choice. Get a consultation today!
Dr. Luis Murrain joined Dreams Fertility in 2021, providing specialty services in Fertility and Reproductive Genetics. With a shared vision that everyone deserves to have the family of their dreams, we are dedicated to helping all of our patients. We believe that families come in all shapes and sizes, and all of them are beautiful. We are proud to have a long history of providing services to all, including gay, lesbian, and transgender individuals and couples on their road to parenthood.