Family Building for Transgender Individuals & Couples

Transgender individuals and couples face the same medical, emotional and financial challenges as all other fertility patients. Just like other fertility patients, transgender men, women or couples may require special consideration due to the need for third-party help. This may involve a surrogate mother or a gestational carrier to carry a pregnancy or a donor to provide sperm, eggs or embryos.

The type of fertility treatments depend on the reproductive capabilities of the people involved, as well as on the makeup of the transgender couple.For example, a transgender female with reproductive capability may not need a sperm donor, and a transgender male may be able to carry his own child.

In addition to these options, transgender individuals seeking gender reassignment may want to consider fertility preservation. For example, a transgender woman may wish to freeze sperm before having a surgery to remove his male genitals.

Following are the third-party reproductive techniques that may be appropriate for a transgender person or couple seeking to have a child and to be involved in the pregnancy and birth.

Surrogacy and artificial insemination

In traditional surrogacy, a woman agrees to carry a child for parents who are incapable of doing so themselves. In the case of an intended transgender parent or couple who only have male reproductive capabilities, a surrogate will be required to become pregnant and deliver a child. The intended transgender parent can provide the sperm. The surrogate’s genes transfer to the child along with the genes of the transgender parent who provided the sperm.

If the surrogate is to be artificially inseminated, sperm may be provided by a transgender women and inserted via artificial insemination into the vagina, by way of intrauterine insemination (IUI), or through intracytoplasmic sperm injection (ICSI), in which the sperm is directly injected into the female egg. ICSI must be done via in vitro fertilization (IVF), a laboratory process of fertilizing an egg with sperm outside the woman’s body. Both IUI and ICSI increase the chances of a successful pregnancy.

Gestational carrier and egg/embryo donation

Similar to a surrogate, a gestational carrier is a woman who agrees to carry a pregnancy and deliver a child for an intended parent/couple. However, it is not her egg that will be fertilized, but an egg donated by another woman. It can also be an embryo (a fertilized egg) that is donated, generally after it has been retrieved, fertilized via IVF and frozen for future implantation.

The donated embryo, or the donated egg that has been fertilized via IVF, is then implanted in the gestational carrier’s womb via IVF. Thus the gestational carrier will not provide any of her genes to the subsequent child she carries and delivers.

One of the intended transgender parents (if both are biologically male) can provide the sperm to fertilize the donated egg. Egg donors can be someone the intended parent(s) know or may be anonymous and most likely located through an egg donation service or a fertility clinic. Generally, the resulting child will have the genes of the transgender parent who donated the sperm and the genes of the woman who donated the egg.

A close relative of one of the intended transgender parents can also be the egg donor and the other intended transgender parent can furnish the sperm. The resulting child would have the genes of both transgender parents: of the parent providing the sperm and of the other intended transgender parent because his female relative’s genes are passed on to the resulting child in the egg she has donated. After the egg is fertilized via IVF, it will be implanted into the gestational carrier for pregnancy and birth.

Counseling for transgender parents

Such complex parenting situations involve unique emotional and psychological issues for intended parents, surrogates, gestational carriers and for egg or embryo donors. Transgender parents should receive thorough counseling on the emotional and legal aspects of family building.

Transgender parents face the same issues as any parents who use a third party for reproduction. These psychological concerns include:

  • Raising a child who is not genetically related
  • Guiding the child as he or she develops an identity
  • Helping children understand how they were conceived
  • Determining appropriate information to provide about a child’s donor (egg, sperm), surrogate or gestational carrier.

Transgender parents may face other specific situations that can be challenging. For example, a parent who provided sperm and fathered a child as a man can later become the child’s mother. Or the mother may later become the father. The specifics will vary from case to case, depending on who the mother and father are, whether or not there is a second parent, that parent’s gender, and other variables that present with different transgender combinations.

Our staff psychologists are experts at sorting out these issues and helping individuals manage them. They are well versed in the various issues involving third-party reproductive treatments that may include egg donation, surrogate pregnancy or gestational carriers. Their counsel on thorny genetic issues and helping patients cope with non-traditional means of parenting are very beneficial to transgender people or couples in need of fertility services.

Legal issues also need to be addressed and well understood by all parties. For example, details about visitation rights of a surrogate mother or gestational carrier need to be resolved before any medical procedures occur. States have different laws about recognizing parenthood and the guidelines that must be met, and these legal issues should be well understood by all parties. Our psychologists can offer suggestions on obtaining legal counsel.

Transgender men and women interested in exploring parenting can also find helpful links to resources on the Infertility Network’s website.

Contact University of Colorado Advanced Medicine if you have more questions about family building or would like to schedule an appointment.