Prioritising fertility conversations
Having a family may not be front of mind if you are transitioning and are already facing the social, medical, surgical, and legal steps ahead. However, it’s worth taking a moment to consider whether you may want the possibility of having a biological child in the future. We recommend seeking advice on your options from a Fertility Specialist
before you start any medical transition.
Flinders Fertility strongly supports rainbow families, and we are happy to help families make choices that suit their particular needs.
HOW CAN WE HELP?
Fertility services for those assigned male at birth
Fertility services for those assigned female at birth
Fertility preservation for AMAB
Sperm freezing
For those assigned male at birth (AMAB) sperm freezing (cryopreservation) allows sperm to be stored almost indefinitely. This enables a transgender woman with a female partner a chance to have biological children in the future using their sperm to fertilise their partner’s eggs. Sperm collection is usually done at our clinic at Glenelg though in some circumstances this can be done at home if you are close enough to deliver the sample within an hour.
We recommend that sperm freezing is done before taking gender-affirming hormone therapy (GAHT) as this has been shown to significantly lower total sperm count and increase sperm abnormalities making it less likely that they will be viable1.
Fertility preservation for AFAB
Egg freezing
If you were assigned as female at birth (AFAB), freezing eggs may be a consideration if you’d like to keep the door open to having a biological child at a later date.
Egg freezing should preferably be done before commencing gender-affirming hormone therapy (Testosterone or “T”). It is sometimes possible to undergo a stimulated cycle to retrieve eggs later, but this entails a suspension of gender-affirming hormone therapy for an extended period and may be a confronting and difficult process depending on your stage of transition.
If you decide to freeze your eggs, you’ll need to take a course of hormonal ovarian stimulation medication to produce ovarian follicular growth, and then undergo an egg collection procedure. The eggs are then frozen and stored for later use.
Partner/Reciprocal IVF
If you are a transgender man and have a partner who was assigned female at birth it may be possible to have a family using your eggs and donor sperm if your partner can carry the pregnancy.
Partner IVF involves undergoing an IVF cycle where your oocytes (eggs) are collected, fertilised with donor sperm, and the resulting embryo is then frozen. Your partner can then undertake a subsequent frozen embryo transfer cycle.
Requests for partner IVF are becoming more common, and many couples prefer it as they are both involved in creating their family.
If you are considering reciprocal IVF, there are some factors to consider:
■ The risk of pregnancy complications, including pre-eclampsia and miscarriage, is higher than in pregnancy
involving embryos created from the gestational carrier’s eggs.
■ Clinics are obliged to retain details for the SA Donor Register. On a practical note, this means that there are more forms to fill.
■ The process may also involve more tests than standard IVF using your eggs.
If you are considering egg freezing or partner IVF, we recommend discussing this with your doctor at your first appointment. They can arrange tests as early as possible to establish your suitability for this program, and to reduce the likelihood of delays while additional tests are ordered.
Embryo Freezing and IVF
Embryo freezing may also be an option for gender-diverse individuals. It is often pursued by couples who wish to preserve their fertility options before one member starts transitioning. Initially, sperm are used to fertilise eggs in a laboratory and the resulting embryos are frozen and stored for future use.
It is important to understand that both of you own the embryos created and that one partner cannot use them without the other’s express consent. We, therefore, advise you to both have counselling and obtain legal advice if you are considering this option.
‘Seahorse’ pregnancy
This is still quite rare as many transgender men find it hard to reconcile carrying a pregnancy with their affirmed gender, however, it is possible to stop taking testosterone and become pregnant through partner or donor sperm.
Colloquially known as ‘seahorse’ pregnancies they are sometimes the only way for some couples to have a baby. We recognise how hard it can be to carry an unconventional pregnancy and will treat you with care and respect throughout.
Support for your emotional wellbeing
We recognise the challenges involved in creating a family as an LGBTIQ+ couple or individual. These can go beyond the physical and biological barriers, so in addition to fertility preservation options, we also provide patients counselling free of charge with our ANZICA qualified fertility counsellor Julie Potts.
We encourage gender-diverse individuals to seek advice from a Flinders Fertility doctor before medical transition begins, to discuss all available fertility preservation options. We provide an inclusive, safe, and non-discriminatory environment to assist you before, during, and after your medical transition.
Fertility costs for transgender patients
Treatment costs vary depending on your specific needs and we provide a detailed and customised plan for all patients. Up-to-date prices can be found in the fees section of this website.
Photo by Baran Lotfollahi on Unsplash
References:
1. Sperm quality in transgender women before or after gender affirming hormone therapy-A prospective cohort study
Kenny A Rodriguez-Wallberg, Jakob Häljestig, Stefan Arver, Anna L V Johansson, Frida E Lundberg (Andrology, Nov 2021)