Egg freezing for trans men and non-binary people

If you’re experiencing gender dysphoria, then thinking about having children one day may not be a priority, or it’s something that’s too difficult to contemplate right now. However, preserving your fertility before it’s too late can prevent later regrets, giving you a greater chance of having a biological child one day. If you are a transgender man or non-binary person considering or undergoing hormone replacement therapy (HRT) or genital reconstructive surgery you may be wondering what options are available to you, this article will cover all you need to know about egg freezing.

What is egg freezing? 

Egg freezing is a fertility treatment that preserves genetic material for the future through vitrification (freezing). First you take hormone medications to stimulate the growth of the follicles in the ovaries, you’ll have monitoring scans during this time to check how these are developing, once you’re ready the eggs are then collected in a quick and painless procedure under sedation, before being frozen and stored for future use. Eggs can be stored for up to 55 years in the UK (you will need to renew your consent every 10 years).

You can learn more here.

How does transitioning gender impact fertility? 

While taking testosterone can be a life saving treatment for gender dysphoria, it can also throw a curveball at your fertility. Over time, hormone replacement therapy might put your fertility on pause, and in some cases, it might even cause permanent loss of fertility. Especially if you have genital reconstructive surgery and a hysterectomy. 

If you see a future with a family or children, and you are about to start or have started hormone replacement therapy (HRT) or surgery, then you could have the option to freeze your genetic material (eggs or embryos). If you have a partner,  you may wish to create embryos to freeze, or you could use a sperm donor to create embryos for the future. 

Depending on your situation, you, your partner, or a surrogate could then undergo IVF treatment using your frozen material (eggs or embryos).  If you are considering surgery, such as removal of your fallopian tubes, ovaries or womb, then you would likely need the help of a surrogate or other fertility treatments to have a biological child. 

Will I need to stop testosterone therapy to freeze my eggs? 

You will likely need to pause your testosterone in order to freeze your eggs. This is because you will have to take medications to stimulate the ovaries into producing more eggs to be collected.

This can be difficult and in some people it exacerbates gender dysphoria. You’ll need to discuss this with your hormone provider (either your GP or endocrinologist) and it’s really important  to have a support network in place, and counselling to help you manage any symptoms you have. 

What are the success rates for using frozen eggs? 

Generally there is a higher chance of success when you freeze your eggs at a younger age. The thawing survival rate is around 80-90%, with the technology for this continuously advancing and improving success.

Generally, it’s recommended to freeze a higher number of eggs, around 18 or more, as not all eggs will survive the thawing process.

The success rates for using thawed eggs in future IVF cycles can vary, as there are lots of different factors such as the age of the person at the time of the egg collection, whether there are any fertility issues or conditions that might affect the fertility treatment, and the age of the person carrying the baby. The HFEA states an 18% success rates for frozen eggs used in cycles, with age being the biggest factor that influences success. 

Carrying a baby as a trans man or non-binary person

If you haven’t had a hysterectomy, and you want to carry a baby, then your doctor may suggest that you pause your testosterone therapy. It is possible to get pregnant on testosterone therapy, however it is not recommended to take testosterone as it can affect the development of the baby (NHS).

You may have a partner, or you may wish to use donor sperm to conceive. If you have frozen your eggs previously, you may be able to use these in an IVF cycle, where your eggs will be thawed, mixed with the sperm in a lab, and then transferred back into your uterus to implant and develop into a pregnancy.

If you do not use frozen eggs, but are ovulating having paused your testosterone therapy, then IUI may be recommended with either your partner’s sperm or donor sperm. With IUI, the sperm are injected directly into the uterus to fertilise any eggs naturally, whereas with IVF the eggs are collected from the body and fertilised in a lab before being transferred back into the uterus. 

Egg freezing before and after hormone therapy 

Whether you know right now that you would like children in the future, or you aren’t sure but want to safeguard your options, freezing eggs before you start any medical or surgical transition is recommended. If you have already started testosterone therapy, your doctor may recommend a pause in the treatment so that you can freeze your eggs before recommencing. 

Egg freezing before genital reconstructive surgery

If you are due to undergo genital reconstructive surgery, then talking through family-forming and fertility preservation options prior to this is also recommended, as a hysterectomy or removal of ovaries will permanently harm your fertility.

A fertility doctor will be able to make recommendations for treatment, and talk you through the options available to you. 

The next step - fertility tests for trans men 

You may also have worries about having to visit a clinic, or undergo the different diagnostic tests.

At Apricity we offer at-home tests, where we deliver a clinical-grade diagnostic kit directly to your door to do in the comfort of your own home, with the option of having a scan close to home with one of our accredited providers. 

Find out more about our transgender fertility tests. 

Egg freezing can offer trans and non-binary folks improved chances of having a biological child of their own in the future.

Undergoing any fertility treatment can be overwhelming, and talking it through with your support network or an accredited counsellor can make all the difference.

At Apricity we offer complimentary counselling with all of our treatments to ensure our patients feel supported.

We will always use your respected pronouns, which you can state in our mobile app, and our advisors are here to support you 7 days a week through extended hours. We believe that everyone has the right to feel safe, listened to and included throughout their fertility journey and are here to support you.

References

https://www.nhs.uk/pregnancy/having-a-baby-if-you-are-lgbt-plus/testosterone-and-pregnancy/

https://www.hfea.gov.uk/treatments/fertility-preservation/information-for-trans-and-non-binary-people-seeking-fertility-treatment/

https://www.hfea.gov.uk/about-us/news-and-press-releases/2018/press-release-age-is-the-key-factor-for-egg-freezing-success-says-new-hfea-report-as-overall-treatment-numbers-remain-low/#:~:text=Currently%20women%20using%20their%20own,a%20successful%20pregnancy%20and%20birth.