Fertility Options for the Transgender Communtiy

“Your husband’s ovaries are full of eggs!”

I recently consulted with a lovely young couple who wanted to have a child.  They had been together for 5 years and felt it was the right time to start expanding their family.  The wife was in good health, with regular monthly periods and no risk factors for tubal or uterine problems.  The husband also was in good health, but did not produce any sperm.  Fortunately however, he did have normal appearing ovaries and despite the fact that he had not ovulated in more than 5 years (due to testosterone therapy) his ovaries appeared to have an above average number of eggs.

Transgender individuals or couples have many options when pursuing fertility care.  Depending on the couple or individual’s specific situation (presence or absence of; ovaries, testicles, uterus as well as their willingness to start or stop hormone treatments) a variety of treatment combinations may suite their needs.  Some of these options include:

Both partners have ovaries and uterus:

This scenario allows for multiple combinations.  A sperm donor (known or anonymous) is utilized and eggs from one or both partners can be fertilized through invitro fertilization (IVF) and placed into the uterus of the other partner.  In the couple I described above, they are using the eggs from the husband and fertilizing them with sperm from a selected donor then placing the fertilized eggs (embryos) into the uterus of the wife. 

This allows for each parent to have a biologic contribution to their child and is a wonderful way to use modern medicine to help a loving family have a child.  Even if the husband has been on hormone therapy for an extended period of time, there is still a good chance (especially if he is less than 35) that eggs can be obtained from his ovaries.

Both partners have testicles:

In this scenario, the use of a gestational surrogate (uterus) and an oocyte (egg) donor are necessary.    Once the eggs are obtained and a gestational surrogate is prepared, sperm form one of both partners can be used to fertilize the eggs and then place them into the uterus.  Additionally, sperm can be introduced into the reproductive tract of a traditional surrogate through a procedure called IUI (intrauterine insemination).  While traditional surrogacy is less expensive and considered more natural, the legal complexities of having a child through this method are considerably more complex and perilous.

The husband has ovaries/ uterus and the wife has testicles:

There are many options for couples in this situation, but the most straight forward method may be getting both partners to stop whatever hormone therapy they are taking and stimulate production of eggs and sperm (this may take up to 3 months in the case of sperm).  Once eggs and sperm are obtained, a gestational surrogate can then be utilized to carry the pregnancy.  Of course, if the partner with a uterus wants to carry the pregnancy, that is possible, but it would require abstaining from hormone treatment for the entire length of the pregnancy.

Storing sperm or eggs prior to transition:

One of the best steps a transgender individual can take in terms of protecting their reproductive health is to bank or preserve their eggs or sperm prior to transition.  Many doctors will recommend this step to their trans patients before starting hormone therapy or prior to surgery that removes ovaries or testicles.   Once preserved, the eggs or sperm can be used up to many years in the future.

Transgender individuals and couples have many options to choose from when they are considering having a family.  With a little work and some creative thinking, the right method for each individual can be determined.