For trans and non-binary people considering medical transition, it can be difficult to find the right information about how fertility can be impacted and what treatments are available. We sat down with Asher, who shared their story about embryo freezing, pre-medical transition. Quick facts: Fertility concerns for trans+ individuals Thoughts about fertility may seem very far away when you’re experiencing the distress of having a body that doesn’t align with your identity.  But for trans and non-binary people considering a physical transition, whether with hormone therapy or gender-affirming surgery, the decisions made before and throughout can have a lasting impact on fertility.  Trans healthcare can be incredibly hard to access, with waiting lists for NHS Gender Identity Clinics in the UK being an average of 10 years wait or more.  Educational resources and personal stories of transition can also be hard to find. So we sat down with Asher, who was willing to share their journey with egg freezing to preserve their fertility before transitioning.  Before we dive into Asher’s story and the important decisions people may need to make around preserving their fertility, let’s understand some important terminology: Now let’s meet Asher. After many challenging years of living with gender dysphoria, they were able to access gender-affirming care. Yet it wasn’t until diagnosis and the start of a physical transition, that Asher was made aware of the fertility implications they could face.  Did anyone along your journey recommend preserving your fertility before undergoing any treatment? I discovered the importance of this process at the same time I was about to begin physically transitioning — literally the same day I was diagnosed with gender dysphoria and recommended for Testosterone HRT (hormone replacement therapy).  What were your fears and how did you overcome them? At the point of discovering this, I had surpassed the tipping point of how long I could cope with the soul-destroying experience of suppressing who I am in order to live in a world that taught me I shouldn’t exist. Managing gender dysphoria and trying to present yourself as something you’re not is an always-on 24/7 painful mask and bodysuit that you can’t take off. By the time I broke through internal and external barriers and played the arduous waiting game to speak with a doctor, I didn’t want to live another second with that feeling. My whole being was exhausted, terrorised, neglected and desperate for relief. Hearing then that I should freeze my eggs if I ever want children in the future not only felt like an extra obstacle for something so seemingly distant and intangible. The experience itself also sounded like it would be even more painful than what I’d been living with, as it essentially sounded like it would take me in the opposite direction.  On top of that, the information felt impossible to make sense of and the whole process itself seemed daunting, uncertain and expensive. I’ve always known that if life permits I’d love to raise a child someday, but I was totally unable to connect to this purpose. After a few off-putting initial conversations and appointments and my own research, I didn’t think I would be able to cope and was about to walk away.  Luckily, this is when I was introduced to Hertility and thank goodness I was! Finally some humane guidance, clarity and crucially being seen and understood as a trans person. The whole process became a lot clearer and felt more manageable, and honestly, I started to feel inspired by the gift of being able to do this. Was it easier than you expected to freeze your embryos? Yes. Although it wasn’t exactly easy, the actual process wasn’t nearly as bad as I imagined, especially with triggering my dysphoria. I suffered most in the angst-ridden anticipation before speaking with Hertility! It’s all the unknowns and uncertainty that make things feel worse than they are when you just take things day by day. How did you feel once it was over? So happy and so grateful. At the offset, I couldn’t have fathomed how joyous it would feel to get through this and know I’d honoured the future parent in me. This feeling only served to enrich how amazing it felt to start my physical transition after. Do you think we need more awareness in the community about fertility preservation so people know their options prior to gender reassignment surgery?  Absolutely. I wish I had been more informed and sooner but there was no mention of it, and even when it was it was almost a side-note. Transitioning alone is not an easy, self-determined process so we need to be informed about everything to expect as early as possible to start preparing, mentally and practically.  Help with gender dysphoria and transition If like Asher you are living with gender dysphoria and are considering physically transitioning, it is important to understand the implications this may have on your fertility, should you want children in the future.  Loads of great organisations can help you with the medical, practical and emotional aspects of gender journey and transition including: 

