Family building and fertility for the transgender community

October 4, 2022 Dr. Mark Leondires 5 min read

What are the options for transgender folks on the path to parenthood?

If you are considering taking hormonal or surgical steps towards transitioning, one of the most important things to consider is cryopreservation of either your eggs or your sperm prior to the start of hormone blockers. These preserved gametes (eggs or sperm) can be used in the future to help complete a biological family-building journey – whether you’re single or partnered at that time.

Transgender Family Building

We’ve pulled together a list of facts and questions that you may be wondering about your future family and fertility as a trans person. Let’s dive in.

FAQs for Trans Persons

I plan on transitioning soon – what are my options to have a biological child in the future?

Talk to your physician about freezing your eggs or sperm before undergoing any hormonal or surgical treatment that may affect your fertility.

What does the sperm freezing process involve?

The process of sperm freezing involves a semen analysis (to evaluate your specimen before freezing), and bloodwork around the time that you freeze sperm. Fertility practices are evaluated by the FDA, and this testing will allow you to use your frozen specimen in the future.

How much sperm should you freeze? This will depend on many factors indicated by your initial semen analysis report. Your fertility specialist will be able to help you determine how many samples you should cryopreserve.

What does the egg freezing process involve?

Compared to freezing sperm, the egg-freezing process is a little bit more complicated – but is very common, so you should not have trouble finding a board-certified REI who is able to help you.

You would first take a few tests to evaluate your baseline fertility levels. Then, you would take fertility medication over the span of 2 weeks in order to ready your ovaries for a short in-house procedure called a transvaginal “egg retrieval.” You would also have to complete bloodwork around the time you freeze your eggs. Fertility practices are evaluated by the FDA, and completing this bloodwork will allow you to use those frozen eggs in a future conception cycle.

How long can eggs and sperm stay frozen?

To date, there is no known limit to how many years specimens can be cryopreserved. This allows trans people the opportunity to preserve their fertility early on in life, and then pursue family building in their 30s or 40s. Of course, your family-building plan will need to be personalized for you and your partner (if applicable). A chat with a reproductive endocrinologist is a good first step to building that plan.

I’m in the process of transitioning and I haven’t cryopreserved my eggs or sperm. What can I do?

Talk to your physician about your fertility options. They may refer you to chat with a fertility specialist to help plan your personal fertility and family-building journey – which may include freezing eggs or sperm.

I’ve transitioned, or am in the process of transitioning. What are my options to use my cryopreserved (frozen) eggs or sperm?

If you identify as MTF, male-to-female, or a trans woman, and have frozen sperm, there are a few options if you’re considering a biological family-building journey.

If you’re in a relationship with a cisgender female, you can use your sperm and your partner’s eggs to complete an IUI or IVF journey to pregnancy
If you’re in a relationship with a cisgender man, you can use an egg donor and gestational carrier (surrogate) to create embryos with one or both of your sperm, and complete a pregnancy journey
If you’re single, you can use an egg donor and a gestational carrier (surrogate) to create embryos and complete a pregnancy journey

If you identify as FTM, female-to-male, or a trans man, and have frozen eggs, there are a few options if you’re considering a biological family building journey

If you’re in a relationship with a cisgender woman, you could use your eggs and donor sperm to complete a reciprocal IVF cycle.
If you’re in a relationship with a cisgender man, you can use donor or your partner’s sperm to complete a pregnancy journey. Some of these journeys may require a gestational carrier.
If you’re single, you can use donor sperm to complete a pregnancy journey. This may require a gestational carrier.

If you don’t think your personal situation fits into any of the categories above – not to worry! The first step to building your plan is to chat with a fertility specialist, who will help you navigate your personal path to parenthood.

Fertility Preservation for Trans Persons

Finding a provider that is LGBTQ-friendly is important – family and fertility are personal topics, and I want you to be as comfortable as possible as you embark on your path to parenthood. One tool that I recommend for choosing an LGBTQ-friendly practice is the Healthcare Equality Index (HEI) put out each year by the Human Rights Campaign.

You have many options for fertility preservation and family-building as a trans person, and deserve the highest level of care as you work to grow your family!