Transgender people are starting families more than ever before. However, their needs are not being met by a healthcare system that still prioritizes heteronormativity. Here’s what you need to know as a trans person starting your fertility journey. 

The three potential steps of transitioning

Gender transition is an incredibly personal process that begins with the exploration of gender identity. When someone feels ready to move forward with actions to affirm their gender, the steps may include social and medical transition. None of the following is required to validate a gender identity, and there is no specific order for these steps. 

1. Social—a social transition, changing how one presents themselves

2. Medical—taking hormones or other medications to align the body more closely to gender identity

3. Surgical—undergoing surgical procedures, also meant to align the body more closely to gender identity

The impact of hormone therapy on fertility 

There are a lot of unknowns around the long-term impact of hormone therapy on sperm and egg production. There hasn’t yet been extensive research on which hormones contribute to the loss of sperm and egg production or exactly how long it takes to regain fertility after pausing hormones. Here’s what we do know: 

  • Some people pause hormone therapy to potentially allow for conception. While there is no guarantee fertility will be restored, there have been natural conceptions using this method. 
  • Many of the changes to a trans person’s physical appearance due to hormone therapy are reversible, meaning that pausing hormones will lead to a reversal. This shift can trigger gender dysphoria. Because of these effects and the impacts on mental health and daily life, many trans people will opt not to pause or stop hormones, choosing to explore other options like surrogacy or adoption
  • While only three percent of trans people preserve their fertility, 51 percent of trans women wish they had. 

Options for fertility treatments for trans people

There are surgical transitions that take away access to someone’s own eggs, sperm, or uterus, and some medical transitions can have potentially negative effects on the quality or viability of eggs or sperm. But even if someone has medically or surgically transitioned, they may still be able to have children that are genetically related to them. It’s typically recommended that people preserve their fertility before medically transitioning, but individuals should talk to their healthcare providers to create a personalized plan for their fertility journey. 

The current options to have biological children for trans men (a person who has transitioned from female to male) are: 

  • Embryo cryopreservation: The procedure removes eggs from the ovaries, fertilizes them to create embryos, lets them grow for several days, and freezes them.   
  • Oocyte cryopreservation: Also called egg banking, egg cryopreservation, and egg freezing, oocyte cryopreservation is a process in which a person’s eggs are extracted from the ovary, frozen, and stored.  
  • Ovarian tissue cryopreservation: Ovarian tissue cryopreservation can remove the egg-producing portion of the ovary, called the ovarian cortex, before a patient’s treatment. The cortex is then frozen and stored. The tissue can be transplanted years later to make pregnancy possible. 

The current options to have biological children for trans women (a person who has transitioned from male to female) are: 

  • Sperm freezing or cryopreservation: Sperm freezing is a procedure that takes place to stabilize sperm in subzero temperatures. If the frozen sperm is mature sperm (ejaculated rather than testicular) it can remain viable for years. 
  • Surgical sperm extraction: This procedure involves retrieving sperm surgically, often coordinated with a partner’s egg retrieval. The sperm is then frozen and stored. 

How Maven can support trans people on their fertility journey 

Maven is here for you, no matter what steps you choose to take on your fertility journey. When you join Maven, you’ll be assigned a dedicated Care Advocate who can help you find the right providers and advocate for your needs throughout your fertility journey. With Maven, you have 24/7 access to a team of providers like Reproductive Endocrinologists, Fertility Awareness Educators, OB-GYNs, and more. Maven also offers surrogacy and adoption services for all members looking to build their families. 

Want to talk to someone about your fertility journey today? Join Maven to learn more.

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