There is a broad spectrum of treatment options for trans individuals and couples, both pre-and post-transition depending on the individual situation[1]. Some transgender patients may be able to conceive independently, and some may need the help of assisted reproductive technology to build their families.
Fertility options for trans women
For trans women, options include sperm cryopreservation (freezing), intrauterine insemination (IUI), in vitro fertilization (IVF), and gestational surrogacy.
Sperm freezing
Gender-affirming hormone therapy, such as other aspects of gender transition, can significantly impact the health of a person’s sperm and the ability to create a pregnancy in the future. Thatʼs why the appropriate kind of fertility preservation for trans women is sperm freezing. It is the cryopreservation method of one or more semen “samples,” or ejaculates, for possible use during pregnancy attempts later.
Trans women or girls can start their sperm freezing as soon as they turn puberty and produce sperm. The best time for cryopreserving sperm is before the beginning of the medical gender transition because estrogen and antiandrogen drugs may impair sperm production and fertility outcome[2]–[3].
The process of sperm freezing looks like follows: A person produces semen via masturbation. This sample must be processed and analyzed in the laboratory to estimate its quality. If it is healthy enough, it will be placed into liquid nitrogen. This sperm will be stored at a temperature of -196ºC, at which all biological processes stop.
However, other fertility options are available for trans women, even without preserving their fertility.
Intrauterine insemination (IUI)
Transgender couples have the available method of intrauterine insemination using trans woman sperm if there are still penis and testicles, and female partnerʼs uterus or using partnerʼs sperm and surrogateʼs uterus. When the semen analysis shows low sperm motility or concentration, the method of intracytoplasmic sperm injection (ICSI) can be helpful. If a trans woman cannot produce sperm but has frozen semen samples, it can be used during IUI or IVF. When cryopreservation wasnʼt provided, donor sperm can be used.
In vitro fertilization (IVF)
IVF options for trans women:
- IVF, using own fresh or frozen sperm and female partnerʼs egg, the embryo is transferred to the female partnerʼs uterus
- IVF, using own fresh or frozen sperm and female partnerʼs egg, the embryo is transferred to the surrogateʼs uterus
- IVF, using partnerʼs sperm, donor egg, the embryo is transferred to the surrogateʼs uterus
- IVF, using donor sperm, donor egg, the embryo is transferred to the surrogateʼs uterus
- IVF, using own and partnerʼs sperm, donor egg, the embryo is transferred to the surrogateʼs uterus
Fertility options for trans men
It’s certainly possible for trans men to get pregnant and have healthy babies. There are fertility options for them.
Egg or embryo freezing
Perfectly, egg freezing must be done before the beginning of hormone therapy. As researches show, testosterone treatment contributes to anovulation. The majority of trans men taking testosterone stop having periods within six months[4]. Nevertheless, recent studies say that fertilization outcomes may be successful, even if a person has undergone hormone therapy[5].
The egg freezing process looks like follows: beginning with the second day of periods, a person should take hormone medications to stimulate the ovaries to release eggs. After the eggs have matured, the doctor will provide egg retrieval, which takes about 15 minutes. The therapist will gently insert a needle attached to a catheter through the vaginal wall. One by one, the eggs will be drawn out using light suction, collected in test tubes with the name and unique identification number written on the label. Finally, the eggs will be frozen (cryopreserved). After the procedure, some spotting, soreness in the vaginal area, some abdominal cramping may appear. But don’t worry, these unpleasant symptoms will escape in the following days.
Intrauterine insemination (IUI)
Before gender transition, trans men may use the IUI method, using partnerʼs or donor sperm. Semen will be injected into the uterus, and trans men will be able to carry this pregnancy. If a trans man feels uncomfortable about pregnancy carrying, his partner could undergo the IUI procedure if itʼs possible. Alternatively, the couple can try IVF.
In vitro fertilization (IVF)
IVF options for trans men:
- IVF, using own frozen egg, partnerʼs sperm, the embryo is transferred to the surrogateʼs uterus
- IVF, using partnerʼs egg, donor sperm, the embryo is transferred to the partner’s uterus
- IVF, using partnerʼs egg, donor sperm, the embryo is transferred to the surrogateʼs uterus
- IVF, using donor egg, partnerʼs sperm, the embryo is transferred to the surrogateʼs uterus
- IVF, using donor egg, donor sperm, the embryo is transferred to the surrogateʼs uterus
- IVF, using own frozen and partnerʼs egg, donor sperm, the embryo is transferred to the surrogateʼs uterus
- IVF, using own frozen and partnerʼs egg, donor sperm, the embryo is transferred to the partnerʼs uterus
References
- Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril. 2015 Nov;104(5):1111-5. doi: 10.1016/j.fertnstert.2015.08.021.
- Marsh C, McCracken M, Gray M, Nangia A, Gay J, Roby KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet. 2019 Aug;36(8):1639-1648. doi: 10.1007/s10815-019-01504-y.
- Schneider, F., Kliesch, S., Schlatt, S. Neuhaus, N. Andrology of male-to-female transsexuals: influence of cross-sex hormone therapy on testicular function. Andrology, 2017; 5: 873-880. doi: 10.1111/andr.12405.
- Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017 Nov 1;2(1):195-201. doi: 10.1089/trgh.2017.0021. PMID: 29142910; PMCID: PMC5684657.
- Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014 Dec;124(6):1120-1127. doi: 10.1097/AOG.0000000000000540.