Fertility may be the last thing on your mind when you’re experiencing the distress of having a body that doesn’t express your identity. Understandably, many trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you have treatment without preserving your fertility and then realise later on that you want a biological family. Thinking through all these issues now and understanding your options will help you make an informed decision.
How does medical treatment for gender dysphoria affect fertility?
Hormone therapy (oestrogen or testosterone) suppresses your fertility function and over time can lead to a complete loss of fertility. In some cases, people who stop taking their hormone therapy will have their fertility restored, although this is by no means guaranteed. Generally, the longer you are having hormone therapy the more your fertility is likely to be permanently affected.
If you think you would like biological children at some point and you haven’t started medical treatment or had surgery, you may wish to preserve your fertility by having your sperm, eggs or embryos frozen and stored for later use in fertility treatment.
Depending on your situation, you, your partner or a surrogate may undergo fertility treatment (such as IVF) using your stored sperm, eggs or embryos. Having genital reconstructive surgery will prevent you from having biological children without the use of a surrogate or interventional fertility treatments. Relevant genital surgery includes having a salpingo-oophorectomy (removal of the fallopian tubes and ovaries), hysterectomy (removal of the womb), orchidectomy (removal of the testes) and penectomy (removal of the penis).
Sperm Storage
Sperm freezing involves masturbating or undergoing vibratory stimulation to produce a sperm sample, which is then frozen and stored. If you do not feel comfortable producing sperm in this way, it is possible to extract the sperm in different ways (such as through surgical sperm extraction) although these involve more invasive surgical procedures. We do not currently offer long-term fertility preservation at Gateshead Fertility Unit due to our limited capacity. A list of local clinics is at the end of this information sheet.
I’ve already started taking hormone therapies or puberty suppressing medication, what are my options for preserving my fertility?
If you’ve already started hormone therapy or you’re taking puberty suppressing medication you should speak to a fertility specialist. They will probably recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. This means your ovaries may start to ovulate again or your body may start producing sperm. This can take up to 6 months and sometimes longer. Certain tests may be performed to check whether eggs or sperm are then being produced. It could mean a year or more without your medication.
Some Trans and non-binary people find it distressing to come off their hormone therapy and may consider other options for having a family, such as using donated sperm or eggs in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family.
Our fertility specialists will be able to advise you of your treatment options and medical suitability for using your own eggs or sperm, or donated eggs or sperm. Any necessary counselling can be arranged prior to treatment.
It is also advisable to speak to you Endocrinologist to discuss a safe way of gradually stopping your medication to prevent any long-term health issues.
I’ve been undergoing hormone therapy and am about to go for genital reconstructive surgery, what are my options for preserving my fertility?
If you’re ready for genital reconstructive surgery, it may be possible for your surgeon to collect ovarian tissue or collect sperm via surgery which you can store for future fertility treatment. The only way in which the ovarian tissue can be used at the moment is by replacing it back in you: it cannot be put in another person, and eggs cannot be grown from it ‘in the lab’ at the moment, though this may become possible in the future. This option is not available at Gateshead Fertility Unit at present.
You can’t have children using your own sperm, eggs or embryos once you’ve had genital reconstructive surgery, unless you store your sperm, eggs or embryos prior to surgery.
How long can I store my eggs, sperm, embryos or reproductive tissue?
The standard storage period for eggs, sperm, embryos or reproductive tissue is 10 years but it can be extended to up to 55 years if you are, or are likely to become, prematurely infertile, for example as a result of hormone therapy or genital reconstructive surgery. Your clinic should advise you how to give consent to your storage being extended beyond 10 years.
What kind of tests will I need?
Before your eggs, sperm or embryo(s) are frozen you need to be screened for various infectious diseases and genetic conditions by a blood test. Make sure you talk to your clinic about your plans for using your stored material so they can give you all the information you need.
Before you consent to storage or treatment you and, if applicable, your partner may also need to have blood tests to screen for HIV, Hepatitis B, Hepatitis C and human T cell lymphotropic virus (HTLV) I and II. Some hormonal assessments will be required if you are considering using your own eggs or sperm.
If you wish for your embryos to be used in another person’s treatment (e.g., in a surrogacy arrangement), the same screening rules on donation apply. You and if applicable your partner will both be required to have further screening tests for cystic fibrosis, karyotype (chromosome analysis), cytomegalovirus, syphilis and gonorrhoea. In addition, your blood groups will be checked. If surrogacy is something you may consider in the future, we can direct you toward specialist fertility clinics.
Can I have fertility preservation treatment on the NHS?
This is not straightforward to answer, and is subject to change and may depend on where you live. Funding for storing your eggs, sperm or embryos before having medical treatment for gender dysphoria varies depending on where you live, with Scotland, Wales and Northern Ireland all making their own decisions about funding.
In England, funding decisions about storage and fertility treatment are decided locally by Clinical Commissioning Groups (CCGs). Some CCGs will fund treatment and others will not. At present, the National Institute for Health and Care Excellence (NICE), which provides guidelines to CCGs and medical professionals on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria. In some cases, the NHS may store your sperm or egg, however, this does not always mean your treatment will be funded by the NHS.
The best thing to do is to talk to your GP as it can be tricky to find out exactly what’s available in your local area and if you’re eligible. Also bear in mind that even if you can have your eggs, sperm, embryos or tissue stored on the NHS, you may need to pay to use them in treatment later on.
Where can I go to get support, or discuss these issues further?
We recommend that anyone thinking about having fertility treatment, for whatever reason, gets plenty of support, whether from family and friends, social networks, organisations or a professional.
Treatment can be a very emotional experience so it’s important you’re getting the right support before, during and after treatment.
- British Infertility Counselling Association (BICA) provides counselling to people of all ages who are considering fertility treatment and preservation.
- Fertility Network UK campaign for equitable access to NHS funded fertility treatment.
- Gendered Intelligence works with transgender people and those who impact on the lives of trans people, specialising in working with young trans people.
- GIRES is a charity that listens, helps, empowers and gives a voice to transgender and non-conforming individuals. www.gires.org.uk
- Mermaids support families with children and young people with gender dysphoria. www.mermaidsuk.org.uk
- The Human Fertilisation and Embryology Authority is the UK Government’s independent fertility regulator. www.HFEA.gov.uk
Regional Fertility Clinics
Centre for Life – Newcastle
Tel: (0191) 213 8213
London Women’s Clinic – Darlington
Tel: 01325 371 074
James Cook University Hospital – Middlesbrough
Tel: 01642 282733