Transgender People and Fertility Preservation

Background

I have recently conducted a project on transgender people and fertility preservation (with Clare Bartholomaeus). This project explores how transgender and non-binary adults, and parents of transgender and non-binary children make decisions about fertility preservation, and their experiences of undertaking fertility preservation in the Australian context. Infographics showing the key findings are available here, here, and here.

A full list of my research publications on the topic of transgender people and fertility preservation can be found further down the page, and are drawn on in the applications of research findings sections below. I have recently contributed to a new Australian Psychological Society information sheet on transgender people and fertility preservation, available here.

Applications of research findings for practitioners

Findings from my research on transgender and non-binary people and fertility preservation suggest that it may that only a minority of transgender and non-binary people wish to preserve their fertility. Nonetheless, fertility preservation is a reproductive right, and there is much practitioners can do to facilitate this. This may include advocating for the inclusion of fertility preservation for transgender and non-binary people on social healthcare registries, so as to reduce or waive costs. It can also mean providing outreach to transgender and non-binary communities to provide information about the availability of fertility preservation.

In the clinical space, it is important that clinicians are aware of and use people’s pronouns and names correctly: misgendering can be a significant barrier to accessing services. Further, for some transgender or non-binary people using terms for specific gametes may be upsetting, and so using the generic term ‘gametes’ may be preferable. Finally, our research has found that for transgender and non-binary people who wish to become parents, only a minority may be invested in having children to whom they are genetically related. This means that talking about the importance of genetic relatedness can be a useful way of opening up conversations about fertility preservation.

Applications of research findings for transgender people considering fertility preservation

As noted above, a helpful way to think about parenthood is to think about what you are trying to achieve. Do you simply want to become a parent, or is it important that you are the parent of children to whom you are genetically related? Thinking about this question opens up avenues for unpacking whether or not fertility preservation is in your best interest.

For transgender and non-binary young people, decision making can be complicated by the views of parents, and issues associated with access to services (where parents may be required to pay on behalf of their children). It is important that transgender and non-binary people, where possible, think about an imagined future where they might wish to become parents, and think about what it would mean to use their gametes: might this be distressing or might it be okay?

Resources for practitioners

Australian

Australian Psychological Society. (2016). Information sheet: Australian Psychological Society recommends mental health practices that affirm transgender people’s experiences.

Australian Psychological Society – Transgender people and fertility preservation

International

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. Washington: APA.

Centre of Excellence for Transgender Health. (2016). Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people.

Oliphant, J., Veale, J., Macdonald, J., Carroll, R., Johnson, R., Harte, M., . . . Bullock, J. (2018). Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato.

Telfer, M., Tollit, M., Pace, C., & Pang, K. (2017). Australian Standards of Care and Treatment Guidelines: For trans and gender diverse children and adolescents. Melbourne: The Royal Children’s Hospital.

World Professional Association for Transgender Health. (2013). Standards of Care, version 7.

Resources for transgender people considering fertility preservation

Australian

Victorian Assisted Reproductive Treatment Authority (VARTA) – Transgender and gender diverse people

International

Center of Excellence for Transgender Health (US) – Fertility options for transgender persons

Human Fertilisation & Embryology Authority (UK) – Information for trans and non-binary people seeking fertility treatment

NHS Choices (UK) – LGBT paths to parenthood

Reproductive options for trans people (Canada)

Books/sources with personal stories

Abramovich, A. (2016). Trans men need the competent fertility care I never got. Advocate. 9 March.

Almendrala, A. (2018). Transgender people often have to choose between their fertility and their transition. Huffington Post. 1 November.

Spataro, J. (2018). Adventures in transgender fertility. New York Times. 24 April.

Picture books (parents who are transgender)

Boenke, M., & Dudley, D. (2004). Carly: She’s still my daddy. The Transgender Network of Parents, Families and Friends of Lesbians and Gays.

Hall, G. (2012). My dad wears pirate shoes. Expose.

