Share your experiences by joining our Patient Engagement Forum.Information for trans and non-binary people seeking fertility treatment
Fertility may be the last thing on your mind when you’re experiencing the distress of having a body that doesn’t express your identity. Understandably, some trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you have treatment without preserving your fertility and then realise later on that it is not possible or more difficult to have a biological family. Thinking through all these issues now and understanding your options will help you make an informed decision.
Fertility treatment for trans people
Some medical treatments for gender dysphoria, including hormone therapy and surgery, can have an impact on your fertility. If you’re considering starting treatment to physically alter your body, or you’ve already started, find out what your options are for preserving your fertility.
How does medical treatment for gender dysphoria affect fertility?
Hormone therapy (oestrogen or testosterone) suppresses your fertility function and over time can lead to a complete loss of fertility. In some cases, people who stop taking their hormone therapy will have their fertility restored, although this is by no means guaranteed. Generally, the longer you are having hormone therapy the more your fertility is likely to be permanently affected.
If you think you would like biological children at some point and you haven’t started medical treatment or had surgery, you may wish to preserve your fertility by having your sperm, eggs or embryos frozen and stored for later use in fertility treatment.
Depending on your situation, you, your partner or a surrogate may undergo fertility treatment (such as IVF) using your stored sperm, eggs or embryos. Having genital reconstructive surgery will prevent you from having biological children without the use of a surrogate or interventional fertility treatments. Relevant genital surgery includes having a salpingo-oophorectomy (removal of the fallopian tubes and ovaries), hysterectomy (removal of the womb), orchidectomy (removal of the testes) and penectomy (removal of the penis).
I haven’t started hormone therapy or puberty suppressing medication yet – what are my options for preserving my fertility?
If you’ve already gone through puberty you may be able to freeze your eggs or sperm and store them until you’re ready to use them in treatment.
Egg freezing involves taking fertility drugs to stimulate your ovaries and then collecting the eggs by a surgical procedure whilst you’re sedated. It is mostly very safe, although there is a risk of ovarian hyperstimulation, which can need hospital treatment and in very rare cases can be fatal.
Find out more about egg freezing
Find out more about the risks of fertility treatment
Sperm freezing involves masturbating or undergoing vibratory stimulation to produce a sperm sample, which is then frozen and stored. If you do not feel comfortable producing sperm in this way, it is possible to extract the sperm in different ways (such as through surgical sperm extraction) although these involve more invasive surgical procedures.
Before puberty
If you haven’t gone through puberty yet and you’re keen to start hormone therapy or puberty suppressing medication as soon as possible, it may be possible for you to store your ovarian tissue or testicular tissue, which can be collected via a surgical procedure. These treatments are experimental and there have only been a very small number of resulting live births worldwide following replacement of the ovarian tissue. It is unclear at present how stored testicular tissue would be used to restore fertility: this has not been achieved yet. It’s also worth bearing in mind that very few clinics offer these treatments so you may need to travel some way on multiple occasions to have this procedure.
You can use the Choose a fertility clinic search function to find clinics that store ovarian or testicular tissue.
I’ve already started taking hormone therapies or puberty suppressing medication, what are my options for preserving my fertility?
If you’ve already started hormone therapy or you’re taking puberty suppressing medication you should speak to a fertility specialist. They will probably recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. This means your ovaries may start to ovulate again or your body may start producing sperm, generally over a few months.
Some Trans and non-binary people find it distressing to come off their hormone therapy and may consider other options for having a family, such as using donated sperm or eggs in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family.
I’ve been undergoing hormone therapy and am about to go for genital reconstructive surgery, what are my options for preserving my fertility?
If you’re ready for genital reconstructive surgery, it may be possible for your surgeon to collect ovarian tissue or collect sperm via surgery which you can store for future fertility treatment. The only way in which the ovarian tissue can be used at the moment is by replacing it back in you: it cannot be put in another person, and eggs cannot be grown from it ‘in the lab’ at the moment, though this may become possible in the future. You should discuss this with a fertility specialist.
You can’t have children using your own sperm, eggs or embryos once you’ve had genital reconstructive surgery, unless you store your sperm, eggs or embryos prior to surgery.
How long can I store my eggs, sperm, embryos or reproductive tissue for use in treatment?
