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 are 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 is an egg successfully fertilised with sperm to allow potential development of a baby.

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

Sperm freezing is freezing of ejaculate sperm 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 ovaries have been removed, eggs can no longer be collected from them. Eggs or embryos 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's appropriate for you.

A full medical history, screening blood tests, an ultrasound scan to assess your ovaries (if you have them), and the relevant consent forms are needed before starting treatment. We might be able to do the ultrasound scan over your tummy.

Stopping testosterone

We do not routinely ask you to stop testosterone for a fixed period before egg freezing. In our observational study, egg numbers were similar in people with and without previous testosterone exposure, but evidence about later pregnancy outcomes is still limited. Your specialist will discuss whether any change to treatment is appropriate for you, and how stopping testosterone 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 or tissue

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 gametes may be stored for (eggs 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 about 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