Fertility preservation

Fertility is the ability to have children using your own genetic material, or "gametes". Gametes are the sperm or eggs produced by the body and which are necessary for human reproduction.

Some gender affirming care options - hormone therapy and some surgeries - may reduce your fertility or permanently impact your fertility, meaning that you would no longer be able to have biologically-related children.

This leaflet aims to help you think about your options regarding your fertility, alongside accessing gender-affirming care. Our clinicians will support you to make informed choices about your fertility. This means that, having all the facts and information, you can make the choices which are best for you.

Every individual will have their own thoughts and wishes regarding fertility preservation and parenthood. During your gender journey so far, you might have already given some thought to your parenting options and you may wish to try in the future to become a parent to your own biological children.

You might have decided to foster or adopt children in the future and pass on your love and nurture in this way. Many people do not feel they need to pass on their gametes in order to create their family, or gamete storage may not be high priority for many other reasons. You may have already decided you have no desire to be a parent now or in the future, with or without attempting to use your own gametes. Everyone having gender-affirming care will have their own individual thoughts and feelings around fertility and future parenthood, or non-parenthood.

If you have considered surrogacy as a possible option to have your future family, it is worth being aware that, at present, the NHS does not fund surrogacy in any way. If a person stores their own gametes and another person carries the resulting pregnancy for them (a surrogate), they would need to pay privately for the fertility clinic care and support towards achieving the pregnancy with their chosen surrogate, even if that surrogate is their own partner.

You may wish to store your gametes before your fertility is impacted by your gender-affirming care. If you decide that this is not something you wish to pursue, you can discuss this with your Sussex Gender clinician and move on to the next stage of your care. If you are already taking hormone therapy, you can discuss the process of pausing your hormone therapy to proceed with gamete storage. This process is individual to each person depending on their hormone regime, so please discuss this process with your gender specialist nurse or doctor.

Gamete storage is the process of storing eggs or sperm by freezing (cryopreservation), which can be later defrosted and used at a time when they are needed. It is important to be aware that while gamete storage increases your chance of biologically related children, it does not guarantee the ability to have a baby in the future.

Please do talk with your Sussex Gender clinician if you wish to explore your options, or, if you have any concerns about the impact of your gender-affirming care on your fertility.

Hormone therapy can affect your fertility. Sometimes the impact on fertility can be temporary, however it is important to be aware that the impact could be permanent. The longer you take hormone therapy, the more likely it is that your infertility will be non-reversible.

Some people might have reduced fertility before they start gender -affirming hormone therapy. This means if you happen to have reduced fertility before you start gender-affirming hormone therapy, your fertility is even less likely to recover or improve. The NHS does not offer routine fertility screening prior to starting hormone therapy, if you are not pursuing gamete storage.

Before hormone therapies are given, your gender clinician will discuss the fertility implications with you and ask you to sign a consent form to document that you are aware of the risks to your fertility.

Taking oestrogens with or without testosterone blockers can reduce your sperm count and lead to difficulty sustaining erections or ejaculating. However, it is important to acknowledge that people can still remain fertile during gender - affirming hormone therapy. Contraception is therefore advised if your sexual activity involves penile-vaginal intercourse. Please speak to your local sexual health clinic, GP, practice nurse or Sussex Gender Service clinician regarding contraception.

Your monthly bleeds (menstruation/periods) may become irregular or stop altogether on testosterone therapy. However, some people do remain fertile and so contraception for you and your sexual partner(s) (condoms, progesterone-only pill, coil, implant etc) should be taken if intercourse involves penile-vaginal intercourse. Please seek support from your local sexual health clinic, GP, practice nurse or Sussex Gender clinician.

It is NOT advisable to become pregnant whilst taking testosterone. This is because testosterone could cause serious harm to a developing embryo. If you are taking testosterone and wish to become pregnant, you should talk to your GP or Sussex Gender clinician before stopping your contraception or your testosterone.

It is not currently known for certain if lower doses (micro-dosing) of gender affirming hormones will affect fertility, therefore gamete storage is advised for anyone who wishes to consider fertility preservation, and are already micro-dosing or wish to micro-dose hormones.

This is a personal decision, and everybody will have different priorities they will be weighing up. You may experience an increase in gender dysphoria if you stop hormone therapy, and therefore this can be a distressing period in your life. However, you may also decide that it is worth it to pursue your fertility goals. We advise extra support and self-care during any time off hormones for fertility reasons, especially as the process of preserving fertility can also be challenging.

If you choose to stop your hormone therapy, you would need to carefully weigh up the benefits and disadvantages for you pausing your hormone therapy, with the reality that there are no guarantees that fertility would return completely, partially or at all. As each person is an individual, fertility return is not something that can be predicted. The longer you have taken hormones, the harder it may be for your fertility to return, or you may have already become irreversibly infertile. If you have any concerns or worries regarding next steps, please speak to a Sussex Gender clinician.

Unlike hormone therapy, where there is a possibility that fertility could return, it is vital to understand that the following gender affirming surgeries will lead to permanent loss to your reproductive function:

• Orchidectomy - removal of testes - this causes irreversible infertility
• Oophorectomy - removal of ovaries - this causes irreversible infertility
• Penectomy - removal of penis - sperm may be collected from the testes directly, gamete storage is advisable before the operation should you wish to preserve fertility
• Hysterectomy - removal of uterus +/- cervix - eggs may be collected from the ovaries directly, gamete storage is advisable before the operation should you wish to preserve fertility

If you wish to be referred for fertility preservation, please advise your Sussex Gender clinician of your intentions as soon as possible.

The first step will be an appointment with your named Sussex Gender Service
nurse, and a personal plan will be discussed with you.

Your care plan may involve advising you to pause your hormone therapy, if you are already taking hormones. We would then wait for signs of fertility to return (e.g. return of monthly cycle, or ability to ejaculate). This is unpredictable, and may take 3 months, up to 6 or 9 months+.

When you have signs of returned fertility, we can then send a referral to a Sussex fertility clinic, who will see you after approximately 4 weeks.

The current legal maximum time period for storing gametes with a fertility clinic is 55 years. The current policy for storage beyond 10 years requires you to contact the clinic in writing and give your consent for onward storage - therefore it is crucial that the clinic has your up to date contact details when you move house, change your name or phone number.

Human Fertilisation & Embryology Authority is the UK fertility regulator which
licences, inspects and monitors the UK fertility clinics, including specific
information for trans and non-binary people exploring fertility preservation.
Gender Construction Kit
NHS information
Clinic T Sexual Health service

Agora Clinic
Main Clinic: Brighton
Satellite Clinics: Eastbourne and Worthing

Care Fertility
Main Clinics: Tunbridge Wells and Woking
Satellite: Sittingbourne

Complete Fertility
Main Clinic: Southampton

London Women’s Clinic
Main Clinic: Harley Street, London
Satellite Clinics: Tunbridge Wells, Canterbury, St Thomas Street (London Bridge)

The Hospital Fertility Group
Main Clinics: Bromley and Eastbourne
Satellite Clinics: Brighton

Wessex Fertility
Main Clinic: Southampton
Satellite Clinics: Chichester and Waterlooville (Portsmouth)