Bringing Awareness to Fertility Preservation Options for Those Transitioning

For many individuals, transitioning is a liberating and exciting experience which can lead to self-discovery. However, transitioning can sometimes affect fertility, and this is something that not all people might be fully aware of. The good news is that fertility preservation can offer transitioning individuals the chance to have biological children in the future, if that’s something they want. Everyone deserves to make informed choices about their bodies and their futures, which is why it’s so important that those beginning their transition are made aware of these options from the very start.

● Gender-Affirming Surgery: This involves undergoing surgery to align one’s physical features with their gender identity. Some of these procedures can impact fertility. For example, an orchidectomy (removal of the testicles) in a male-to-female transition makes sperm production impossible. Similarly, an oophorectomy (removal of the ovaries) in a female-to-male transition makes natural pregnancy no longer possible.
● Hormone therapy: Many individuals who are transitioning take hormones like oestrogen and testosterone to induce physical changes. The longer these are taken, the greater the risk of permanent infertility.
*Reversibility varies between individuals and how long treatment has been in place.
Always ask your gender clinic team for personalised advice.

If you want to have biological children later down the line, it’s a good idea to understand what options are available to you now. However, fertility preservation is a personal decision; it’s not right for everyone.

There are many alternative pathways to having a family, such as adoption, using donors, and co-parenting. It’s about finding the path which is right for you, and for some, choosing not to have children can be equally valid and empowering.

Fertility Preservation Options
Egg Freezing
A lot of people choose to freeze their eggs before starting their transition, giving them the option to have biological children later on if they want to.
Here’s what you can expect when choosing to freeze your eggs:
1) In order to check for any infectious diseases, such as hepatitis, you’ll have a blood test. This ensures your eggs are stored safely to avoid contamination. They can still be stored, regardless of the result.
2) You’ll then begin the IVF process, which can take up to three weeks. This usually involves taking drugs to help your eggs mature and increase egg production.
3) When they’re ready, your eggs will be collected whilst you’re under sedation or general anaesthetic. They’ll then be mixed with a cryoprotectant to protect them. The eggs will then be frozen (often through a process called vitrification, which involves rapid cooling) and stored in tanks of liquid nitrogen.
Storage: Up to 55 years in the UK, with consent refreshed every 10 years.
Cost guide: £3.5k–4k per cycle privately, plus ~£370/year storage.
Note: If you have a healthy egg reserve, some clinics may offer a reduced cost for egg freezing if you choose to donate some of the eggs collected. This can help other families who are struggling to start their own.

Sperm Freezing
Sperm can be frozen and stored for future use, giving you the freedom to start a family when the time feels right.
So, what is the process behind sperm freezing?
1) The sperm will be analysed to see if it has any diseases, such as HIV. This stops contamination from occurring during storage, and the sperm can still be frozen regardless of the result.

2) You’ll be asked to provide a fresh sperm sample at the clinic. In some cases, this can be retrieved surgically or produced at home.
3) The sample is then mixed with a cryoprotectant to protect it. The sample will usually be placed in separate containers, allowing it to be used for multiple treatments if necessary. Finally, the samples are cooled and placed in liquid nitrogen.
Storage: Also 55 years with 10-year consent renewals.
Cost guide: £400–£700 upfront, ~£370/year storage.

Embryo freezing
For many couples, freezing embryos is a reassuring way to keep the door open for starting – or expanding – a family down the line.
Here’s a rundown of what’s involved in the process of embryo freezing:
1) You’ll first be tested for any infectious diseases to prevent contamination during storage.
2) Next, you’ll start the IVF process to encourage eggs to mature and boost egg production.
3) When ready, the eggs will be retrieved and taken to a lab where they’ll be combined with sperm. They’re then left (usually for five to six days) to develop into mature embryos.
4) Only the best quality embryos are selected for freezing. They’ll be put in a cryoprotectant to protect them. The embryos are then frozen (usually through vitrification) and stored in tanks of liquid nitrogen.
Consent: Everyone providing eggs or sperm must sign – and can withdraw consent at any time before use.
Storage & cost: Same 55-year rule: ~£5,000, ~£370 storage.
Some Other Things to Note
● Does freezing guarantee a baby later? Sadly, no. Success depends on age at freezing, health, and future treatment choices. Check out the HFEA’s most recent trends and figures here.

● What if I change my mind? You can discard, donate or continue storing your samples – it’s your choice!
● Where can I get advice? It’s a good idea to book a chat with a fertility specialist, they can walk you through realistic success rates, explain each step, and give you a clear breakdown of the costs upfront.

It’s okay if fertility preservation isn’t for you. But awareness is crucial. Having clear, timely information helps people transitioning make choices that align with their hopes, values, and futures.
At Not A Phase, we’re a nationwide, trans-led charity who are dedicated to uplifting and improving the lives of trans+ adults through social projects, awareness campaigns, and funding trans+ led initiatives.
Check our website to find out more about how we’re committed to creating a thriving and supportive space for trans+ and gender non-conforming communities.

Thank you to Holly Dodd for kindly contributing this piece for Not A Phase!