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Transgender and gender diverse individuals have the same range of reproductive desires as non-transgender people. It is recommended that prior to transition all transgender patients be counseled regarding the effects of transition fertility and reproduction.
For example, exogenous testosterone is used in transgender men to induce the development of male physical characteristics (virilization) and suppress feminizing characteristics and exogenous estrogen is used in transgender women to help feminize patients. Both administration of exogenous hormones and surgical management, including removal of reproductive organs such as the testes, ovaries and/or uterus can have clear impacts on fertility. Administration of exogenous hormones often suppress both ovulation and spermatogenesis (sperm cell development) which can often, although not always, resume after discontinuation of hormonal treatment. Surgical treatments that remove the ovaries or testes result in permanent loss of fertility.
Currently, we offer a number of fertility preservation options, including oocyte, embryo, and sperm cryopreservation.
Egg Freezing, or Oocyte Cryopreservation: a process by which eggs (oocytes) are extracted, frozen, and stored as a method to preserve reproductive potential. Ovarian stimulation is carried out in the same manner that is used with in vitro fertilization (IVF), using injectable medications. Following ovarian stimulation, eggs and the surrounding fluid in the ovarian follicles are aspirated vaginally while under sedation. The eggs are then cryopreserved by a method known as vitrification. Currently, vitrification is the method of choice for cryopreserving eggs, and this is achieved by ultra-rapid cooling into liquid nitrogen where they can be stored. The eggs can then remain frozen until their use at a later date.
The eggs are thawed and fertilized by intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the egg. Sperm from either a sperm-bearing partner or a sperm donor can be used to fertilize the egg. The fertilized eggs will grow in culture until the embryo(s) are ready to be transferred into the uterus to achieve pregnancy, typically 3-5 days after fertilization. These embryos can be transferred into the uterus of either a transgender man who has stopped testosterone treatment, a partner, or a gestational carrier.
Given limited data, it is preferable to freeze eggs prior to initiation of hormone treatment. However, for those transgender men who have already initiated hormonal treatment, an interruption of testosterone for 2-3 months prior to ovarian stimulation is recommended to restore possible therapy-induced effects.
Embryo cryopreservation: Embryo cryopreservation is carried out in the same manner as described for oocyte (egg) cryopreservation. However, instead of cryopreserving (freezing) the eggs upon removal from the ovary, the eggs are fertilized by sperm immediately after removal and the embryos are grown in culture for 5-6 days prior to cryopreservation (freezing). Embryo cryopreservation would be a good option for transmasculine patients with a sperm-bearing partner with whom they would like the possibility to have a genetically related child.
Sperm Cryopreservation: There are so many considerations when undergoing gender transition. As a result, fertility concerns are sometimes overlooked by both patient and provider alike. Transfeminine patients may want to consider banking sperm prior to surgery to leave the option open in the future for biologic offspring. Sperm banking is easy to do and not very expensive. When the patient is ready to use the sperm, it can be thawed and used in assisted reproduction. If a patient is unable to collect a sperm sample, male reproductive surgeons at UCLA can surgically extract sperm for sperm banking.
For questions or additional information, email genderhealth@mednet.ucla.edu or call us at (310) 267-4334.
