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Fertility Treatments for Transgender Couples

Published on June 17, 2019 by SCRC Contributor
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We’re proud to support transgender individuals and couples with fertility services to help start your family. You have numerous options, enabling you to choose what’s best for yourself and your family. Our team of fertility specialists will help by providing information and answers to your questions.

Some of the most common questions we get are: What are my options? Does hormone therapy decrease fertility? Do I have to stop taking your hormones? For how long?
If you haven’t begun hormones, medications or gender confirmation procedures, now is a good time to see a specialist about cryopreservation (freezing) of eggs or sperm. It may make conception less challenging, whether in the near or distant future.

It is not a problem if you are already on hormones, however, and we encourage you to talk to us today about all of your options.

Choosing Your Future

Just as you may have pursued medical, hormonal and other paths to live your preferred gender, there are many paths to parenthood and many emotions that accompany the experience. That’s true for every parent, and that’s especially true for transgender parents. You will likely feel both empowered and excited as well as other complicated emotions including fear and uncertainty. There is no single right way to feel about it. And if you choose to use your own reproductive system, it can be even more of a roller coaster.

No matter what you choose, we’re here to support you through your fertility journey. We strongly encourage you to gather a strong support system, too.

Fertility Treatment Options for Trans Women

Several fertility options exist for trans women. Because long-term estrogen use impacts sperm quality, it’s ideal to preserve your sperm through cryopreservation (freezing) for future use before starting estrogen. If already on hormones, you may pause for a few months or more to generate higher quality sperm. In either case, intrauterine insemination (IUI) and in vitro fertilization (IVF) are two great options when sperm quality is impacted. IUI is less invasive and less expensive than IVF. IVF can be used with a partner or donor eggs, and carried using the partner’s uterus or a gestational carrier.

You may also not wish to suspend hormone treatment. Surgical extraction and other routes are available. Talking with a specialist can help you decide what’s best for you.

Fertility Treatment Options for Trans Men

Similar to trans women, trans men may choose to freeze eggs or embryos, or undergo IUI or IVF procedures with a partner or donor. You may also choose to use a surrogate, or to carry the baby yourself. Each state has its own laws the govern donors and surrogates.

We’ll talk about some of the preparations and implications below. Be sure to talk to a specialist in your state about how the laws will affect your choice.

It’s important to note that testosterone cannot be taken during pregnancy or while breastfeeding. High testosterone levels are toxic to a developing fetus, and may inhibit lactation.

Your Ovaries and Uterus

Are you planning to remove your uterus and/or your ovaries? Egg retrieval makes it possible to bank eggs for future use or use for immediate fertilization. Not as much information is obtained from frozen eggs as compared to frozen embryos, but either are good options to transfer back into the original donor or a surrogate to carry the pregnancy.

Regarding a hysterectomy, you may wish to hold off if you’d like to get pregnant. There are options if you’ve already had your uterus removed, or are determined to, but it’s certainly trickier. Because testosterone does not automatically eliminate your chances of pregnancy, especially early on in a hormone regimen, some plan their hormone therapy around (after) childbearing. Talking with a specialist can help you decide the best course of action.

Can I get pregnant if I’ve been on hormones?

First, it is possible to get pregnant if you’ve been on hormones. It’s also true that years of hormone therapy can make it more challenging, however.

Trans men who have been on testosterone often have their menstrual cycles return after stopping hormones, allowing for ovulation and pregnancy. The longer you’ve been on testosterone, the longer it may take to return. You may require assistive technologies to become pregnant. Hysterectomies and other surgeries open up avenues for further conversation with a specialist who may be able to help with conception. Other options are also available, including donors, adoption and surrogacy. Even if you’ve had a hysterectomy but still have ovaries, then it is possible to harvest your eggs.

Trans women taking estrogen will likely be advised to stop estrogen for a few months in order to conceive. Estrogen affects ejaculate quality as well as erections and functions integral to conception.

What About Breastfeeding?

There isn’t much research, and what there is largely anecdotal, but it seems that hormone therapy may allow for breast tissue to grow and, ultimately, for you as a trans parent to breastfeed your child. Both mechanical stimulation and medications can aid in milk supply.

Even if you don’t breastfeed, though, an at-breast supplementer, which allows for a baby to be fed at the breast with milk supplied through the nipple via tubes, can provide a similar bonding, nurturing experience.

Other Options

There are so many fertility options available. We’ve talked about how to optimize your own chances of conception. But what if you’re interested in surrogacy or the services of a donor? We’ve handpicked some articles just for you.

Egg donor: We offer comprehensive egg donor services to find you the right match and make the process as smooth as possible.
Sperm donor: Though we work with only the best sperm banks, we also welcome our clients to choose their own donor.
• Surrogacy: We are a top-ranked IVF surrogacy clinic, which you can read all about here.

When cryopreservation and gestation aren’t right for you, these are excellent options for starting your family.

The Big Picture

Most transgender people transition in reproductive years. According to a 2012 study, 62% of trans men wanted kids. Statistics are similar among trans women. Many are able to have successful pregnancies with assistive technologies.

However complex fertility is, it’s even more so for the transgender community. At Southern California Reproductive Center, we take your health seriously and personally. We want you to feel safe and welcome at our clinic, and strive to give you a positive, supportive experience. The hormones, medications and/or procedures that help you to live as your preferred gender can make conception and pregnancy more challenging, but it doesn’t make it impossible and it doesn’t preclude you from excellent care.

Talk to one of our fertility specialists about how we can help get your family started and support you along your fertility journey.

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