Everyone should have the choice to have a child if they want to, and Progyny recognizes that the path to parenthood is not the same for everyone.
If you’re a transgender person who wants to build your family, it makes sense to consider the implications of hormone and gender affirming therapy.
Both can impact your ability to have genetically-related children in the future. To find out more, we spoke to Dr. Samuel Pang, a board-certified reproductive endocrinologist at Boston IVF, a clinic in the Progyny network.
Dr. Pang has been treating gay and transgender people since 1998. Here, he discusses options for preserving your fertility and building your family before and after transitioning, when you feel comfortable to do so.
Your Options Pre-Transition
Pang suggests starting a conversation with your physician about freezing your eggs or sperm before undergoing treatment — surgery or hormonal. It’s important to remember while hormonal and surgical interventions are gender-affirming, they may affect your ability to preserve your own fertility, if your plans include family building with or without a partner.
If you and your partner desire to use your own tissue, both sperm and eggs, then you may be able to benefit from intrauterine insemination (IUI). If neither you or your partner wish to carry a pregnancy, if neither are able to, you can look into whether or not a gestational carrier is right for you.
Egg donation and sperm donation are both available as options and are increasingly affordable and easily accessible. Check to see if your insurance plan includes coverage for donor tissue.
Besides IUI, In Vitro Fertilization (or IVF) is treatment plan where embryos can be created from one’s own and their partner’s egg and sperm or by utilizing donor tissue.
Reciprocal IVF may be a great option as it allows one partner to carry the embryo. Reciprocal IVF is often a great option as both partners can be involved in the process. Partner A can provide their eggs while Partner B can carry the pregnancy.
Fertility Preservation
“What if I already started my transition with hormone therapy but did not freeze my sperm or eggs prior?”
The best first step is to sit down with a reproductive endocrinologist to discuss your options. Most of time, when HRT is stopped, some treatment may be possible.
What’s unknown is how long you can be on hormone therapy before it could potentially become irreversible. This is something you would need to explore with a trusted physician.
“I have had transgender men who have been on testosterone therapy for up to 18 months, and when we stopped testosterone therapy, they began ovulating and menstruating, which then allowed us to stimulate their ovaries and retrieve their eggs,” Pang says.
But, asking a transgender person to stop their transitional therapy is also asking them not to be themselves. Some transgender people, for example, may be reluctant to stop their therapy because it can be psychologically distressing.
You’ve been living as your true self and now your body isn’t working the way it should. It’s difficult, and timelines vary per person. Whichever you decide, we recommend that you work with a therapist in conjunction with your reproductive endocrinologist.
If you’re considering an oophorectomy or orchiectomy, surgeries that remove ovaries and testicles respectively, you should think about fertility preservation beforehand. If the ovaries are removed, you’ll no longer produce eggs. And if the testicles are removed, you’ll no longer produce sperm.
The good news is not all is lost if you’ve had these procedures done already. Egg and sperm donation are both options to build your family.
Options for Children Under 18
Transgender children are coming out and transitioning at younger ages as our society is slowly becoming more accepting. If you have a child under the age of 18 who is considering transitioning, there are options for preserving their fertility.
If the child is post-pubertal, eggs or sperm can be retrieved and frozen. “The biggest obstacle would be when the child is given medications to suppress puberty,” Pang says. Because these medications block specific hormones needed for reproductive growth during puberty, it will present a huge challenge in creating viable egg and sperm in the future.
Finding the Right Doctor
Safety is our main concern. Unfortunately, not every doctor is LGBTQ+ friendly so you’ll need to find one that is. Referrals by your friends, family, and local LGBTQ+ organization can guide you to the right doctor for you.
Pang emphasizes, you don’t want a fertility practice that simply treats the LGBTQ+ community because it’s good for business. You want a practice whose entire staff is welcoming and culturally sensitive, that cares about you and your family building outcomes.
If you have the Progyny benefit, speak with your Patient Care Advocate so they can find an LGBTQ+ friendly specialist in your area.
Dr. Jovana Lekovich is a board-certified obstetrician and gynecologist and reproductive endocrinologist and infertility specialist. She is the Director of the Oncofertility Program at Blavatnik Family- Chelsea Medical Center at Mount Sinai. Dr. Lekovich is an assistant clinical professor at the Icahn School of Medicine at Mount Sinai in New York, where she specializes in treating all aspects of reproductive medicine and infertility, including conditions such as amenorrhea, polycystic ovary syndrome, and diminished ovarian reserve with ovulation induction, intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection and preimplantation genetic testing of embryos. She also uses minimally invasive techniques such as laparoscopy and hysteroscopy to treat a variety of surgical conditions including endometriosis and uterine factor infertility.