Fertility Care for Trans Men: How RHWC Can Help

Regardless of one’s gender identification, the choice to start a family is a significant driver of self-identification and validation of our humanness. Individuals who identify as transgender or gender nonconforming (TGD) report interest in having children at rates comparable to cisgender people.

Comprehensive fertility counseling before the start of gender-transitioning therapies is essential to the care of patients who identify as transsexual, since several medical and surgical gender-affirming therapies may alter the capacity to reproduce. Both trans men and trans women may face unique fertility challenges. Fertility is a complex issue for both groups that involves the proper understanding of the changes in the reproductive system due to gender transitioning. Such individuals need to be proactive in empowering themselves with the knowledge and information that may help them to ensure that they can have a chance at achieving parenthood through the birth of their biological children.

Trans Men Fertility: What are the Treatment Options?

More than a million Americans identify as transgender, which means their own gender identification differs from the sex they were assigned at birth. 1% to 3% of Canadians identify as transgender or gender-diverse, and 40% to 54% of TGD individuals want to have children. While transgender people and gender-diverse individuals desire to parent at levels similar to cisgender people, evidence reveals that many do not obtain proper fertility guidance.

Transgender men and women can have children of their own, with the array of treatment choices made available to them, thanks to modern medicine. The use of partner or donor sperm, as well as egg and/or embryo freezing (cryopreservation), are some of the fertility possibilities for trans males. Trans men may need IVF (also known as the trans IVF process) using their own, their partner’s, or a donor’s eggs or they may choose to have IUI using a donor’s or partner’s sperm. They have the option of transferring embryos to either their uterus, their partner’s uterus, or a gestational surrogate. Let us learn about each of these options in detail.

Trans Men Fertility and How Testosterone Affects It?

Even after over a decade of testosterone use, hundreds, perhaps even thousands, of transgender men have successfully given birth or contributed their eggs to pregnancy in some way or the other. When taking testosterone, the body typically stops ovulating.  Instead, the eggs are just absorbed over time and slowly the egg reserve decreases.   

 When stopping testosterone, ovulation may or may not resume – the longer a person is on testosterone, it becomes less likely that the ovaries will resume normal function. However, a Boston IVF study discovered that the amount and quality of eggs (as well as other factors related to pregnancy and egg harvesting) were the same in transgender men and cisgender women.  Transgender men, who have their eggs collected or harvested through IVF, (in which the eggs are fertilized with sperm in a lab, and the resulting embryo is reimplanted in the body) experience pregnancy in the same ways and had the same results as the cisgender women in the study. Trans pregnancies can be very similar to regular pregnancies; however, if a person using testosterone therapy gets pregnant and intends to take the baby to term, it is imperative that they stop taking their hormones for the duration of the pregnancy. The developing fetus may suffer severe harm as a consequence of continued testosterone treatment.

Fertility Preservation in Trans Men

In most cases, trans males are counseled to preserve their fertility in a manner akin to that of cisgender women. Options for fertility preservation for TGD (Trans and Gender Diverse) persons with ovaries include 

• egg freezing, or oocyte cryopreservation
• embryo freezing, and
• ovarian tissue freezing
• IUI (intra uterine insemination or artificial insemination)
• IVF (in vitro fertilization)

Generally speaking, there are two options for trans individuals looking to start or grow their own families.

1) Preservation of fertility in TGD adults who wish to have a biological child in the future.

2) Fertility therapies for TGD adults who are at the point of embarking on the journey of parenthood.

Fertility Preservation Options for Trans Men

Cryopreservation of oocytes or embryos is the desirable fertility preservation treatment option. This involves injectable fertility treatment or an oral-injectable drug combination, called controlled ovarian stimulation (COS), and subsequent ultrasound monitoring. Although there is little research on COS following high-dose testosterone gender-affirming hormone therapy, there do not appear to be any long-term negative effects on the ovaries from testosterone.