If your eggs, sperm or embryos are not used immediately in treatment, you may wish to store your eggs, sperm or embryos so they can be used for treatment in the future. To be stored eggs, sperm or embryos are frozen. You will need to think about how far in the future you might want or be able to use stored eggs, sperm or embryos and the potential costs of storing. This is something you should discuss with your clinic.
You should be aware that embryos can only be stored if both you and the egg or sperm provider have given consent. This may be your partner or may be a donor (if donated eggs or sperm were used in treatment).
On 1 July 2022, the rules on how long you can store eggs, sperm or embryos changed. Before 1 July 2022, most people could normally only store their eggs, sperm or embryos for up to 10 years. Only if they had premature infertility or were going to be having medical treatment which could affect their fertility, could they store for up to 55 years.
The law now permits you to store eggs, sperm or embryos for use in treatment for any period up to a maximum of 55 years from the date that the eggs, sperm or embryos are first placed in storage. However, crucially for storage to lawfully continue you will need to renew your consent every 10 years. You can give your consent on the relevant consent form. You will be contacted by your clinic with relevant information and they should also provide you an offer of counselling before you give consent to storage of your embryos. Your clinic will contact you and provide the consent forms that you need to complete at the appropriate time. It is therefore essential that you keep your contact details up to date with your clinic as you will need to be contacted. If your clinic is unable to contact you your eggs, sperm or embryos will be at risk of being removed from storage and disposed of.
You don’t have to match the length of storage to any contract for paying for the storage (whether you, or the NHS, is paying). However, if you don’t pay for storage as agreed, the clinic may be within its right to dispose your eggs, sperm or embryos. Your clinic should have explained this to your clearly when you stored yours, sperm or embryos.
What happens if I do not renew my consent to storage at the appropriate time?
If you do not renew your consent to storage your eggs, sperm or embryos will be removed from storage and disposed of when they no longer can be lawfully stored.
If you do not wish to renew your consent to storage or to continue storing your eggs, sperm or embryos then you can withdraw your consent to storage . You will need to contact your clinic and complete the relevant withdrawal of consent form. At this point you may wish to consider donating the eggs, sperm or embryos that you do not wish to use for your own treatment for training purposes, or for use in someone else’s treatment. You would need to discuss this with your clinic and provide the additional consents where relevant. You can also consider donating your eggs, sperm or embryos for use in research, helping to increase knowledge about diseases and serious illnesses and potentially develop new treatments. Your clinic will need to give you more information about this and advise you whether this is an option for you.
I stored my eggs, sperm or embryos before 1 July 2022, what should I do?
If you stored your eggs, sperm or embryos before 1 July 2022 for up to 10 years but would like to store for longer (up to a maximum of 55 years from the date that the embryos are first placed in storage), you should contact your clinic to discuss whether this is possible and complete additional consent forms where necessary.
If you previously consented to store your eggs, sperm or embryos for longer than 10 years (up to a maximum of 55 years) because of premature infertility or because you were going to be having medical treatment which could affect your fertility you should contact your clinic as soon as possible as consent will now have to be renewed at each 10 years. You and the sperm or egg provider will need to complete additional consent forms in order for your clinic to legally continue to store your embryos (even if the clinic are still storing your eggs, sperm or embryos within the consent period you originally specified). Your clinic will know the date when you must complete and return the relevant consent form for storage to continue. If you do not renew your consent the eggs, sperm or embryos will be removed from storage and disposed of.
Keep your contact details up to date
Make sure you tell your clinic if any of your contact details change. Because your clinic needs to contact you about your consent to storage, you should always inform your clinic if your contact details change or if your circumstances change (eg, in the event of separation from your named partner). If your clinic is unable to contact you to obtain your consent, then your embryos will be removed from storage and disposed of when they can no longer be lawfully stored. If you're having NHS treatment you may need to pay to store your embryos.
What if I want my eggs, sperm or embryos to be used and stored after my death or in the event of my mental incapacity?
If you want your eggs, sperm or embryos to be used and stored after death, you’ll need to have given all the appropriate consents for this. You should speak to your clinic as this can be quite a complicated area.
