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If you are considering gender-affirming care, you may have questions about how it can impact your ability to have a biological child in the future. Treatment such as hormone therapy and surgery can cause changes in the reproductive system. The impact of these treatments varies widely.

No matter where you are on your journey, it’s important to know that treatment options are available to help you conceive.

How Gender-Affirming Care Affects Fertility

Hormone Replacement Therapy (HRT) can influence fertility in several ways because estrogen and testosterone have direct impacts on reproductive health—estrogen being crucial for ovulation and the health of the uterine lining and testosterone for sperm production. Depending on the type of hormones administered and the duration of therapy, these changes can be temporary or more enduring.

Surgical treatment may include the removal of reproductive organs such as the uterus, ovaries, or testes. Once these organs are removed, the ability to biologically conceive is no longer possible without fertility preservation or the use of a donor or gestational carrier.

Fertility Preservation Options for Those Seeking Gender-Affirming Care

Fertility preservation empowers you to take control of your reproductive future. Freezing eggs, sperm, or embryos can safeguard your ability to have biological children. For those considering gender-affirming care, it’s advisable to discuss fertility preservation options with a healthcare provider early in the process.

Cryopreservation of eggs or sperm serves as a bridge to the future, increasing the chances of having a biological child when you’re ready to build your family.

Another option is embryo freezing, which involves fertilizing eggs with sperm to create embryos. Embryos can be created using the eggs or sperm of a partner or from a donor.

IVF and Other Assisted Reproductive Technologies

There are many pathways to parenthood using assisted reproductive technology (ART) such as intrauterine insemination (IUI) and In Vitro Fertilization (IVF). The path you choose will be based on your goals and individual circumstances.

IUI, which involves directly inserting sperm from a partner or donor into the uterus, may be an option when one partner can carry the pregnancy. For people with a uterus who are on testosterone, this typically requires pausing therapy and the resumption of the menstrual cycle, which may take several months. Ovulation-inducing medication may also be recommended to improve the chances of conceiving. During this time, fertility testing and ovulation monitoring are performed to determine the optimal timing for the procedure.

IUI may also be a possibility for people with testicles if sperm was frozen before HRT. Pausing hormone treatments could potentially resume sperm production that can be used for the procedure, but it’s important to note that results vary from person to person.  

Another option is IVF, which involves using eggs and sperm to create an embryo and transferring the embryo into the uterus.

Like with IUI, temporarily halting hormone therapy to undergo egg or sperm retrieval may still be possible. When using one’s own eggs or sperm is not an option, individuals and couples might consider donor eggs, sperm, or embryos. For individuals and couples unable to carry a pregnancy, there is also the option of using a gestational carrier.

Finding a Supportive Fertility Plan for LGBTQIA+ Individuals

Engaging in a candid discussion with a fertility specialist who respects and understands the unique needs of the LGBTQIA+ community and individuals who have undergone or plan to undergo gender-affirming care is essential on your family-building journey. You and your physician can map out a plan that identifies the specific steps you can take together to pursue your dream of starting a family.

Fertility Centers of Illinois (FCI) has proudly served the LGBTQIA+ community for more than 30 years and has a dedicated Third-Party program that works extensively with donors and surrogates. Our team will provide you with guidance and support throughout the medical, legal, and emotional aspects of your family-building journey.

Remember, every family-building journey is unique, and there are numerous paths to achieving the dream of parenthood. With the right support and information, you can navigate this process with confidence and clarity to find your success.

Medical contribution by Allison K. Rodgers, M.D.

Dr. Allison Rodgers is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing medicine since 2004. Dr. Rodgers’ personal experiences with both secondary infertility and pregnancy loss have given her a unique insight into reproductive medicine, and she is well-known for her compassionate and individualized patient care. 

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