A Guide to Fertility Preservation for Transgender Individuals
Written by Varsha Vijayakartik
Edited by Numa Islam
April 5, 2024
Edited by Numa Islam
April 5, 2024
Research
Transgender individuals constitute a relatively small proportion of the U.S. population, but their social presence seems to be growing ever larger and more influential - especially in popular culture and social media. Despite the increase in transgender representation in these kinds of media, gender health in medical institutions is largely underdeveloped. In U.S. healthcare, the lack of emphasis on providing transgender patients with the appropriate tools and information to take control of their health during and after transitional procedures makes this reduced demographic even more vulnerable. With this article, we aim to provide a detailed overview of the various fertility preservation options for transgender individuals considering parenthood.
The first step in fertility preservation is always the same: sperm and eggs must be produced and extracted. However, the nature of this process differs based on the stage at which transgender patients are in their transition as well as whether that transition is surgical or hormonal (Ainsworth et. al 2020).
Sperm production for transgender women (women that were assigned male at birth) depends on whether or not the patient has function of their sexual organs. If the patient does have sexual organ function, the simplest option is ejaculation. However, for patients with a genital obstruction (such as a vasectomy, which cuts off flow of sperm into semen), a second option is more feasible: testicular sperm extraction. This surgical process is relatively simple: the semen will be suctioned out of the testicles and stored (Ainsworth et. al 2020).
After sperm extraction, there are two main ways to fertilize an egg with it. The most common is in vitro fertilization (IVF) where mature sperm fertilize mature eggs in laboratory conditions (Wang & Sauer 2006). The second is intrauterine insemination, where sperm is directly inserted into the uterus (Penn Medicine). Patients who cannot produce sperm normally can only use IVF.
Individuals who are taking hormones that suppress sex-specific biological attributes will need to cease those medications for at least three weeks to allow sperm count (which declines severely after hormone therapy) to rebound (Ainsworth et. al 2020).
There are three main procedures for transgender men (men who are assigned female at birth) who have not yet undergone transition therapy or surgery. A patient may choose to freeze either their embryo or eggs, and both processes have similar success rates in terms of later fertilization. However, embryos are five percent more likely to survive the process than eggs. The main difference is that with freezing embryos, the sperm must already have fertilized the egg. The third option is ovarian tissue cryopreservation, where a portion of the ovary is removed, stored, and then transplanted back later to facilitate pregnancy (Choi & Kim 2022).
Finally, transgender women and men who have undergone complete genital reconstruction, where the sex organs have been irreversibly altered or removed, are currently unable to undergo fertility preservation procedures (Choi & Kim 2022).
Continuing to push the boundaries of medicine to include even the smallest, most underrepresented demographics is imperative; diversifying treatments and optimizing patient experience is the only way of holistically improving health outcomes across the board.
Bibliography
Ainsworth, A. J. & Allyse, M. & Khan, Z. (2020). Fertility Preservation for Transgender
Individuals. Mayo Clinic Proceedings Vol. 10. pp. 784-792. doi: https://doi.org/10.1016/j.mayocp.2019.10.040
Choi, J. Y. & Kim, T. J. (2022). Fertility Preservation and Reproductive Potential in Transgender
and Gender Fluid Population. Biomedicines Vol. 10. p. 2279. doi:
10.3390/biomedicines10092279
Intrauterine Insemination. Penn Medicine.
The first step in fertility preservation is always the same: sperm and eggs must be produced and extracted. However, the nature of this process differs based on the stage at which transgender patients are in their transition as well as whether that transition is surgical or hormonal (Ainsworth et. al 2020).
Sperm production for transgender women (women that were assigned male at birth) depends on whether or not the patient has function of their sexual organs. If the patient does have sexual organ function, the simplest option is ejaculation. However, for patients with a genital obstruction (such as a vasectomy, which cuts off flow of sperm into semen), a second option is more feasible: testicular sperm extraction. This surgical process is relatively simple: the semen will be suctioned out of the testicles and stored (Ainsworth et. al 2020).
After sperm extraction, there are two main ways to fertilize an egg with it. The most common is in vitro fertilization (IVF) where mature sperm fertilize mature eggs in laboratory conditions (Wang & Sauer 2006). The second is intrauterine insemination, where sperm is directly inserted into the uterus (Penn Medicine). Patients who cannot produce sperm normally can only use IVF.
Individuals who are taking hormones that suppress sex-specific biological attributes will need to cease those medications for at least three weeks to allow sperm count (which declines severely after hormone therapy) to rebound (Ainsworth et. al 2020).
There are three main procedures for transgender men (men who are assigned female at birth) who have not yet undergone transition therapy or surgery. A patient may choose to freeze either their embryo or eggs, and both processes have similar success rates in terms of later fertilization. However, embryos are five percent more likely to survive the process than eggs. The main difference is that with freezing embryos, the sperm must already have fertilized the egg. The third option is ovarian tissue cryopreservation, where a portion of the ovary is removed, stored, and then transplanted back later to facilitate pregnancy (Choi & Kim 2022).
Finally, transgender women and men who have undergone complete genital reconstruction, where the sex organs have been irreversibly altered or removed, are currently unable to undergo fertility preservation procedures (Choi & Kim 2022).
Continuing to push the boundaries of medicine to include even the smallest, most underrepresented demographics is imperative; diversifying treatments and optimizing patient experience is the only way of holistically improving health outcomes across the board.
Bibliography
Ainsworth, A. J. & Allyse, M. & Khan, Z. (2020). Fertility Preservation for Transgender
Individuals. Mayo Clinic Proceedings Vol. 10. pp. 784-792. doi: https://doi.org/10.1016/j.mayocp.2019.10.040
Choi, J. Y. & Kim, T. J. (2022). Fertility Preservation and Reproductive Potential in Transgender
and Gender Fluid Population. Biomedicines Vol. 10. p. 2279. doi:
10.3390/biomedicines10092279
Intrauterine Insemination. Penn Medicine.