FERTILITY PRESERVATION

Fertility preservation is something that can be important to consider if you plan on getting an oophorectomy (removal of your ovaries) or a hysterectomy (removal of your uterus at any point. Once your uterus is removed, you are no longer able to become pregnant, and once your ovaries are removed, your body no longer procedures any reproductive material. This means that you will have no material that could be fertilized and grown in a surrogate or by another means.

The use of testosterone does not seem to negative affect the outcomes of fertility preservation [1], so even if you have been on testosterone for a while, you can still undergo fertility preservation so long as you still have your ovaries. The only time this may not be the case is if you were on puberty blockers and then went on testosterone. In this case, you may not have developed reproductive capacity [2]. On this page, we will only discuss individuals who do have reproductive capacity.

There are three common types of fertility preservation [2]:

OOCYTE CRYOPRESERVATION

This involves “controlled ovarian hyperstimulation,” which means that the ovaries are stimulated using injectable gonadotropin hormones. You are not able to take testosterone while undergoing this process. The oocytes (eggs) are retrieved through transvaginal aspiration, and then frozen until you are ready to use them.

EMBRYO CRYOPRESERVATION

This is the same procedure as ooctye cryopreservation, except the ooctyes are fertilized with sperm to create embryos before they are frozen.

OVARIAN TISSUE CRYOPRESERVATION

This method is more experimental. A portion of the ovary, or the entire ovary, is removed from the body and frozen. No hormonal stimulation is needed before undergoing this process.

CONSIDERATIONS RELATED TO FERTILITY PRESERVATION

COST

Fertility preservation can be expensive - possibly tens of thousands of dollars for the procedures and storage of reproductive material [3]. Many insurance plans do not cover fertility preservation [2], so it is often only available to people who are able to pay for it out-of-pocket. It can be even more cost-prohibitive for younger people who will have to pay longer storage fees, and who often have no income, or a lower income than many adults [2].

THE PROCESS

Some people may find the process of undergoing fertility preservation to be off-putting, as it can involve temporarily stopping testosterone, going on hormones which can increase estrogen levels, and possibly undergoing abdominal and/or transvaginal scans/procedures [2].

FAMILY PRESSURE

Some trans people may have feelings related to their reproductive capacity that differs from how their parent(s)/family of origin feel. This can be especially relevant for younger people whose access to medical care is contingent on support of a parent or guardian. However, there are also many cases where parent(s)/guardian(s) do support their child’s desires for their reproductive capacity, whatever those may be [4]. If you are dealing with unsupportive family members or guardians, some things that might be helpful can be:

  • Family therapy

  • Community/peer support groups, like PFLAG

  • Talking to a licensed medical provider about your options

It can be helpful to talk to a reproductive endocrinologist [2] to start the process or talk about any questions you might have. Many trans people are able to successfully have genetically-related children to them after undergoing fertility preservation. There are also other options, like adoption, that are options for having children as well.

REFERENCES

  1. Ghofranian, A., Estevez, S. L., Gellman, C., Gounko, D., Lee, J. A., Thornton, K., & Copperman, A. B. (2023). Fertility treatment outcomes in transgender men with a history of testosterone therapy. F&S Reports, 4(4), 367–374.

  2. Blakemore, J. K., Quinn, G. P., & Fino, M. E. (2019). A discussion of options, outcomes, and future recommendations for fertility preservation for transmasculine individuals. The Urologic Clinics of North America, 46(4), 495–503.

  3. Fertility Center Financial Information & Patient Forms. (n.d.). Retrieved March 9, 2025, from https://nyulangone.org/locations/fertility-center/fertility-center-financial-information-patient-forms

  4. Persky, R. W., Gruschow, S. M., Sinaii, N., Carlson, C., Ginsberg, J. P., & Dowshen, N. L. (2020). Attitudes toward fertility preservation among transgender youth and their parents. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 67(4), 583–589.