Kelly, E., & Webster, E. (2003). The little boy: A special story about Daddy by Grandma & Mummy. Glebe, NSW: FTM Australia.

Martinez, J., & Winchester, K. (2011). My mommy is a boy. Lulu.

Mossiano, L., & Mossiano, S. (2012). My new mommy. Spun Silver Productions.

Mossiano, L., & Mossiano, S. (2012). My new daddy. Spun Silver Productions.

My research publications

Bartholomaeus, C., & Riggs, D.W. (Online First 2019). Transgender and non-binary Australians’ experiences with healthcare professionals in relation to fertility preservation. Culture, Health & Sexuality.

Riggs, D. W. (forthcoming). Diverse pathways to parenthood: From narratives to practice. Elsevier.

Riggs, D.W. (2019). An examination of ‘just in case’ arguments as they are applied to fertility preservation for transgender people. In V. Mackie, S. Ferber & N. Marks (Eds.), The body and the globe: From IVF to global reproductive industry. New York: Lexington Books.

Riggs, D. W., & Bartholomaeus, C. (2018). Fertility preservation decision making amongst Australian transgender and non-binary adults. Reproductive Health, 15, 181-191.

Other research publications (selected)

International

Abern, L., & Maguire, K. (2018). Fertility preservation among transgender individuals. Fertility and Sterility, 110(4 Supplement), e281.

Abern, L., Maguire, K., Diego, D., & Wong, A. (2017). Contraceptive use and fertility preservation among transgender individuals: are we doing enough? Fertility and Sterility, 108(3), Supplement e115.

Adeleye, A., Cedars, M., & Mok-Lin, E. (2018). Ovarian stimulation outcomes for transgender males. Fertility and Sterility, 110(4 Supplement), e281.

Adeleye, A., Reid, G. M., Mok-Lin, E., & Smith, J. F. (2017). Fertility preservation for transgender females after gender affirming treatment is effective. Fertility and Sterility, 108(3), Supplement e391.

Alphonso, A., Olezeski, C., Kallen, A., & Cron, J. (2018). Fertility knowledge and preferences among transgender and gender non-conforming adolescents. Journal of Pediatric and Adolescent Gynecology, 31(2), 185.

Armuand, G., Dhejne, C., Olofsson, J., & Rodriguez-Wallberg, K. (2017). Transgender men’s experiences of fertility preservation – a qualitative study. Human Reproduction, 32(2), 383-390.

Barnard, E., Menke, M., Witchel, S., Dhar, C., Montano, G., Goodall, J., . . . Valli-Pulaski, H. (2018). Fertility preservation outcomes in feminizing transgender patients: Experience at a single institution. Fertility and Sterility, 110(4 Supplement), e282.

Broughton, D., & Omurtag, K. (2017). Care of the transgender or gendernonconforming patient undergoing in vitro fertilization. International Journal of Transgenderism, 18(4), 372-375.

Chen, D., Bernardi, L.A., Pavone, M.E., Feinberg, E.C., & Moravek, M.B. (2018). Oocyte cryopreservation among transmasculine youth: a case series. Journal of Assisted Reproduction and Genetics, 35(11), 2057-2061.

Chen, D., Kolbuck, V.D., Sutter, M.E., Tishelman, A.C., Quinn, G.P., & Nahata, L. (2019). Knowledge, practice behaviors, and perceived barriers to fertility care among providers of transgender healthcare. Journal of Adolescent Health, 64(2), 226-234.

Chen, D., Kyweluk, M.A., Sajwani, A., Gordon, E.J., Johnson, E.K., Finlayson, C.A., & Woodruff, T.K. (2019). Factors affecting fertility decision-making among transgender adolescents and young adults. LGBT Health, 6(3), 107-115.

Chen, D., Matson, M., Macapagal, K., Johnson, E.K., Rosoklija, I., Finlayson, C., . . . Mustanski, B. (2018). Attitudes toward fertility and reproductive health among transgender and gender-nonconforming adolescents. Journal of Adolescent Health, 63(1), 62-68.

