Family planning for Trans and Gender-Diverse people

There are many options available to help you create a family. In this post, we help explain these options, so you know what you can do and where to get support as a future parent.

How can transitional hormones impact fertility?

Before exploring your options for starting a family, it’s important to understand how medical affirmation can impact fertility.

Different forms of medical affirmation may interrupt, reduce or turn off natural fertility functions.​ Some methods (like hormones) have reversible impacts on fertility, while others (like surgery) can be more permanent.

Testosterone therapy impacts the menstrual cycle and stops periods and egg production, while oestrogen (and anti-androgen) stops the production of sperm and the ability to have an erection or ejaculate¹. If you go down the surgical route and have your reproductive organs sterilised or removed, this eliminates your ability to produce either eggs or sperm and reproduce without assistance.

Transitioning is a deeply personal choice. It’s entirely up to you how you choose to present and the extent to which you want to transition. We’re here to make sure you have all the information available, so you can make choices and plan for the future in a way that feels right for you.

How can I plan a family?

The best first step you can take to planning your family or preserving your fertility, whatever your orientation or gender identity, is by speaking with a fertility specialist.

Our reproductive health experts are here to help people build families in a way that factors in their unique circumstances. While it’s advised to think about your fertility and chat to these experts before starting medical affirmation, we understand it’s not always an option if you’ve already begun or completed the process.

However, if you haven’t thought about fertility preservation before beginning medical affirmation/transition – there’s still options available to you. Wherever you’re at in your transition, there’s options to help you plan your family.

Pre-transition preservation

Preserving your fertility before starting hormones or undergoing surgery can give you better chances at creating a genetically related child. This process involves collecting and freezing the reproductive cells your body produces (i.e. egg or sperm) and saving it for later. By doing this, you can use your DNA for fertility treatments down the line.

Testosterone users

For people starting testosterone, fertility preservation options include:

• Freezing eggs
  This involves multiplying eggs via hormonal stimulation before extracting, freezing and storing them for future fertility treatments¹.

• Freezing embryos
  This takes things a little further, working by taking eggs and a partner’s or donor sperm to create an embryo before freezing it for later use¹.

• Freezing ovarian tissue
  Though uncommon, this is a surgical procedure where a small amount of ovarian tissue is collected, sliced, frozen and stored. These tissue slices can be thawed and transplanted back at a later date (if uterus and ovaries aren’t removed) with the aim to restore natural hormone production and egg release.¹

Oestrogen Users

For people starting oestrogen, fertility preservation options include:

• Freezing sperm
  This involves collecting sperm from ejaculation (or surgical extraction) and freezing them for future use¹.

• Freezing testicular tissue
  This is a procedure involving surgically extracting and freezing a portion of testicular tissue, then thawing it at a later date to try and retrieve sperm from it¹. It can prove useful for those unable to produce sperm, ejaculate or have no sperm present in their ejaculate.

Post-transition assistance

If you’ve already transitioned, here’s what you can do about fertility during or following your transition.

Testosterone users

• Egg retrieval
  Even if you’ve commenced testosterone treatment, it’s possible to collect healthy eggs from your ovaries to fertilise and create embryos – even years after testosterone use. To give this method a shot, you’ll have to temporarily pause the testosterone to stimulate the ovaries to produce eggs​; your specialist will keep this period as short as possible as to not interfere with your transition excessively².

• Natural reproduction
  Testosterone therapy is not a contraceptive and some people on it do fall pregnant without fertility treatment. If you haven’t had your uterus and ovaries removed, it may be possible to cease hormone treatment, begin to produce eggs again, and try to conceive¹. If you’d be open to carrying a pregnancy, you’ll want to stop T prior to conception, so it’s a good idea to talk to your fertility specialist before trying. This approach needs to be carefully managed medically and may create emotional challenges, so bear this in mind and discuss with your specialist first¹.

• Assisted reproduction
  If you haven’t had your uterus and ovaries removed, pregnancy also remains possible via intrauterine insemination (IUI) or in vitro fertilisation (IVF) using donor sperm or partner sperm¹. If you still have your original reproductive organs, and frozen ovarian tissue, you may also be able to grow your family this way.

• Partner or surrogate pregnancy
  If you have frozen eggs or embryos, but have had your uterus and ovaries removed, your genetically related child may be born using a surrogate or your partner (if they have a healthy uterus and are willing) using your thawed eggs or embryos¹.

Didn’t freeze your eggs or embryos? That’s ok – there is always the option to use donor eggs to grow your family.

Oestrogen users

• Sperm regeneration
  Oestrogen treatment is not a contraceptive and even after a long time on it, some people on it may still be able to make viable sperm. If you haven’t had surgeries impacting your reproductive organs, it may be possible to temporarily cease hormone treatment and produce sperm again with the aim to freeze them.

It’s a no-go to freeze sperm while on estrogen; halting estrogen for at least three months before preserving fertility is recommended to get the healthiest sperm. Stopping hormone therapy may create additional emotional challenges and needs to be carefully monitored by medical professionals, so consider this option carefully¹. If you have frozen testicular tissue on hand, you may be able to regenerate sperm this way.

• Partner or surrogate pregnancy
  If you have a partner with sperm, pregnancy with the use of an egg or embryo donor is an option. If you have a partner with a uterus and ovaries, they could carry for the pregnancy using donor sperm treatment¹. Planning on being a solo parent? You can always look into IVF and a surrogate using embryos created with donor eggs and donor sperm.

• Using frozen sperm
  If you have a partner who has eggs and a uterus and is willing to carry a pregnancy, your frozen sperm can be thawed and used for IVF or IUI¹. Surrogacy is an option if you don’t have a suitable partner to carry a pregnancy or you’re hoping to be a solo parent¹. Depending on your situation, you may need to source a known egg donor to use your donor sperm¹

The bottom line

Everyone deserves the chance to start a family and take a baby home, and with the help of fertility preservation and treatment options you can make those dreams a reality.

If having a child one day is something you desire, seek out a fertility specialist to go over your options and pave a pathway to parenthood, specific to your circumstances.

Monash IVF provides an inclusive, safe and non-discriminatory environment and support trans, gender fluid or non-binary individuals with fertility advice through transition and beyond.

References

1. Victorian Assisted Reproductive Treatment Authority (VARTA) (n.d.) Preserving fertility. Available at: https://www.varta.org.au/ferti... (Accessed: [20 June 2024]).

2. Anazodo, A., Laws, P., Logan, S., Saunders, C., Travaglia, J., Gerstl, B., Bradford, N. & Cohn, R. (2019) ‘How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care’, Human Reproduction Update, 26(1), pp. 1–22. Available at: https://pubmed.ncbi.nlm.nih.go... (Accessed: [20 June 2024]).