There is a range of fertility preservation options for people who are AFAB trans or nonbinary and want to have biological children. Here's what you need to know.
Lots of people, cis and trans alike, want to have biological kids. Just because you decide to transition doesn’t mean that you no longer desire to become a parent; however, it does mean that the process can become more difficult and confusing.
People who are AFAB, or assigned female at birth, have unique challenges when it comes to having biological children. Beyond the physical and hormonal challenges, pregnancy and giving birth are typically associated with "femininity." This means that the process of pregnancy and the bodily changes that accompany it can trigger gender dysphoria.
Gender-affirming care for trans men is also positioned to reduce fertility. For that reason, some AFAB trans or nonbinary folks prefer to rely on their partners or others to carry children; others might choose to delay gender-affirming care to ensure their fertility preservation.
What is fertility preservation?
Gender-affirming care can be a lifesaving medical procedure for folks that feel that they were assigned the wrong gender at birth. For people who seek this type of care and want to one day have a child, it’s important to consider fertility preservation. Fertility preservation is surgical action taken before undergoing treatment that might impact your capacity to be biologically related to one’s potential children.
This can take different forms for different bodies: for people who were assigned male at birth, it might mean preserving sperm or testicular tissue, while for people who were assigned female at birth, it can mean the extraction of eggs or ovarian tissue.
All of the options for fertility preservation for AFAB people involve the removal and cryopreservation, or freezing, of parts of the reproductive system, so that they might be used later — perhaps in someone else’s body.
Fertility preservation options for AFAB trans and nonbinary individuals
Egg freezing (also known as oocyte cryopreservation) is the most popular form of fertility preservation. To make sure there are enough mature eggs to harvest, you’ll get hormonal injections that provoke your ovaries to produce more than one mature egg at a time.
Over the course of two weeks, doctors will monitor the effects of those injections on your follicles and determine the best moment to administer a trigger shot that initiates ovulation. At this point, the doctors will retrieve 15–20 eggs using a needle that goes straight to your follicles. Then the retrieved eggs are frozen until you give the word to have them thawed!
An embryo is a fertilized egg. When you freeze embryos, the fertilization process happens outside of the body — your eggs are extracted in the same manner used when freezing eggs, then fertilized using a sperm sample, and then transferred to freezers.
Unfortunately, the embryo can be damaged by the process of freezing and defrosting, but fertility doctors will communicate how many viable embryos you have. When you’re ready for embryos to be used, they are implanted back into the body using the same IVF process that’s regularly used to combat infertility.
Ovarian Tissue Cryopreservation
In this procedure, which is called an oophorectomy, you are put under, and doctors make an incision so that they can insert a slim tube called a laparoscope into your body. The doctors use the laparoscope to remove tissue containing immature eggs from one of your ovaries.
That tissue can then be preserved and put back into your body when you want to have a child. This strategy is a less popular choice for trans men who may not want to carry a child in the future.
Factors to consider when planning for transition and fertility
Transitioning and hormonal treatment
Your capacity to have a biological child depends on where you are in your gender-affirming care treatment. If you are transitioning surgically, then you should look into fertility preservation options beforehand.
Meanwhile, gender-affirming hormone treatment can also impact your fertility: taking testosterone stops ovulation, but if you go off T, ovulation can return after something between 3–6 months.
These considerations are important if you’re interested in carrying your own child and may impact the timeline of when you choose to transition.
Assisted reproductive technologies (ARTs) are, simply put, not cheap. According to US Fertility, egg freezing can cost between $10,000 and $15,000, not including the cost of storage, which is usually between $300–500/year. Embryo freezing costs around the same as egg freezing, but storage is generally more expensive, ranging from $400–600. It’s an enormous investment, and you should take that into account before making any big decisions.
Emotional and psychological well-being
Trying to conceive can always take a toll on a person’s mental health. Combining that pressure with the added tension coming from experiencing dysphoria is… a lot. Make sure to consider the effects that this process will have on your own well-being before choosing a route.
Of course, if you’re considering fertility preservation in the context of transitioning, it’s also important to consult professional healthcare providers about making the right choice for your situation and your body. The most important thing is making a decision that you’re comfortable with.
For a much more comprehensive deep dive into fertility options for AFAB trans and nonbinary folks and the queer community at large, check out Kristen L. Kali’s seminal book Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-to-be.
Kali, K. (2022). Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-to-be.
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