For example, if in the event of your death or mental incapacity you would like your partner to be able to use your eggs, sperm or embryos in their own treatment or with a surrogate, your partner must be named on the relevant consent form. If a surrogacy arrangement would be required, you will need to receive relevant information, be offered counselling, undergo further screening tests and complete additional consent forms before you die. It is therefore vitally important that you and your clinic discuss posthumous use and the different treatment options in those circumstances. Please ask your clinic about this.
How long can my eggs, sperm or embryos be used and stored for in the event of my death?
If you consent to your eggs, sperm or embryos being used for treatment after your death, the law permits your eggs or embryos to be stored for your named partner’s use for up to 10 years from the date of your death. You must consent to both use and storage of your eggs or embryos continuing after death. This storage period cannot be extended. You can consent to storage and use for a shorter period than 10 years after your death if you wish on the relevant consent form.
If your named partner does not use your eggs or sperm within this 10 year period, then 10 years after your death, your clinic will be required to remove all your eggs or sperm from storage and dispose of them.
If your named partner does not use your embryos, whether created before or after your death, within this 10 year period, then 10 years and 6 months after your death, your clinic will be required to remove all your embryos from storage and dispose of them.
Your embryos can only be used and stored during this 10 year period if there is also effective consent for use and storage from the egg or sperm provider.
In the event of your death, you may have eggs or embryos that your named partner does not want to use (for example, because the eggs or embryos are not needed, or are not suitable, for treatment). You can consent to your eggs, sperm or embryos being used and stored after your death for potential use by designated healthcare professionals to practice the techniques involved in fertility treatment.
If you consent for your eggs or sperm being used for training in the event of your death, your sperm or eggs can be stored and used for training purposes for 55 years from the date of first storage.
If you consent for your embryos being used for training in the event of your death, your embryos can be stored and used for 10 years from the date you sign the relevant consent form. You should be aware that embryos can only be used and stored for training purposes if both the egg and sperm provider gives consent.
How long can my eggs, sperm or embryos be used and stored for in the event of my mental incapacity?
If you consent to your eggs, sperm or embryos being used for treatment in the event that you lose mental capacity, the law permits your eggs, sperm or embryos to be stored for your named partner’s use for 10 years from the date that a medical practitioner certifies in writing that you lack capacity. You must consent to both use and storage of your eggs, sperm or embryos continuing after you lose capacity. This storage period cannot be extended. You can consent to storage and use for a shorter period than 10 years after you lose capacity if you wish on the relevant consent form.
If you regain mental capacity within 10 years (or the shorter period if you have specified less than 10 years) of being certified as lacking capacity you will be able to renew your consent to storage of your eggs, sperm or embryos for your treatment. You will need to notify your clinic as soon as possible if you are certified as having regained mental capacity and wish to renew your consent to storage of your unused eggs, sperm or embryos.
In the event of you losing capacity, you may have eggs, sperm or embryos that your named partner does not want to use (for example, because the eggs or embryos are not needed, or are not suitable, for treatment). You can consent to your eggs, sperm or embryos being used and stored after you lose capacity for potential use by designated healthcare professionals to practice the techniques involved in fertility treatment.
If you consent for your eggs or sperm being used for training in the event of you losing capacity, your sperm or eggs can be stored and used for 55 years from the date of first storage.
If you consent for your embryos being used for training in the event of you losing capacity, your embryos can be stored and used for 10 years from the date you sign the relevant consent form. You should be aware that embryos can only be used and stored for training purposes if both the egg and sperm provider give consent.
How will my eggs, sperm or reproductive tissue be used in treatment?
If you’ve stored eggs, they’ll need to be fertilised with sperm using intracytoplasmic sperm injection (ICSI) or IVF and then the resulting embryos will be transferred to a person’s uterus (this could be your partner, yourself if you’ve kept your uterus, or a surrogate).
If you’ve stored sperm, your sperm can be used in intrauterine insemination (IUI). Alternatively, your sperm can be mixed with eggs from your partner, or donor in an IVF or ICSI treatment. If you’ve had to stop hormone therapy in order to collect and store your sperm, the sperm quality may not be as good.
