Fertility

Fertility is a concern for some trans and gender diverse people, for a range of reasons. Different forms of medical affirmation may interrupt, reduce, or cease a trans person’s fertility, and little is known about exactly how our bodies and fertility work over time.

The 2018 Australian TGD Sexual Health survey found that “less than half of participants had been given information on reproductive health and fertility preservation options1”, many of whom had undertaken some form of hormonal or surgical affirmation.

It’s important to note that a person’s fertility or infertility doesn’t change who they are, how good a parent they will be, or how involved they are able to be in a parental role. We celebrate and value parents who hold a logical connection, not only a biological one, to their family, and fertility management and preservation is just one possible route to parenthood.

Choosing to start hormones or access affirmative surgeries without engaging in fertility preservation or management is your decision to make. It can be a good idea to discuss options and your feelings about these with a mental health provider.

Fertility and hormones

There is some evidence that short to mid-term gender affirming hormonal usage can impact fertility but not make someone permanently infertile2,3,4, with many stories of people with bodies that produce eggs or sperm being able to temporarily stop hormones in order to conceive. Talk with your doctor.

Fertility and surgeries

There are some surgeries which do affect a person’s fertility, including most genital surgeries. In these cases, your surgeon will require you to sign paperwork saying you understand that this is the case, and that you consent to the procedure.

For some trans people, fertility preservation is an important part of affirming who they are, while allowing space for a potential future of trying to conceive.

Note that sperm and eggs can only be stored for up to 10 years, and very rarely longer than this, so depending on the time-frame of your fertility preservation and your time-frame for having children, fertility preservation may not be the right option for you.

Fertility preservation can take the form of:

Freezing sperm

The storing of sperm cells involves taking a sperm sample from a collected vial of ejaculate (cum), and storing it at a temperature of -196°C.

Frozen sperm cells are legally able to be stored for up to 10 years.

Collecting and freezing eggs

The storing of egg cells involves a collection process, after which the cells are frozen until you are ready to have them inseminated with sperm and implanted.

To collect egg cells, you will need to go through part of the IVF cycle known as the ‘Egg Pick-Up’, which involves a period of cycle monitoring and (in many cases) hormonal medications, such as estrogen, to stimulate fertility.

After your doctors find the right ovulation time, you’ll be given a trigger injection which starts the egg maturation process, and an egg collection procedure will be scheduled just over 30 hours later to collect the eggs.

This procedure requires day surgery, and the procedure itself takes about 30 minutes, usually under a local anaesthetic. If you’d prefer to undergo it under general anaesthetic, you will need to talk to your fertility specialist.

Frozen egg cells are legally able to be stored for up to 10 years.

For some trans people, accessing particular forms of gender affirmation includes a process of sterilisation. Sterilisation, which is any process that results in someone being unable to sexually reproduce, is a complex and difficult topic, and can come with a lot of pain.

This may be sterilisation by choice, for example by accessing surgeries that remove the testes or ovaries and are actively a part of how we affirm who we are, or coerced sterilisation, such as requiring people to have had (often) sterilising surgeries to update certain forms of ID in NSW, such as a birth certificate.

As trans people, our fertility is not a simple subject, and people may have different wants, needs, opinions, fears, and hopes. It’s important to recognise that no perspective is better, more correct, or more valuable than any other. For one person, preserving their reproductive ability or freezing sperm or eggs will be a critical part of affirmation, while another person may have no interest at all in preserving any reproductive ability.

Many people will sit somewhere between these two perspectives, and their relationship to their body and reproductive ability might be complicated, and at times difficult and uncomfortable.

You don’t need to have all the answers now, or ever, and that’s a really normal thing. People make decisions about their fertility and reproductive ability every day, or find out that things aren’t what they expected, or may require outside assistance, whether from medical professionals, donors, or surrogates.

Reproductive ability doesn’t mean anything about your role as a partner, lover, parent, family member, or person.