Future fertility planning is an integral aspect of transgender medicine. For women transitioning into men, egg-freezing (and possible embryo freezing) remains the most effective method to maximize the likelihood of conception as part of their reproductive journey.
While undergoing their journey of gender-affirmation, transgender men often undergo hormone replacement therapy (HRT) with testosterone supplementation. However, it is unclear what effect HRT has on long term ovarian function and egg quality. Since testosterone therapy prevents egg maturation, it will need to be stopped while the egg-freezing process is being done.
The process of egg freezing is conceptually simple. Once menses occurs, ovarian stimulation is performed using gonadotropins. These are the same hormones that naturally stimulate the development of eggs. However, the doses given are much higher so that many more eggs develop. Stimulation typically takes 7-12 days. The eggs grow in follicles whose growth is tracked using ultrasound and blood work every 1-3 days or so during stimulation. Once the follicles reach the right size, a trigger injection is given to mature the eggs in those follicles. About a day-and-a-half afterwards, the patient then undergoes a retrieval.
A retrieval is the procedure during which the eggs are extracted using a needle and gentle vacuum. It can be done vaginally or abdominally depending on whether gender-affirming surgery has already been done or patient preference. Once the eggs are extracted, they can be stored immediately. OR if the patient wishes to make embryos, the eggs are fertilized and the resulting embryos are then frozen. Both eggs and embryos can be stored for years and even decades with little-to-no degradation.
How transgender men can build their family after egg freezing
When the transgender male patient wishes to proceed with family-building, the eggs or embryos can be easily thawed. If the patient desires to carry the pregnancy, then testosterone therapy will need to be stopped for the whole duration of the pregnancy due to the risk of harm to a fetus. An alternative, if the patient does not wish to carry the pregnancy or has undergone gender-affirming surgery and the uterus has been removed, the embryos can then be transferred to a gestational carrier who will carry the pregnancy. However, additional testing and legal preparation will be necessary to use a gestational carrier.
For any of the above treatments, mental health support is crucial. Optimal counseling ensures the well-being of transgender men. Given that patients can experience symptoms of dysphoria during the egg/embryo-freezing or the preparation for transfer, support from an experienced mental health provider is indispensable.
Regardless of where in their reproductive journey a transgender patient is, our goal is to provide compassionate and evidence-based care at every crucial step. By providing the highest quality care we not only support the patient, we also strengthen the community.