It explains the different ways fertility can be preserved, what the process involves, possible risks, and how long stored eggs or embryos can be kept. It also includes information on consent and potential funding.
When to consider fertility preservation
Fertility preservation is best considered before starting any gender-affirming medical treatment that could reduce your ability to have biological children in the future. Some treatments, such as testosterone therapy or certain types of surgery, can reduce the number and quality of eggs, or stop ovulation altogether.
If you have already begun hormone treatment, fertility can start to decline within a few months. In some cases, these changes may be permanent. It may still be possible to preserve fertility, but you might need to pause hormone treatment for a period of time. The length of time required varies from person to person and should be discussed with your clinical team, who can help you understand the potential effects on your health and wellbeing.
How fertility preservation works
Fertility preservation for trans men and non-binary people who were assigned female at birth usually involves either:
• Egg freezing – eggs are collected from the ovaries after a course of hormonal stimulation and then frozen for future use.
• Embryo freezing – eggs are collected, fertilised with sperm in a laboratory to create embryos, and then frozen.
The freezing process is called cryopreservation and allows eggs or embryos to be stored for many years without significant loss of quality.
When you are ready to use them, the frozen eggs can be thawed and fertilised in a laboratory, or the frozen embryos can be thawed and transferred to the uterus as part of fertility treatment such as in vitro fertilisation (IVF).
Before you start
Before beginning fertility preservation, you will have a video consultation appointment to talk through your options, the steps involved, and whether this approach is right for you.
You will be asked about your medical history and any treatments you are currently having.
It’s also important to think about how you want your stored eggs or embryos to be used in the future.
If you would like to explore this further we will arrange an ultrasound scan and blood tests to check for egg reserve and infections such as HIV, hepatitis B, and hepatitis C.
You will be asked to complete consent forms, which cover how they can be used and what should happen if your circumstances change. You can change or withdraw your consent at any time.
If you are taking testosterone, you may need to pause treatment before starting ovarian stimulation. Your healthcare team will explain how long this should be for and discuss any physical or emotional effects you might experience during that time.
What happens during the process
The first stage is ovarian stimulation. You will take hormone injections for around two weeks to encourage your ovaries to produce multiple mature eggs. During this time, you will have ultrasound scans and sometimes blood tests to monitor your response.
When the eggs are ready to be collected, a short procedure is carried out under sedation or anaesthetic. A fine needle is passed through the vaginal wall, guided by ultrasound, to collect the eggs from the ovaries.
If you are freezing eggs, they will be prepared and frozen soon after collection. If you are freezing embryos, the eggs will be fertilised with sperm in the laboratory before being frozen.
Risks and limitations
• Not all eggs or embryos survive the freezing and thawing process.
• The quality of eggs or embryos may vary, and this can affect the chances of success in future fertility treatment.
• There is no guarantee that stored eggs or embryos will result in a pregnancy.
• Ovarian stimulation can cause side effects such as bloating, discomfort, or mood changes.
• In rare cases, ovarian hyperstimulation syndrome (OHSS) can occur, which may require medical attention.
• Pausing testosterone before treatment may cause temporary physical or emotional effects.
How long eggs or embryos can be stored
In the UK, eggs and embryos can usually be stored for up to 55 years, provided you renew your consent at least every 10 years. You can choose to store them for a shorter time if you prefer.
The clinic will contact you before your consent period is due to end to confirm whether you want storage to continue. If consent is not renewed, the eggs or embryos will be removed from storage and disposed of according to your instructions.
Consent
Before any eggs or embryos are stored, you will be asked to complete detailed consent forms. These allow you to decide:
• How your stored eggs or embryos can be used in the future.
• Whether they can be used after your death or if you lose the ability to make decisions for yourself.
• Whether they can be used by a partner, if you have one.
• How long you want them to be stored.
You can change or withdraw your consent at any time, as long as the eggs or embryos have not yet been used in treatment. If you withdraw consent, they will be removed from storage and disposed of according to your wishes.
Funding
Fertility preservation may be funded by the NHS if it is required before gender-affirming treatment that is expected to affect fertility. The criteria for NHS funding can vary depending on where you live. Your healthcare team can explain the local arrangements and whether you are eligible.
If you do not meet the criteria for NHS funding, you can still choose to have fertility preservation as a self-funded treatment. The clinic can provide details of the costs for storage and any future use in treatment.
Using your stored eggs or embryos in the future
When you decide you would like to use your stored eggs or embryos, they can be thawed and prepared for fertility treatment. The most suitable treatment will depend on your individual circumstances and the quality of the eggs or embryos after thawing.
Frozen eggs are usually fertilised in a laboratory to create embryos, which can then be transferred to a uterus. Frozen embryos can be thawed and transferred directly. Your fertility specialist will discuss the options with you and explain the likely chances of success.
Support
Fertility preservation as part of your gender-affirming journey can bring up a range of emotions and questions. You may be thinking about how the process fits with your transition plans, or you may have concerns about pausing hormone therapy.
Specialist fertility counselling is available, and you can access this before, during, or after the preservation process. Counsellors can help you explore your feelings, understand your options, and make decisions that feel right for you.
You may also find support and information from:
• Fertility Network UK – www.fertilitynetworkuk.org
• LGBT Foundation – www.lgbt.foundation
• Gendered Intelligence – www.genderedintelligence.co.uk
Contact information
For more information or to arrange an appointment, please contact:
Newcastle Fertility Centre
Newcastle upon Tyne Hospitals NHS Foundation Trust
Telephone: 0191 213 8213 (Monday to Friday, 8am–4:30pm)
Email: [email protected]