Patients can then freeze unfertilized eggs or freeze fertilized eggs. For the latter, the person must decide whether they want sperm from a donor or a partner to be on hand when the eggs are being extracted.

There are several benefits to freezing embryos as opposed to eggs, such as greater clarity regarding how the eggs may fertilize and develop into high-quality blastocysts. Unlike eggs, blastocyst-stage embryos can also undergo preimplantation genetic testing for aneuploidy (chromosomal abnormalities).

It is advisable for trans men considering ovary removal surgery to freeze their eggs first (or embryos). The ability to carry a pregnancy will be lost if a trans man decides to have a hysterectomy to remove his uterus.

Fertility Care for Trans Men: Options to Achieve Pregnancy 

A genetic connection to future offspring is still very much possible for trans men who do not wish to get pregnant themselves. In order for this to occur, a trans man can donate his eggs during an IVF procedure. The embryos produced by those eggs can then be transferred to either a partner’s uterus or the uterus of a gestational carrier.

It is possible to use a gestational carrier, often known as a “surrogate,” to carry a fetus if a trans man has undergone gender-affirming surgery to remove the uterus or if he simply doesn’t feel comfortable stopping his hormone treatments and going through the pregnancy process. With appropriately screened gestational carriers and high-quality embryos, IVF success rates are often very high.

• IUI (Intra-Uterine Insemination) or Artificial Insemination

Many trans men (who have temporarily stopped taking testosterone), who happen to engage in penetrative intercourse with their partner, can become pregnant without the help of a doctor or artificial reproductive techniques. 

If help to get pregnant is needed, IUI, or intrauterine insemination, is one of the least expensive and invasive reproductive treatments available.  This process, also known as artificial insemination, comes the closest to natural conception. An IUI involves inserting processed sperm into the junction of the fallopian tube and the uterus via a thin, flexible tube. This ensures that substantially more sperm than would typically occur during sexual activity reach this crucial spot. The sperm may come from a donor or a partner.

The majority of transsexual men opting for IUIs do not have a diagnosis of underlying infertility. However, IUI success rates can vary greatly based on several variables, most notably the age of the individual carrying the pregnancy to term.

• In Vitro Fertilization

In vitro fertilization or IVF, offers a wide range of choices for transmasculine family formation. The IVF procedure involves removing eggs from the ovaries, fertilizing those eggs in a lab, growing the resulting embryos, and then transferring those developing embryos into the uterus. The eggs, sperm, and uterus can all be provided by different people, thanks to the versatility and flexibility of the IVF procedure. As long as the uterus hasn’t been removed as part of the transition, a trans man can carry the embryos till the term of pregnancy. Sperm can be donated by a partner or donor, and eggs can be provided by a partner or donor as well.

Reverse IVF is another option for trans men, whose partners have a uterus.  Reciprocal IVF allows both partners to biologically contribute to the future child. One partner (usually the trans man) contributes the eggs. These eggs are then fertilized using donor sperm. The resultant embryos are transferred into the uterus of the female partner who carries the pregnancy to term.

Parting Thoughts

Pregnancy and parenthood have frequently been discussed in terms of heteronormative, cisgender family arrangements. Patients who don’t fit into this gender- and sexual framework have traditionally faced discrimination, been denied access to assisted reproductive technologies, and even had their parental competence questioned. Community physicians can assist in educating transgender, non-binary, and gender-variant patients on the various options for birthing a biological child.

At Reproductive Health & Wellness Center, a premier fertility clinic in Orange County, CA, we are honored to help all patients achieve their dreams of parenthood and we will always be proud supporters of the LGBTQ community. We also understand that same-sex and transgender couples/individuals have unique fertility needs, and we offer a wide array of reproductive options for transgender patients.

If you are a transgender individual and wish to start your family, we welcome you to schedule an initial consultation with our fertility doctor. At that visit, we will review your medical history, family goals, and any necessary testing. You will also learn about the different family-building options you have for moving forward.

Contact our fertility specialist today.