Bioethics Blogs

Fertility preservation for transgender individuals

The field of oncofertility emerged to preserve the fertility
of cancer patients whose treatment might render them as infertile or sterile.
Today, the field of fertility preservation has expanded to other patient
populations whose medical treatment may affect their fertility. One such
population is transgender individuals undergoing gender affirming treatments.
Although research on transgender individuals is limited overall and in
particular regarding issues surrounding reproduction, transgender individuals
are interested in biological reproduction. Because various gender affirming
treatments will permanently affect their fertility, such as hormonal treatment
and surgical removal of the gonads, it is important for transgender individuals
to be offered fertility preservation before they start these treatments.

There are, however, some factors that may make fertility
preservation difficult or less attractive of an option for transgender
individuals. Healthcare professionals offering fertility preservation should be
aware of these factors so they can help mitigate them. Here I will discuss two
of them.

First, undergoing fertility preservation treatment can be
stressful for both transgender and cisgender people, but there are some unique
challenges for transgender individuals. Individuals with gender dysphoria may
find it particularly difficult to undergo procedures involving anatomy that is
discordant with their identity. For example, transgender women who are asked to
retrieve sperm via masturbation may find this request exacerbates their gender
dysphoria and may not be possible to do. Transgender men who are asked to
undergo vaginal ultrasounds may find this psychologically traumatic. In
recognizing how fertility preservation treatment can be particularly difficult
for transgender individuals, healthcare professionals should be prepared to
find ways to alleviate these difficulties, such as by offering surgical methods
of sperm retrieval for transgender women and sedating transgender men during
vaginal ultrasounds.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.