Chen, D., & Simons, L. (2018). Ethical considerations in fertility preservation for transgender youth: A case illustration. Clinical Practice in Pediatric Psychology, 6(1), 93-100.

Chen, D., Simons, L., Johnson, E.K., Lockart, B.A., & Finlay, C. (2017). Fertility preservation for transgender adolescents. Journal of Adolescent Health, 61(1), 120-123.

Chiniara, L. N., Viner, C., Palmert, M., & Bonifacio, H. (Online First 2019). Perspectives on fertility preservation and parenthood among transgender youth and their parents. Archives of Disease in Childhood.

Clark, B., Jarin, J., Strang, J., Call, D., Solages, M., & Gomez-Lobo, V. (2017). Transgender adolescent attitudes towards their future fertility. Journal of Pediatric and Adolescent Gynecology, 30(2), 326.

De Roo, C., & T’Sjoen, G. (2018). Sperm preservation in transgender patients. In M. Ahmad & A. Ashok (Eds.), The complete guide to male fertility preservation (pp. 121-128). Cham: Springer.

De Roo, C., Tilleman, K., T’Sjoen, G., & De Sutter, P. (2016). Fertility options in transgender people. International Review of Psychiatry, 28(1), 112-119.

De Sutter, P. (2009). Reproductive options for transpeople: Recommendations for revision of the WPATH’s standards of care. International Journal of Transgenderism, 11(3), 183-185.

De Sutter, P., Kira, K., Verschoor, A., & Hotimsky, A. (2002). The desire to have children and the preservation of fertility in transsexual women: A survey. International Journal of Transgenderism, 6(3).

Defreyne, J., Van Schuylenbergh, J., Wyverkens, E., Motmans, J., & T’Sjoen, G. (2018). Child wish and fertility preservation in assigned male at birth transgender persons living in Belgium. Endocrine Abstracts, 56, 971.

del Toro, H.O., Grossoehme, D., Helmrich, A., Gordon-Fogelson, M., Conard, L.A., & Trotman, G.E. (2018). Knowledge, desires and perceived barriers to fertility preservation in a transgender adolescent and young adult population. Journal of Pediatric and Adolescent Gynecology, 31(2), 185.

deNormand, S. (2017). Fertility preservation in transgender and gender-nonconforming youth and adolescents. In L. Campo-Engelstein & P. Burcher (Eds.), Reproductive Ethics: New Challenges and Conversations (pp. 77-84). Cham: Springer.

Dhejne, C., Stefenson, M., Degerblad, M., & Olofsson, J.I. (2014). Preserving eggs for men’s fertility. A pilot experience with fertility preservation for female-to-male transsexuals in Sweden. Fertility and Sterility, 102(3), Supplement e160-e161.

dickey, l.m., Ducheny, K.M., & Ehrbar, R.D. (2016). Family creation options for transgender and gender nonconforming people. Psychology of Sexual Orientation and Gender Diversity, 3(2), 173-179.

Dunne, P. (2017). Transgender sterilisation requirements in Europe. Medical Law Review, 25(4), 554-581.

Dunne, P. (2017). Legal gender recognition in Europe: Sterilisation, diagnosis and medical examination requirements. Journal of Social Welfare and Family Law, 39(4), 497-500.

Ethics Committee of the American Society for Reproductive Medicine. (2015). Access to fertility services by transgender persons: An ethics committee opinion. Fertility and Sterility, 104(5), 1111-1115.

Feigerlová, E., Pascal, V., Ganne-Devonec, M.-O., Klein, M., & Guerci, B. (Online First 2019). Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice. Clinical Endocrinology.

Finlayson, C., Johnson, E.K., Chen, D., Dabrowski, E., Gosiengfiao, Y., Campo-Engelstein, L., . . . Woodruff, T.K. (2016). Proceedings of the working group session on fertility preservation for individuals with gender and sex diversity. Transgender Health, 1(1), 99-107.

