Transgender individuals have multiple options to build a family, but the sooner individuals prepare and plan for their fertility future, the more choices they have.

We recommend that any transgender individuals and the parents of transgender or gender-diverse minors meet with a fertility specialist for more personalized family-building planning and support. This is also a good time to begin planning for fertility treatments, which may affect which health insurance policies you choose as some plans are more fertility treatment-friendly than others.

Transgender Fertility Options

There are several family-building options, but those who want to have a biological connection to their child should meet with a fertility specialist before starting any hormone therapies or surgical procedures.

While there are examples of transgender parents who experienced temporary reversals to contribute sperm to their partner/gestational carrier or to carry a baby through pregnancy, that path is complicated and has a higher risk of complications. Making fertility plans ahead of time supports the fertility path in every way – making it more affordable, easier on the body/psyche, and improving fertility treatment success rates.

Consider Fertility Preservation Before Pursuing Hormone Therapy or Surgery

Because transitioning involves treatments that alter a person’s reproductive function, fertility preservation should be a top consideration for transgender or gender-diverse men and women before they begin hormone or surgical therapies.

By obtaining sperm samples or retrieving eggs, freezing, and storing them (cryobanking), patients can pursue IUI (intrauterine insemination) or IVF with a future partner or gestational carrier to share a biological connection with their child.

Fertility Treatments for Transgender Families

Here are some of the most common fertility treatment options for transgender parents and families.

1. Cryobanking of eggs and sperm

As mentioned above, cryobanking of eggs (transgender men) or sperm (transgender women) is the safest way to protect reproductive cells as you move through the transition process. Eggs and sperm are available for future use with a partner or a gestational carrier/surrogate when you’re ready to have a baby.

2. Cryobanking embryos

Sometimes, men or women decide to transition after they’re already partnered or have started a family as a heterosexual couple. If there’s any chance they may want to have more children down the road, we recommend cryobanking embryos. In this case, we can use both partners’ eggs and sperm to create embryos for future IVF procedures.

3. Using gestational carriers or surrogates

Depending on whether you plan to have children as a single parent or with a partner who cannot (or doesn’t want to) carry a baby, gestational carriers are also an option. In this case, either partner’s genetic material is used to create embryos for IVF. Donor sperm and eggs are also options depending on the reproductive health and choices of either partner.

If you have a close family friend or family member willing to be a gestational carrier, that is certainly an option. In that case, we recommend scheduling a consultation with a legal team specializing in gestational/surrogate cases to ensure the arrangement is legal.

More often, we connect patients with gestational carriers/surrogate agencies. Once you’ve interviewed and selected the right gestational carrier, you (and your partner) are directly connected to your child’s pregnancy and birth.

4. Discontinuing hormone therapy for transgender men

Transgender men who have kept their uterus and eggs have the option to discontinue hormone therapy to retrieve eggs or to get pregnant. This is a more complicated parenting path and can be very challenging due to both the physiological response to discontinuing and recalibrating the hormones and the emotional ramifications that can also arise during the process.

In this situation, you would use a partner or donor’s sperm, your own or a donor’s eggs, and then take advantage of IVF to transfer the embryo into your uterus. This option is also dependent on whether or not surgical interventions have altered your ability to transfer an embryo or carry a baby. Those interested in discontinuing hormone therapy should go through a complete fertility evaluation by a specialist. We also recommend therapy to discuss the ramifications of this decision for the time it will take to conceive and experience a full-term pregnancy.

5. Third party reproduction

If you’ve already transitioned and aren’t interested in discontinuing hormone therapy, or biological connection to a child isn’t a top priority for you, there are other third-party reproduction options. Depending on your choices, you can use donated eggs, sperm, or embryos – as well as a gestational carrier.

When you’re ready to start your family, we’ll use IVF to transfer embryos into your gestational carrier, after which you’ll be there every step of the way for your baby’s pregnancy.