Fertility Treatment Options for the Transgender Community
By David Khalili, LMFT
The transgender community has long faced a variety of challenges when it comes to reproductive and sexual health. One of the most significant challenges facing transgender individuals is navigating fertility and family-building processes. Fortunately, medical advances have created many new fertility treatment options for transgender patients, making it possible for them to realize their dreams of having biological children.
For members of the transgender community, these fertility treatment options can provide a way to start or expand their family, but selecting both the right fertility care and health care provider is not easy. Hormone therapy and other aspects of gender transition can significantly impact fertility, and navigating the complex medical system and correct standards of care can be challenging. If you are a member of the transgender community and considering fertility treatment, this article will provide an overview of fertility treatments available, what to consider when selecting a treatment option, and the risks associated with fertility treatment in the trans community.
Fertility Treatments Available for the Transgender Community
Transgender people can work with fertility specialists (or reproductive endocrinologists) to use assisted reproductive technology (ART) options such as in vitro fertilization (IVF), including egg retrievals and embryo transfers, to preserve their eggs, sperm, or ovarian tissue. Egg retrieval involves retrieving eggs from the ovaries and fertilizing them with partner or donor sperm. IVF involves fertilizing eggs outside the body, and transferring the resulting embryo to the uterus. Embryo transfer involves transferring embryos that you or a donor created to yourself, your partner or a gestational carrier.
The community has the backing of many medical professionals. Health organizations worldwide, such as the American Society for Reproductive Medicine (ASRM), the World Professional Association for Transgender Health (WPATH), and the European Society of Human Reproductive Endocrinology (ESHRE) have all come out encouraging more research and visibility to fertility treatment for transgender people.
For many transgender individuals who may want to start a family, fertility preservation is a priority. Fertility preservation involves freezing eggs, ovarian tissue, or sperm for use later. The choice of available options depends on the individual and their goals for future gender transition. For transgender men, fertility preservation options include egg retrieval and oocyte cryopreservation (egg freezing), while for transgender women, the options include sperm cryopreservation (freezing) before medically transitioning or after a 3-month discontinuation of estrogen. Let’s look a little deeper into the options:
Egg Freezing
Oocyte cryopreservation, also known as egg freezing, has become a go-to for individuals undergoing fertility treatments, particularly those who have undergone transgender hormone therapy. It involves retrieving eggs from the patient and freezing them in liquid nitrogen for future use. For many, the process of IVF can be physically and emotionally draining, but the option to freeze eggs for future use can provide a sense of control, hope and empowerment in an otherwise uncertain process.
Sperm Freezing
Cryopreservation also refers to sperm freezing, which is a medical procedure that involves collecting, freezing, and storing semen in special containers at very low temperatures. It’s a relatively simple yet effective way of preserving male fertility for future use. As hormones and surgeries for transition change the reproductive organs, trans women may find it difficult to conceive, as estrogen can alter sperm count. Sperm freezing provides transgender women the chance to have a biological child later in life. The process is typically affordable and accessible, making it an empowering fertility service for people wanting more reproductive options. In some rare cases, surgical sperm extraction is recommended to retrieve the sperm for freezing.
It’s important to note that if sperm freezing doesn’t happen before a medical transition, there is still hope. This process can usually be done after stopping estrogen for three months and allowing sperm to be produced once again.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm directly into the uterus during ovulation. IUI is a relatively non-invasive and cost-effective method that can increase the likelihood of pregnancy. Although fertility treatment options for the transgender community can be limited, IUI is a viable option for many individuals seeking to start or expand their families. It typically has a higher success rate when combined with other medical treatments, such as fertility drugs.
In Vitro Fertilization (IVF)
In vitro fertilization, or IVF, is a fertility treatment that has helped countless individuals and couples achieve their dreams of starting a family. While traditionally used by cisgender men and women struggling with infertility, IVF can also be a powerful tool for transgender people who are trying to conceive a child. By using hormone therapy to stimulate the production of “ova” or eggs (also known as ovarian stimulation), these individuals can obtain viable eggs that can be fertilized in a lab and then transferred into the uterus. For many, egg stimulation can take several weeks to a few months. As mentioned before, for transgender men who are not yet ready to start a family, freezing their eggs can also be an option for preserving fertility.
What to Consider When Selecting a Fertility Treatment Option
When selecting a fertility treatment option, several factors need to be considered. These include goals for gender transition, the stage of transition, age, physical and emotional readiness for parenthood, financial resources (including insurance coverage), and availability of fertility clinics nearby.
It is also essential to work with an experienced fertility specialist who understands the unique needs and concerns of the LGBTQ+ and specifically the transgender community. Ask for recommendations from your community on trans-friendly providers. The fertility process can be stressful enough to deal with that discrimination and negligence from a naive or hostile provider may lead many to avoid treatment.
The impact of the medical transition on fertility
Hormone therapy, a critical aspect of gender transition, can significantly impact fertility. For example, estrogen therapy can impact the quantity and quality of sperm for transgender men. These changes can reduce fertility potential, making it essential for individuals to consider fertility preservation before starting a medical transition. Also, it’s important to note that studies have found that transmen who decided to get pregnant were able to return to menses after stopping testosterone for six months.
Holistic approaches to fertility treatments
Non-invasive holistic approaches include acupuncture and herbal medicine, which can complement traditional fertility treatments and reduce stress levels. Acupuncture is a traditional Chinese medicine technique that involves inserting thin needles into specific points of the body. Acupuncture has been demonstrated to improve the success rate of IVF when used in conjunction with Western medicine. This form of holistic support is often sought by transgender men who are taking testosterone to transition, as hormone therapy can decrease fertility.
Acupuncture has been shown to increase blood flow to reproductive organs, balance hormones, and reduce stress levels. It is also commonly used along with assisted reproductive technologies like egg freezing and IVF, potentially increasing the success rates of these fertility treatments. Herbal medicine may improve fertility by helping to increase the production of embryos and sperm, depending on your diagnosis.
Risks associated with fertility treatment in the trans community
Like any medical intervention, fertility treatments have risks. Using hormonal medications can increase the risk of blood clots, ovarian cysts, and ectopic pregnancy. Some who have done IVF have reported feeling impacted emotionally, and physically, as well as experiencing impacts on their romantic relationships. Some have reported feeling like all the medical exams and treatments impacted their privacy, while others note that they were impacted by the hormonal treatment. However, it’s also important to remember that some who went the IVF route have found positives in their experience, such as finding the motivation and encouragement to lean more toward a healthier lifestyle.
Transgender individuals may also face discrimination in accessing fertility treatments and overtreatment due to societal pressure. It is essential to work with a fertility specialist who understands the unique needs and risks associated with fertility treatment in the trans community.
Finding support
Regardless of your choice of treatment, the anxiety that comes with these journeys can often feel overwhelming. The shared experience of stress is where seeking social and emotional support becomes crucial. While it can be daunting to reach out to friends and family about such personal matters, taking the time to consider which supportive people in your life you can lean on can make all the difference. In addition, considering mental health support like individual and group therapy throughout the fertility process can be genuinely empowering in the face of what can feel like insurmountable obstacles.
Fertility treatment options for members of the transgender community are expanding, and everyone deserves the opportunity to start or expand their family safely and effectively. As noted, fertility preservation can provide hope for individuals who plan to start a family in the future, and evidence-based fertility treatments such as IVF can help in achieving that. Still, it’s important to address fertility concerns early in the gender transition process, and it is essential to have open communication and work with a fertility specialist who understands the needs and concerns of the transgender community.
