Episode 185: Fertility 101: Transgender Family Building Options

The Fertility 101 Series, because there’s no shortage of daunting terms to keep your mind running, is a quick and dirty breakdown on a specific topic with insights from a fertility expert.

This week’s episode answers all the questions around transgender family building options and how it works. Dr. Daniel Potter at HRC Fertility joins us to discuss the impact of hormone affirming therapy, the importance of fertility preservation, questions to consider if one is deciding to build a family, and how to better serve this community.

Guest: Dr. Daniel Potter, Regional Medical Director at HRC Fertility

Host: Dan Bulger, Progyny

For more information, visit Progyny’s Podcast page and Progyny’s Education page for more resources. Be sure to follow us on Instagram, @ThisisInfertilityPodcast and use the #ThisisInfertility. Have a question, comment, or want to share your story? Email us at thisisinfertility@progyny.com.

This episode is also a video! Watch it here:

Fertility options for transgender women

01:27 – 02:06

It involves freezing sperm, and that sperm could either be obtained through ejaculation or we can surgically extract it if it’s too dysphoric for them to produce a specimen through masturbation. Additionally, there are experimental protocols where they can harvest testicular tissue and freeze it at the time of orchiectomy.

Fertility options for transgender men

02:07 – 02:54

They can freeze eggs, they can freeze embryos, and you know, there also are experimental protocols, freezing ovarian tissue. But, you know, for trans men, there really seems to be very, you know, really little impact of gender affirming hormone therapy on their reproductive outcomes. So, once they stop testosterone, after a washout period, nearly all trans men will resume ovulation and menstruation and respond pretty normally to ovarian stimulation.

Preserving fertility earlier in treatment

03:09 – 05:21

For trans men, it doesn’t seem to make much difference how long they’ve been in transition. For trans women, there is limited data available. But generally speaking, the longer that they have been on gender affirming hormone therapy, the poorer the semen parameters are going to be. But the thing is, with assisted reproduction, like IVF, we don’t really need normal semen parameters to achieve success. With intracytoplasmic sperm injection, we can take a single sperm and inject it into the egg and achieve fertilization. Perhaps they have 25 eggs, which means, you know, the lab needs to find 25 normal sperm, which isn’t hard to do. And even in the case of a very poor semen specimen, I mean, there are probably at least hundreds of thousands, if not low millions of total number of sperm.

Awareness

06:16 – 08:51

Historically, if you look at data, you know, the majority of trans men or trans women would freeze sperm, if they were made aware of it prior to transitioning, because it’s such a simple thing to do. It’s something that patients should really be made aware of.

And what we really want to do for all of our patients, including our transgender patients, is put them in the position to be informed patients and consumers so they don’t have regrets later on. And the best way to do that is to make sure they’re fully educated as to the options available to them and that those options are made accessible to them.

I think that one of the bigger issues that trans people have is that, you know, as a group, they’re one of the most misunderstood and discriminated against groups of human beings on this planet. So, you know, absolutely, there are trans people that have a difficult time finding a clinic that will treat them at all depending on where they live. And then sometimes if they find a clinic that will treat them, I mean, are they being treated with the same dignity, respect and empathy that they should be that all of our patients should be getting? I think that having a welcoming environment is really important when you’re the trans person and you’re looking for a clinic to, you know, help you with these issues.