Reproductive options

During the course of transition, most transsexual people will undergo hormone therapy, which has the side effect of either temporary or permanent sterility (permanent sterility occurring more frequently in trans women with prolonged use of antiandrogens).

Therefore reproductive options should be seriously considered prior to starting hormone replacement therapy or undergoing gender reassignment surgery.

MTF Options

Reproduction options for trans women are similar to the options for cisgendered males undergoing a vasectomy or cancer treatment. In the case of trans women, this is limited to semen storage in a cryogenic storage bank.

Cryobanks offer individuals the ability to store their semen for a nominal monthly rate so to keep their reproductive options open. It is theoretically possible to preserve a semen sample indefinitely.

Options after sperm storage retrieval include IVF (in vitro fertilization) with a cisgender female partner (is the trans person is lesbian) or a surrogate mother (if the trans person is heterosexual).

FTM Options

Reproduction options for trans men are limited to having eggs harvested prior to hormone therapy or bottom surgery.

Typically, eggs are harvested by first inducing multiple follicle development by administering hormones (typically clomiphene citrate, human chorionic gonadotropin (hCG), and gonadotropin releasing hormone (GnRH)) that cause multiple eggs to mature. The matured eggs (secondary oocytes) are them harvested/retrieved from the ovaries.

The eggs are then stored (similar to semen in a cryobank) until the female decides to use them with a nominal monthly fee charged for storage of the harvested eggs. Currently, frozen mature eggs have a low survival rate but some claim that up to 500 babies have been born worldwide from frozen eggs. By comparison 350,000 - 500,000 births over 25 years have come from controlled rate frozen embryos. Immature eggs are more tolerant of cryopreservation conditions but still cannot be effectively matured outside of the body.

Options after eggs storage retrieval include IVF (in vitro fertilization) with a cisgender female partner (is the trans person is heterosexual), a surrogate mother (if the trans person is gay), or implantation into self if hysterectomy has not been performed. A sperm donor may be required in any of the above scenarios.

Surrogate wombs

Surrogacy is an arrangement whereby a woman agrees to become pregnant and deliver a child for a contracted party. A surrogate (mother) is a necessary component for any trans desiring to have a child born of their own stored sperm or eggs after they have transitioned.

The surrogate may be the child's genetic mother (the more traditional form of surrogacy), or she may, as a gestational carrier, carry the pregnancy to delivery after having been implanted with an embryo, the latter being an illegal medical procedure in some jurisdictions.

The legal aspects surrounding surrogacy are very complex and mostly unsettled. There is a default legal assumption in most countries that the woman giving birth to a child is that child's legal mother. In some jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the legal parents from birth. This needs to be considered prior to deciding on using a surrogate (mother).

No reproduction

Some people after transition opt out of the expense and responsibility of having children, while others object to having a part of them that they hate being used to create life.

A few strongly adhere to one or more of the Voluntary Human Extinction Movement's reasons for not reproducing.

With more and more women choosing to wait before having children, or to not have children altogether, the loss of reproductive ability should not hinder transition for trans people.

References

• Gender reassignment and assisted reproduction by Paul De Sutter (Human Reproduction, Vol. 16, No. 4, 612-614, April 2001)

External Links

• Midwest Cryobank
• Egg harvesting
• Surrogacy information

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