For LGBTQIA+ individuals and couples, family forming is never straight forward. Luckily there are lots of fertility treatments and options out there. We’ve put together a list of the different options available, whether you’re looking to embark on family forming now or in the future.  Quick facts: Sourcing sperm for fertility treatment There are three options for sourcing sperm in the UK:  If you source your sperm through a HFEA-licensed UK fertility clinic or sperm bank, your donor will have been vetted and their medical history checked. This includes infections such as HIV and hepatitis or a history of any genetic disorders.  The clinics will also be able to offer support and legal advice and each donor is only allowed to donate sperm to make up to 10 families.  If you’re planning on bypassing a licensed clinic or sperm bank and using donated sperm either from a known donor or another source, it’s recommended to ask the individual to carry out their own medical checks before donation. With using sperm from someone you know personally, there are legalities around who is the legal father of the child. It’s important to research this option thoroughly if this is a route you’re choosing to go down.  If you would like to use a known donor but would still like all the legal protections around parenthood, you will still be protected if you carry out the insemination at a clinic. Intra-uterine insemination (IUI)  Intra-uterine insemination (IUI), also known as artificial insemination, is a type of fertility treatment that involves injecting sperm into the uterus (womb) using a special syringe-like device called a catheter.  IUI is a commonly used fertility treatment for same-sex female couples, where one (or both) partners want to carry a child. For IUI, you’ll need to source some sperm—either through a licenced sperm bank or fertility clinic, or some couples opt to use a sperm donor that they know personally.  As long as you are ovulating regularly and have no issues with your Fallopian tubes you should be eligible for IUI.  However, IUI may not be recommended for you (or your partner) if you: Couples have the choice for the insemination process to take place in a licensed clinic, or they may opt to do this in the comfort of their own home to save them money and time. But, there are some legal risks if you choose this second option. IUI is thought to be a less invasive and more natural process than IVF because it doesn’t involve as many medications. In vitro Fertilisation (IVF)  IVF is a fertility treatment where eggs are removed from the ovaries and fertilised with sperm in a lab. If an egg is successfully fertilised, the resulting embryo is transferred into the uterus.  IVF is another popular fertility treatment for same sex-female or gender-diverse couples and is one of the most common in the UK. Again, it requires a sperm donor which can be sourced from a licenced sperm bank, fertility clinic or someone you know personally.  IVF also forms part of the shared motherhood and surrogacy process. Shared Motherhood Otherwise known as Reciprocal IVF, shared motherhood is where eggs are collected from one partner, fertilised in a lab with donor sperm, and the resulting embryo is transferred to the other partner’s uterus for them to carry the baby.  Shared motherhood can be a great option for couples where both individuals have working female reproductive anatomy, allowing for both partners to be physically involved in the family-forming journey. Not all fertility clinics offer this treatment and eligibility depends on various factors such as your age, weight, lifestyle and medical history. Surrogacy Surrogacy is where an individual agrees to carry a child on behalf of another person or couple.  Traditional or partial surrogacy involves the surrogate’s eggs being fertilised using the sperm from someone within the couple, to create the biological link to one of them. This is often used by male same-sex couples looking to form a family.  Full or gestational surrogacy is when the eggs of the intended mother or a donor are used, and therefore, there is no genetic connection between the surrogate and the baby.  Whilst surrogacy is legal in the UK, it is an altruistic process. Essentially this means it is illegal for a surrogate to receive any monetary gain from helping you on your journey to parenthood, and it is even illegal to advertise seeking a surrogate. A surrogate can receive expenses.  There are a lot of other complicated legal issues to note about surrogacy. The most important is that the surrogate is the legal mother of the child when it’s born. This is even if the eggs and sperm used in the process are yours or were donated, and the carrier is not genetically related to the child.  The surrogate has rights over the child until you receive a parental order from the court – so of course, it is vital to choose someone you trust. For these reasons, it is common for a close friend or family member to carry a child on behalf of the couple. If you are looking for more information, please visit the Human Fertilisation and Embryology Authority (the regulatory body for fertility treatment in the UK) website or Surrogacy UK. Coparenting Co-parenting is a pathway some LGBTQIA+ couples are now choosing to go down. It usually involves two or more people who are not in a romantic relationship deciding to raise a child together. For example, a lesbian couple chooses to have a biological child with a gay male and agrees to raise the child collectively.  They can choose to opt for fertility treatment such as IUI or IVF for this depending on age, medical history and sperm quality. Although this is something that has been going on for years, the rise of the internet has caused a shift in the way prospective co-parents may look for partners. If you are choosing to go down this path, it’s important to understand […]