TGNB Fertility Preservation

by | Jun 24, 2022 | Fertility Preservation, LGBTQIA+, Transgender

Egg and Sperm Freezing for Transgender, Gender Nonconforming, and Nonbinary Individuals

Individuals in the transgender, gender nonconforming, and nonbinary (TGNB) community have the option to preserve eggs or sperm for future use. We have the experience to help counsel and guide patients who are interested in learning more about fertility preservation. Here are some frequently asked questions about TGNB fertility preservation.

Before Beginning Fertility Preservation

Does PNWF offer future fertility counseling?
Yes! Patients may benefit from a visit with one of our physicians to discuss the impact of gender affirming therapy on future fertility options, as well as important things to consider prior to starting hormones or pursuing gonadectomy. We are happy to meet with all patients, including adolescent patients or patients who have already started hormone therapy.
What if I'm already on hormone blockers?
The effects of hormone blockers such as leuprolide acetate (Lupron), histrelin, or spironolactone on fertility are reversible. If you are interested in fertility preservation, your provider will determine whether you should discontinue these therapies prior to proceeding.
What if I've already started testosterone therapy?
The current data, though very limited, is reassuring. Studies suggest that individuals using testosterone therapy can have similar success with egg retrieval as cisgender women. Unfortunately, we do not have long term studies looking at potential effects of testosterone on offspring, if any.

For most patients, we recommend discontinuing testosterone therapy for approximately 1-2 months prior to undergoing egg freezing. However, this is not mandatory, and can be personalized to you.

What if I've already started estrogen therapy?
The limited available data suggests that the effects of estrogen on sperm production may not be fully reversible. While sperm production may resume after stopping therapy, it may take many months and never return to normal. This can vary from patient to patient. Unfortunately, we do not have long term studies looking at potential effects of estrogen on offspring, if any.

Your provider will help determine the right plan for you. It may require monthly semen analyses to monitor the return of sperm in the ejaculate. In some cases, surgical sperm extraction may also be an option.

Egg Freezing FAQs

How does egg freezing work?

The process for egg freezing is similar to a traditional IVF cycle. After consultation and testing, it takes approximately 2 weeks. In these two weeks, the patient takes gonadotropins (injectable hormones) to stimulate the recruitment of multiple eggs in the ovaries. When the eggs are ready, they are retrieved in a simple procedure called an egg retrieval, then frozen immediately.

Once you are ready for family building, the eggs are thawed and fertilized with sperm (either from a partner or a sperm donor). The resulting embryo(s) can be genetically tested and then transferred into the uterus of a partner or gestational surrogate.

What is embryo freezing?
For individuals or couples who have both an egg and sperm source (either partner or donor sperm), embryos can be developed and frozen for future use. Eggs are retrieved in the same process as egg freezing, then fertilized with sperm. The resulting embryos are then frozen, to be thawed when you are ready to build your family.
What are the limitations of egg freezing?
Although egg freezing provides an excellent option to take charge of your reproductive potential, the process may not be right for everyone. Unfortunately, egg freezing does not always guarantee a baby in the future.

The success rates and efficiency of the process are tied to how many eggs you can produce, which varies between patients. For example, a patient with low egg numbers may have to do more than one stimulation cycle to freeze an optimal number of eggs.

It is always a good idea to meet with a reproductive endocrinologist and learn more about what egg freezing would look like for you.

I am a transgender patient planning to do egg freezing. What challenges should I expect?
Egg freezing is an involved physical process that may trigger or worsen gender dysphoria for some patients. 

Typical monitoring during the egg freezing process includes transvaginal ultrasounds. If this would be challenging for you, discuss the option of transabdominal ultrasounds with your provider. The medications involved with ovarian stimulation create a brief rise in estrogen during this process, which can affect your mood. You will also have a period 7-10 days after the egg retrieval, which may worsen gender dysphoria.

We strongly recommend that patients have a mental health care provider and consider increasing their counseling frequency during this process.

Sperm Freezing FAQs

How does sperm freezing work?

Sperm is usually collected via masturbation and then frozen for future use. This may require multiple collections to freeze multiple vials, depending on family building goals. We will help guide you through this process.

Frozen sperm can be used for future inseminations or IVF, with a partner’s eggs or donor eggs.

How much sperm should I freeze?
We can help you determine the optimal amount of sperm to freeze for your future. This depends on your future family goals, the anticipated fertility treatments needed to build your family, and your baseline semen analysis.

If your semen analysis is normal, you may have enough sperm from one collection for 2-3  intrauterine insemination (IUI) cycles, or several in vitro fertilization (IVF) cycles. If your sperm count or quality is low, sperm preservation for future IVF is still an option, as we only need a few sperm to make IVF possible.

We recommend scheduling an appointment with one of our providers either before or after your first collection to review your goals and determine how many collections to do.

If I want to freeze sperm, do I have to schedule a fertility consult first?
No! However, you will need a referral for sperm cryopreservation from your primary provider in order to freeze sperm.

Some providers who prescribe gender-affirming hormones feel comfortable reviewing your sperm analysis results. Others will recommend a consult with a fertility provider to review your results, determine your future family building goals and make recommendations about how much sperm to freeze.

I am a transgender patient planning to do sperm freezing. What challenges should I expect?
Sperm collection is typically performed through masturbation. While this is most commonly done in our office, it can also be done at home. Some patients find this process can worsen their gender dysphoria. If you have any concerns, we recommend scheduling an appointment with us to discuss other options.