Goldman, R.H., Kaser, D.J., Missmer, S.A., Farland, L.V., Scout, S., Ashby, R.K., & Ginsburg, E. S. (2016). Fertility treatment in the transgender community: A public opinion study. Fertility and Sterility, 106(3), Supplement, e365-e366.

Hamada, A., Kingsberg, S., Wierckx, K., T’Sjoen, G., Sutter, P.D., Knudson, G., & Agarwal, A. (2015). Semen characteristics of transwomen referred for sperm banking before sex transition: a case series. Andrologia, 47(7), 832-838.

Honkasalo, J. (2018). Unfit for parenthood? Compulsory sterilization and transgender reproductive justice in Finland. Journal of International Women’s Studies, 20(1), 40-52.

Hudson, J., Nahata, L., Dietz, E., & Quinn, G.P. (2018). Fertility counseling for transgender AYAs. Clinical Practice in Pediatric Psychology, 6(1), 84-92.

James-Abra, S., Tarasoff, L.A., green, d., Epstein, R., Anderson, S., Marvel, S., . . . Ross, L.E. (2015). Trans people’s experiences with assisted reproduction services: a qualitative study. Human Reproduction, 30(6), 1365-1374.

Johnson, E.K., Chen, D., Gordon, E.J., Rosoklija, I., Holl, J.L., & Finlayson, C. (2016). Fertility-related care for gender and sex diverse individuals: A provider needs-assessment survey. Transgender Health, 1(1), 197-201.

Johnson, E.K., & Finlayson, C. (2016). Preservation of fertility potential for gender and sex diverse individuals. Transgender Health, 1(1), 41-44.

Jones, C.A., Reiter, L., & Greenblatt, E. (2016). Fertility preservation in transgender patients. International Journal of Transgenderism, 17(2), 76-82.

Kim, B.H., Segev, D.L., Fung, R.C., Jarvi, K.A., & Millar, A.C. (2017, 1-4 April). Attitudes, knowledge and beliefs regarding fertility among people of transgender experience. Poster Number SUN 110. Paper presented at the Endocrine Society Annual Meeting, Orlando, FL.

Knudson, G., & De Sutter, P. (2017). Fertility options in transgender and gender diverse adolescents. Acta Obstetricia et Gynecologica Scandinavica, 96(10), 1269-1272.

Kyweluk, M.A., Sajwani, A., & Chen, D. (2018). Freezing for the future: Transgender youth respond to medical fertility preservation. International Journal of Transgenderism, 19(4), 401-416.

Leonardi, M., Frecker, H., Scheim, A.I., & Kives, S. (2019). Reproductive health considerations in sexual and/or gender minority adolescents. Journal of Pediatric and Adolescent Gynecology, 32(1), 15-20.

Light, A.D., Zimbrunes, S.E., & Gomez-Lobo, V. (2017). Reproductive and obstetrical care for transgender patients. Current Obstetrics and Gynecology Reports, 6(2), 149-155.

Lowik, A.J. (2017). Reproducing eugenics, reproducing while trans: The state sterilization of trans people. Journal of GLBT Family Studies, 14(5), 425-445.

Mattawanon, N., Spencer, J.B., Schirmer III, D.A., & Tangpricha, V. (2018). Fertility preservation options in transgender people: A review. Reviews in Endocrine and Metabolic Disorders, 19(3), 231-242.

Maxwell, S., Noyes, N., Keefe, D., Berkeley, A.S., & Goldman, K.N. (2017). Pregnancy outcomes after fertility preservation in transgender men. Obstetrics & Gynecology, 129(6), 1031-1034.

Mitu, K. (2016). Transgender reproductive choice and fertility preservation. AMA Journal of Ethics, 18(11), 1119-1125.

Moravek, M.B., Lawson, A.K., Crissman, H.P., Mahany, E.B., Randolph, J.F., & Berger, M.B. (2018). Barriers to fertility preservation in transgender (TG) patients: A survey study. Fertility and Sterility, 110(4 Supplement), e282.