Storing sperm is the only established way to preserve male fertility. Researchers are currently exploring testicular tissue freezing (i.e either as individual cells or as a piece of tissue) as a fertility preservation option. The cells or tissue could later be injected or transplanted back to potentially restore natural fertility. Alternatively, in the future, researchers may be able to produce sperm from these cells in a lab. This sperm could then fertilise an egg in a lab and be used in fertility treatment. However, this research is at its very early stages and would need a change in UK legislation for it to be allowed for treatment. Currently no births have been reported, following testicular tissue freezing.
If you’ve stored ovarian tissue (i.e. a whole ovary or pieces of tissue from an ovary, containing eggs), it could later be transplanted back to potentially restore natural fertility. Currently only a few centres in the UK offer the service of storing ovarian tissue. The use of frozen ovarian tissue in fertility treatment is still relatively new.
To find clinics which store testicular or ovarian tissue, you can use our ‘Choose a fertility clinic’ search function.
If treatment is unsuccessful, you might want to consider using a donor in treatment.
What kind of tests will I need?
Before your eggs, sperm or embryo(s) are frozen you need to be screened for various infectious diseases and genetic conditions by a blood test. Make sure you talk to your clinic about your plans for using your stored material so they can give you all the information you need.
Before you consent to storage or treatment you and, if applicable, your partner may also need to have blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.
If you wish for your embryos to be used in another person’s treatment (e.g. in a surrogacy arrangement), the same screening rules on donation apply. You and if applicable your partner will both be required to have further screening tests for cystic fibrosis, karyotype (chromosome analysis), cytomegalovirus, syphilis and gonorrhoea. In addition, your blood groups will be checked. If surrogacy is something you may consider in the future discuss this with your fertility clinic before storage.
What paperwork will I need to complete?
Your clinic will ask you to complete consent forms depending on the type of storage or treatment you’re having. If you’re planning on using a donor or surrogate later on, you’ll need to give separate consent for this.
If you’re not sure whether you’ll need to use your eggs, sperm or embryos with a donor or surrogate, you may want to initially consent to storage only. You can then update your consent later on – although make sure you’re aware of the additional screening requirements when storing eggs, sperm or embryos for use with a donor or surrogate (see question above).
Can I have fertility preservation treatment on the NHS?
This is not straightforward to answer, and is subject to change and may depend on where you live. Funding for storing your eggs, sperm or embryos before having medical treatment for gender dysphoria varies depending on where you live, with Scotland, Wales and Northern Ireland all making their own decisions about funding.
In England, funding decisions about storage and fertility treatment are decided locally by Clinical Commissioning Groups (CCGs). Some CCGs will fund treatment and others will not. At present, the National Institute for Health and Care Excellence (NICE), which provides guidelines to CCGs and medical professionals on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria.
The best thing to do is to talk to your GP as it can be tricky to find out exactly what’s available in your local area and if you’re eligible. Also bear in mind that even if you can have your eggs, sperm, embryos or tissue stored on the NHS, you may need to pay to use them in treatment later on.
Find out more about access to equitable NHS funded fertility treatment from Fertility Network UK
Where can I go to get support, or discuss these issues further?
We recommend that anyone thinking about having fertility treatment, for whatever reason, gets plenty of support, whether from family and friends, social networks, organisations or a professional.
Treatment can be a very emotional experience so it’s important you’re getting the right support before, during and after treatment.
British Infertility Counselling Association (BICA) provide counselling to people of all ages who are considering fertility treatment and preservation.
Fertility Network UK campaign for equitable access to NHS funded fertility treatment.
Gendered Intelligence works with trans people and those who impact on the lives of trans people, specialising in working with young trans people.
GIRES is a charity that hears, helps, empowers and gives a voice to trans and gender non-conforming individuals.
Mermaids support families with children and young people with gender dysphoria.
In terms of funding, what are the next steps to having eggs, sperm or embryos stored or to have fertility treatment?
If you want to explore storage or getting fertility treatment on the NHS, your GP will need to make a referral to a local fertility service for investigation and discussion around the available options in your area. The GP will need to have details of your diagnosis and treatment plan from the Gender Identity Service you are under the care that will show if the treatment plan includes treatments that could impact on your future fertility.
If you’re paying for your own treatment you can contact a fertility clinic directly. We provide advice on how to choose the best clinic on our website as well as search for a clinic that's right for you with our Choose a Fertility Clinic tool.
Review date: 21 July 2024
