LGBTQIA+

At NY Cryo we have been providing options for LGBTQIA+ individuals or couples to preserve their fertility in our licensed office facility for over 20 years. Patients can store for their own future use or can use a person who they know, and who has agreed to provide sperm for their present or future use. This person is known as a directed donor. Fertility preservation is an important family planning option for LGBT individuals and couples.

For Female couples, the directed donor can be a non-related male friend of either partner or a relative of the partner who will not be inseminated with the directed donor’s sperm. We recommend that the couple seek legal advice before engaging a directed donor. We would prefer to have the three individuals (i.e. both women and the directed donor) present at the office consultation but require that for both the Recipient (i.e., a partner who will be inseminated with the directed donor’s sperm) and directed donor to be present for the initial consultation.

For Male couples, it is most often one of the partners who will be storing sperm for use with a surrogate (i.e. women
who donates her egg and then subsequently carries the child) or gestational carrier (i.e. the woman carrying the pregnancy is not biologically related to the child she is carrying; the eggs are provided by an egg donor and inseminated through In Vitro fertilization). When using either a surrogate or gestational carrier it is strongly recommended that you seek legal advice regarding the locally presiding legal statutes.

Transgender individuals can store their sperm for possible future use whether or not they plan to have hormonal or surgical intervention. The process involves a consultation, physical examination, and blood testing of the individual, producing a specimen for evaluation and storage.

The desire to have children is common among individuals transitioning, with 38% of respondents of the National Transgender Discrimination Survey indicating they are parents. A Belgium study surveyed 121 patients transitioning and found that 40% would want children and that half of these would like a biological child.  Also, in this study, 77% of 101 trans women wanted the professionals treating them to discuss fertility options, with 51% stating that they would have cryopreserved sperm or at least seriously considered this if it had been discussed.

The World Professional Organization for Transgender Health first developed the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People in 1979. However, it wasn’t until 2011 that they introduced specifics on the Reproductive Health needs of transgender people. In the current WPATH Standards, they recommend that before the initiation of therapy, fertility preservation options are discussed, even if the person is currently not interested in future fertility.

Ideally, sperm should be collected before hormones are prescribed. However, it is possible in male-to-female transitioning that stopping feminizing hormones might provide a window to retrieve sperm. Even in the individual who does not have sperm in the ejaculate or cannot produce an ejaculate, the potential for sperm retrieval and banking is possible with other modalities. Testicular biopsy with banking of tissue excised during the procedure can be used for conception with in vitro fertilization (IVF) couple with single sperm injection (ICSI). In addition, a recent study found normal spermatogenesis in 24% of testes removed at the time of sex reassignment surgery for individuals on long-term estrogen therapy.  This suggests that banking of testicular tissue may still be possible in 1/4 of patients treated with long-term hormonal therapy.  However, it must be noted that 75% of patients treated with long-term estrogen therapy did not have sperm in the ejaculate or on biopsy.

At one fertility clinic, 11 patients were referred for sperm banking between January 2010 and May 2014. Nine of these patients banked sperm for future potential use. During this 52-month period, 1 couple used the stored sperm, which resulted in a pregnancy. It should be noted, however, that the mean age of the patients preserving sperm was 26.5 years of age, which might account for the low usage rate of the banked sperm during this study. What was interesting in this study is that there was an increase in yearly referrals to their clinic over the 4.3 years they collected data. However, they found that referrals remained low, which they postulated was due to both the cost of sperm banking as well as lack of awareness that fertility preservation was an option.

Unfortunately, the reproductive needs of transgender individuals are still largely unmet. Hopefully, this will be changing as more health professionals provide much-needed information on reproductive health to individuals undergoing gender transitioning.

References:

1. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. 2015 U.S. Transgender Survey. December 2016:1-302.
2. De Sutter P, Kira K, Verschoor A, Hotimsky A. The Desire to Have Children and the Preservation of Fertility in Transsexual Women: a Survey. International Journal of …; 2002.
3. Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism. 2012;13(4):165-232. doi:10.1080/15532739.2011.700873.
4. Schneider F, Neuhaus N, Wistuba J, et al. Testicular Functions and Clinical Characterization of Patients with Gender Dysphoria (GD) Undergoing Sex Reassignment Surgery (SRS). The journal of sexual medicine. 2015;12(11):2190-2200. doi:10.1111/jsm.13022.
5. Jones CA, Reiter L, Greenblatt E. Fertility preservation in transgender patients. International Journal of Transgenderism. 2016;17(2):76-82. doi:10.1080/15532739.2016.1153992.
6. HUNGER S. Commentary: Transgender People Are Not That Different after All. Cambridge Quarterly of Healthcare Ethics. 2012;21(2):287-289. doi:10.1017/S0963180111000818.
 

We will discuss with you the quality of the specimen and potential options for parenthood. We work with many fertility professionals locally, nationally, and internationally and pride ourselves in providing comprehensive, compassionate, and professional care.

If you have questions or would like additional information please contact us or call 516-487-2700.