Nahata, L., Campo-Engelstein, L.T., Tishelman, A., Quinn, G.P., & Lantos, J.D. (2018). Fertility preservation for a transgender teenager. Pediatrics, 142(3).

Nahata, L., Chen, D., Moravek, M.B., Quinn, G.P., Sutter, M.E., Taylor, J., . . . Gomez-Lobo, V. (2019). Understudied and under-reported: Fertility issues in transgender youth—A narrative review. The Journal of Pediatrics, 205, 265-271.

Nahata, L., Curci, M.B., & Quinn, G.P. (2018). Exploring fertility preservation intentions among transgender youth. Journal of Adolescent Health, 62(2), 123-125.

Nahata, L., Tishelman, A.C., Caltabellotta, N.M., & Quinn, G.P. (2017). Low fertility preservation utilization among transgender youth. Journal of Adolescent Health, 61(1), 40-44.

Nixon, L. (2013). The right to (trans) parent: A reproductive justice approach to reproductive rights, fertility, and family-building issues facing transgender people. William & Mary Journal of Women and the Law, 20(1), 73-103.

Oliphant, J., Veale, J., Macdonald, J., Carroll, R., Johnson, R., Harte, M., . . . Bullock, J. (2018). Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato.

Quinn, G.P., Sampson, A., & Campo-Engelstein, L. (2018). Familial discordance regarding fertility preservation for a transgender teen: An ethical case study. The Journal of Clinical Ethics, 29(4), 261-265.

Saraf, A.J., & Nahata, L. (2017). Fertility counseling and preservation: considerations for the pediatric endocrinologist. Translational Pediatrics, 6(4), 313-322.

Schaffer, R. (2018). For transgender patients and providers, fertility preservation options bring choices, concerns. Endocrine Today, 16(2), 1, 14-16.

Schelble, A.P., Fisher, A.R., Jungheim, E., Lewis, C., & Omurtag, K. (2017). Fertility preservation (FP) referral and follow-up in male-to-female (MTF) and female-to-male (FTM) transgender patients. Fertility and Sterility, 108(3), Supplement e115-e116.

Strang, J.F., Jarin, J., Call, D., Clark, B., Wallace, G.L., Anthony, L.G., . . . Gomez-Lobo, V. (2018). Transgender Youth Fertility Attitudes Questionnaire: Measure development in nonautistic and autistic transgender youth and their parents. Journal of Adolescent Health, 62(2), 128-135.

Wakefield, B.W., Boguszewski, K., Cheney, D., & Taylor, J. (2018). Trends in fertility preservation for transgender adolescents and young adults at an academic referral center. Journal of Adolescent Health, 62(2), s41.

Wallace, S.A., Blough, K.L., & Kondapalli, L.A. (2014). Fertility preservation in the transgender patient: Expanding oncofertility care beyond cancer. Gynecological Endocrinology, 30(12), 868-871.

Walton-Betancourth, S., Monti, E., Adu-Gyamfi, K., Roberts, A., Clarkson, K., Ward, S., & Butler, G. (2018). Attitudes toward fertility and reproductive health among transgender adolescents. Endocrine Abstracts, 58, OC8.3.

Walton-Betancourth, S., Monti, E., Adu-Gyamfi, K., Roberts, A., Clarkson, K., Ward, S., & Butler, G. (2018). Fertility preservation for transgender adolescents: The parent’s view. Endocrine Abstracts, 58, P030.

Wierckx, K., Stuyver, I., Weyers, S., Hamada, A., Agarwal, A., De Sutter, P., & T’Sjoen, G. (2012). Sperm freezing in transsexual women. Archives of Sexual Behavior, 41(5), 1069-1071.

Wierckx, K., Van Caenegem, E., Pennings, G., Elaut, E., Dedecker, D., Van de Peer, F., Weyers, S., De Sutter, P., & T’Sjoen, G. (2012). Reproductive wish in transsexual men. Human Reproduction, 27(2), 483-487.