Fertility Preservation for Trans People

Transgender individuals are often surprised to learn about the potential of fertility preservation and the potential to preserve gametes with the option of biological children in their future.

One third to one half of transgender adults report they would have considered freezing gametes (sperm or eggs) before gender-affirming therapy if offered. In another study, approximately 25 percent of transgender adolescents express interest in having biological children. However, less than 5 percent of transgender adolescents have opted for fertility preservation.

For transgender individuals, gender is not the gender assigned at birth. Individuals may be anywhere on the transgender spectrum and may or may not have undergone gender-affirming surgery. Given this broad transgender definition plus underreporting of transgender status, identifying transgender individuals, and offering comprehensive and supportive care can be challenging.

New guidelines from the World Professional Association of Transgender Health (WPATH), American Society for Reproductive Medicine, and Endocrine Society include counselling and discussion of options for gamete preservation prior to initiation of hormonal treatments. What issues hamper fertility preservation services for transgender individuals?

• Fear of medical professionals’ misunderstanding or bias.
• Lack of finances and insurance coverage for medical services. Countries with global fertility preservation coverage have more individuals opt for gamete preservation, especially transfeminine individuals.
• Insufficient fertility preservation counseling.
• Gender dysphoria and anxiety about the process of gamete preservation. Currently, fertility preservation requires the individual to progress through puberty in the non-congruent gender.

Providing Options for Transgender Individuals

Mayo Clinic’s Dr. Khan explains, “Reproductive endocrinology and infertility specialists have adopted oncology-related fertility preservation methods for transgender individuals because of insufficient transgender population data. Scarce data directly relate to socioeconomic challenges and inadequate health care access for this group. Fertility preservation for transgender individuals is something I value. At Mayo Clinic, we want to provide help and attention for gender affirmation — and the bonus layer of fertility preservation. Our team wants to provide patients hope for a typical life. It’s exciting to participate in saving someone’s ability to conceive.”

Fertility Preservation Methods for Trans Individuals

For transgender men, oocyte or embryo cryopreservation is ideal. This involves controlled ovarian stimulation (COS) with injectable fertility medication or an oral-injectable medication combination and then ultrasound monitoring.

For transgender women, sperm or testicular tissue cryopreservation is utilized, which is less complex than fertility preservation for trans men.

Here at FSMG, we believe that health care providers seeing transgender patients have pivotal roles for ensuring fertility-preservation education and options to preserve gametes, if desired. To learn more about this topic and speak to one of our physicians about fertility treatment, you can request a consultation here.