Fertility and Reproductive Health

Fertility preservation is an important aspect of the care, health and well being for some trans and gender diverse people.

Maximising future fertility options is important for many trans people, and conducting fertility counselling prior to commencement of hormonal or surgical treatment is vital to ensuring patients are giving full informed consent.

When providing reproductive healthcare to trans people, it’s important not to make assumptions based on the similarity of a patient’s gender or body to that of cis patients.

Some trans people are in sexual relationships where pregnancy is possible and may seek contraception and pregnancy tests, some need abortions or neonatal care, and some trans people don’t have sex at all. The reproductive health needs of trans people are as diverse as anyone else’s.

Routine reproductive and sexual health screening should be patient-centred. This includes asking questions relevant to the individual and their reproductive needs, and assessing risk based on practices.

Depending on a trans person’s body, comfort, and needs, different contraception options may be preferred. You and your patients might also benefit from our pages on Fertility, Contraception and Pregnancy.

For more information about sexual health, visit our Sexual Health page.

Language in reproductive healthcare settings

While reproductive healthcare is an important part of many trans people’s lives, services that are heavily gendered can be alienating.

Being inclusive means welcoming people of all genders in prenatal and birth care facilities, reproductive health clinics and sexual health services.

Language can be a really affirming tool, such as:

When creating promotional material and talking about your services, consider that there are women who cannot get pregnant, men who can, and non-binary people at every different level of reproductive capacity and intention who deserve access to your services.

Fertility is a concern for some trans and gender diverse people.

The 2018 Australian Trans and Gender Diverse Sexual Health survey found that “less than half of participants had been given information on reproductive health and fertility preservation options1,” many of whom had undertaken some form of hormonal or surgical affirmation.

Fertility and hormones

The short and long-term fertility capacity of trans people, who are or have been on hormones is still largely unknown. We know anecdotally that many trans people who have been on hormones for a long time do stop taking them for a period of time and conceive with little trouble, but also that others are unable to do so2.

As there is little information and limited research, it’s important to have an honest conversation with your patient about their reproductive potential and risk, and to be honest if we do not have all the answers yet.

Fertility and genital surgery

Many genital surgeries that trans people undergo will result in surgical sterilisation. It is important that trans patients understand the implications of this, and are given options regarding fertility preservation.

Fertility preservation

Trans people’s fertility is not a simple subject, and people may have different wants, needs, opinions, fears, and hopes. It’s important to recognise that no perspective is better, correct, or more valuable than any other. For one person, preserving their reproductive ability, or freezing sperm or eggs, will be a critical part of affirmation, while another person may have no interest at all in fertility preservation.

Many people will sit somewhere between these two perspectives, and their relationship to their body and reproductive ability will be complicated, and at times difficult and uncomfortable.

Fertility preservation can take the form of:

• Freezing sperm

• Collecting and freezing eggs

If you have a patient considering fertility preservation, it can be helpful to contact services ahead of referring a patient to them, so you can provide information to your patient with affirming language in mind. This guide is a great start for knowing what questions to ask.

It is worth keeping in mind that many fertility related services are heavily gendered, and often gender their patients based on reproductive capacity and body parts. It can be valuable to talk to your patient about what they may experience in these settings, and provide support or referrals to mental health services to help them respond.

While it is important to make sure a trans patient has all the necessary information to make decisions regarding their fertility, it is just as important to make sure that, no matter what decision they make, they are supported and affirmed – including if it results in potential or definite infertility.

Trans people are able and allowed to make decisions that affect their current or future fertility for any reason, including comfort, affirmation, or immediate relief. This is also the case for young trans people, who are allowed to make decisions about gender affirmation, even if this might affect their future fertility.

It’s a great idea to ensure any information shared is clear that people are not any less valuable or valid if they are infertile, and that fertility isn’t required to be a parent, carer, or family member. Families take many forms, and while some come from pregnancy, they can also grow from fostering, adopting, or finding chosen families.