Overview

Gender transition can involve hormone therapy and surgery. These treatments can also be called gender affirming hormonal therapy (GAHT) and gender affirming surgery (GAS). Both hormone therapy and surgery can lead to not being able to produce children (sterility).

Your fertility might only be temporarily affected with hormone therapy, meaning that sterility could be reversible. However, this is not guaranteed and can depend on how long you have hormone therapy. Surgery can also lead to permanent sterility.

If you want to naturally produce children, fertility preservation could store some of your reproductive cells giving you an opportunity to use them in the future.

The NHS website has more information about treatment options for gender dysphoria.

Terms we use in this information

We use medical words, such as ovaries, testes, eggs and sperm where they help explain treatment. We know that you might use different words for your body. Please tell us which words you prefer, and we'll use them when we speak with you. 

Gonads are reproductive organs. Ovaries and testicles are gonads.

Gametes: reproductive cells in different stages of development in a gonad. Gametes include oocytes (developing eggs in the ovary) and sperm (cells in the testicles).

Embryo: an egg successfully fertilised with sperm to allow potential development of a baby.

Egg collection: a procedure under sedation where the gametes are retrieved. 

Sperm freezing: freezing of ejaculate gametes after masturbation, or surgery in some cases.

When to consider fertility preservation

Although fertility preservation can be considered and discussed at any stage of transition, we generally advise having fertility preservation treatment before any gender affirming therapy.

If both testicles have been removed (orchidectomy), sperm can no longer be collected from them. Sperm stored before surgery may still be available for future treatment.

Discussing fertility preservation while on hormone therapy

You can be referred to the fertility specialist to discuss the options of preserving fertility while on gender affirming hormonal therapy. Based on your individual management so far, the consultant will discuss and advise treatment that is appropriate for you.

Stopping oestrogen or anti-androgrens

Oestrogen and anti-androgens can reduce or stop sperm production, but some people can still freeze sperm while taking them.

In our study, about 1 in 3 people taking gender-affirming hormones had an unsuccessful first attempt at freezing sperm. This does not mean they had permanently stopped making sperm. Most people in this group ultimately stored a sample. Semen analysis can help us assess your current options.

If sperm cannot be frozen, your doctor can discuss another attempt and whether pausing hormone treatment might help. Recovery is uncertain, and there's no set length of treatment that guarantees sperm production. Your specialist will discuss with you whether any pause in treatment might affect your wellbeing.

Options for fertility preservation treatment

A full medical history, screening blood tests, and all the relevant consent forms need to be completed by you before treatment is commenced.

Your doctor can discuss each option in detail with you, and give you written information to take away.

Read more about freezing gametes

Tests before fertility preservation

In theory, there’s a risk of viral cross-contamination between samples that are stored in liquid nitrogen.

There has never been a report of this happening but, because of the theoretical risk, you (and your partner, where appropriate) must be screened for HIV and hepatitis B and C.

We cannot freeze any samples until we’ve had the results of these tests.

Our assisted conception unit cannot currently offer storage if you or your partner test positive for HIV or hepatitis B or C, but we'll be able to advise where this service is available.

Legal information about storing gametes

Under the terms of the Human Fertilisation and Embryology Act (1990), you are required to give written consent about:

1. storage of your gametes
2. the length of time they may be stored for (sperm can be stored for up to 55 years from first storage if you renew consent every 10 years. NHS funding or a payment agreement may cover a shorter period)
3. the purposes your gametes can be used for
4. your wishes over any gametes stored
5. what should be done with your gametes in the event of your death, or if you become incapable of changing or cancelling your consent.

If your circumstances change, and you want to update your consent, you must contact us. Please call us on 020 7188 2300 or 020 7188 7188 extension 50426, to arrange an appointment to change your consent forms, or for any further consultations.

NHS funding for fertility preservation

Funding criteria are set by local commissioning authorities known as integrated care boards (ICB). This will be assessed when your doctor refers you for fertility preservation. If you're eligible, funding will be provided for the fertility preservation of your gametes for a specific period of time.

Continued storage after this period may incur a charge. A letter from an NHS gender identity clinic will be required to proceed with fertility preservation. We strive for inclusive care for all patients, and we'll support you as much as we can.

Please note that it's not the medical or administrative teams at Guy's and St Thomas' assisted conception unit that make decisions on funding, and we have no authority to grant it.

If you're not eligible for NHS funding

If you're not eligible for NHS funding for fertility preservation, you can still have this treatment with us on a private basis (self-funding). There will be a charge for consultation, screening tests, treatment cycle, and storage of gametes. Our admin team can give you more information and a price list.

NHS funding for future usage of stored gametes

If you require fertility treatment to achieve a pregnancy, your consultant or GP will have to refer you for assisted conception. At the moment, there is no special funding for fertility treatment for transgender patients. The eligibility criteria for funding are the same as for any other person seeking fertility treatment. If you do not meet these criteria, fertility treatment will have to be self-funded.

Counselling and support

We offer an experienced and confidential counselling service as well as medical treatment, and can arrange a counselling appointment for you.

NHS gender dysphoria clinics for adults

www.nhs.uk/nhs-services/how-to-find-an-nhs-gender-identity-clinic/

HFEA 

UK regulating authority of licensed fertility treatment and storage

www.hfea.gov.uk

The Fertility Alliance

UK charity providing fertility information and support

www.thefertilityalliance.org.uk