Embarking on a journey toward parenthood is a profound and personal experience. For transgender individuals, this path may come with unique considerations, particularly concerning the possibility of having biological children. 

Being a trans person does not preclude the possibility of having a biological child, but it does require thoughtful planning and consideration. These medical procedures can include hormone therapies and surgeries, which are significant for many in the transgender community.

Understanding how gender-affirming treatments impact fertility and exploring available fertility options available for the transgender community is crucial in making informed decisions about family planning.

Understanding Gender Identity

What is gender identity?

Gender identity refers to a person’s internal, deeply-held sense of their own gender, which may or may not align with the sex they were assigned at birth. It is a complex and multifaceted concept influenced by various factors, including biology, culture and personal experience.

Unlike sexual orientation, which describes a person’s enduring physical, romantic, and/or emotional attraction to another person, gender identity is about how individuals perceive themselves and what they call themselves. This internal understanding can be male, female or non-binary i.e. a blend of both, or something else entirely).

What Impact can Gender-Affirming Treatments have on Fertility?

Gender-affirming treatments are essential for many transgender individuals in aligning their physical appearance with their gender identity.

Trans people seek various medical procedures, including hormone therapy and surgical interventions, to align their physical appearance with their gender identity. However, these treatments can have significant effects on reproductive capabilities.

Hormone Therapy for Trans Women (assigned male at birth)

For a trans woman who is undergoing gender transition, oestrogen therapy can suppress sperm production, potentially leading to infertility. While some studies suggest that discontinuing hormone therapy may restore spermatogenesis, this is not guaranteed and may depend on the duration and intensity of treatment.

Hormone Therapy for Trans Men (assigned female at birth)

A trans man undergoing testosterone therapy may experience disrupted ovulation and menstrual cycles, affecting fertility. Testosterone therapy is a crucial aspect of aligning a person’s gender identity with their physical appearance. The reversibility of these effects varies among individuals.

Surgical Interventions

Procedures such as orchiectomy (removal of testes) and removal of male reproductive organs in trans women and hysterectomy or oophorectomy (removal of uterus and/or ovaries) in trans men result in permanent infertility.

These surgeries can also alter secondary sex characteristics, further aligning physical appearance with gender identity. Therefore, it’s imperative to consider fertility preservation before undergoing such surgeries.

What Fertility Preservation Options Are There for Trans Men and Women? 

Preserving fertility prior to initiating gender-affirming treatments offers transgender individuals the possibility of having biological children in the future. Understanding the nuances of transgender identity is crucial in providing personalised fertility preservation options. Options include:

For Trans Women:

  • Sperm Cryopreservation:

    Collecting and freezing sperm before starting estrogen therapy or undergoing orchiectomy. This sperm can later be used in assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intrauterine insemination (IUI).

For Trans Men:

  • Egg or Embryo Freezing:

    Undergoing ovarian stimulation to retrieve eggs, which can then be frozen unfertilized or fertilized with sperm to create embryos for future use.

It’s advisable to consult with a fertility specialist experienced in fertility preservation to discuss these options before beginning any medical transition.

Navigating Fertility as a Transgender Individual

How do transgender individuals navigate fertility and family planning?

Transgender individuals often face unique challenges when it comes to fertility and family planning. For many, hormone therapy or surgical procedures are essential parts of their gender transition, but these treatments can impact fertility. Additionally, transgender people may encounter discrimination or barriers to accessing fertility services due to their transgender status.

Despite these challenges, many transgender individuals successfully build families through various means, such as adoption, surrogacy, and assisted reproductive technologies (ART). Some may choose to preserve their fertility by freezing eggs or sperm before starting hormone therapy or undergoing surgery, allowing them the possibility of having biological children in the future.

Access to comprehensive and inclusive fertility care is vital for transgender individuals. This care should address their unique needs and circumstances, and it often involves working with healthcare providers experienced in transgender care. These providers can offer guidance on the specific challenges and opportunities related to fertility and family planning for transgender people.

In England, policies and access criteria for NHS-funded IVF can vary across different integrated care boards (ICBs). Some ICBs may have specific requirements or restrictions for transgender individuals seeking fertility treatment. In other parts of the UK, there are specific policies that cover funding for fertility preservation for trans people. It’s essential for transgender individuals to research and understand the specific policies and criteria in their area to access the fertility care they need.

Navigating fertility and family planning as a transgender individual can be complex and challenging, but with the right support and resources, many people are able to build the families they desire.

Family-Building Alternatives

If fertility preservation treatments like sperm, egg or embryo freezing were not pursued prior to transition, or if biological parenthood isn’t feasible or desired, several alternative pathways to parenthood are available.

Donor Gametes

Utilising donated sperm or eggs in conjunction with ART. This option allows one partner in a relationship to have a genetic link to the child.

Surrogacy

Engaging a surrogate to carry the pregnancy. This can involve the use of preserved gametes or donor gametes. It’s important to understand the legal aspects of surrogacy, as laws vary by jurisdiction. 

What are the legal implications of having a baby through surrogacy?

If you are in the UK, even if you use your own sperm or your own eggs, the surrogate will still retain legal parental rights over the baby until it has been born and a parental order is granted to you as a parent.

Surrogacy agreements are not legally binding in the UK currently, so it is recommended that you seek advice from a family lawyer before starting a surrogacy journey.

Adoption and Fostering

Providing a loving home to a child in need through adoption or foster care. This route doesn’t involve a genetic connection but can offer the fulfilment of parenthood.

Emotional and Psychological Considerations

Ensuring transgender equality in accessing fertility and mental health services is crucial for the well-being and mental health of transgender individuals. It’s essential to address these feelings and seek support when needed.

If you’re a trans man or trans woman, or are part of a transgender couple, then you might want to consider the following before, during and/or after fertility treatment.

Counselling

Engaging with mental health professionals who specialise in transgender issues and fertility can provide a safe space to explore emotions and make informed decisions.

Support Groups

Connecting with others who have similar experiences can offer comfort, shared knowledge and a sense of community.

LGBTQ+ organisations and the Transgender Community

Stonewall,  The LGBT Mummies Tribe, Two Dads UK and New Family Social are just some of the organisations that can offer specific information and support around conception and parenting to members of the LGBTQ+ community:

What are the Financial and Legal Aspects of Having a Baby as a Transgender Individual? 

Navigating the financial and legal landscapes of fertility treatments and family building is a critical part of the process. Unlike individuals whose gender identity matches their assigned sex at birth, transgender individuals may face unique legal and financial challenges.

Financial Planning

Fertility preservation such as sperm and egg freezing and fertility treatments like IVF, IUI and ICSI can be costly.

In England, just as with same sex partners and single heterosexual people, if you are a trans individual you will have to self-fund at least six unsuccessful cycles of IUI before being considered for NHS treatment.

If you decide to use a surrogate, you may also need to pay their expenses.

So, investigate insurance coverage, payment plans and financial assistance programmes that may be available.

Legal Considerations

Laws regarding legal parenthood, parental rights, surrogacy, and gamete donation vary by location globally.

Consulting with a legal professional knowledgeable in family and reproductive law can help ensure that all agreements are valid and that parental rights are secured.

Want more help? 

At IVFN, we are committed to supporting all individuals on their path to parenthood, offering resources and expert, tailored guidance. Understanding the word transgender and its implications is crucial for providing respectful and inclusive support.

Check out our Ask The expert broadcasts on the journey to parenthood for the LGBTQ+ community here.