Skip to main content
SpringerLink
Log in

Medically Assisted Reproduction and Transgender Persons

  • Chapter
  • First Online:
Case Studies in the Ethics of Assisted Reproduction

  • 80 Accesses

Abstract

Requests for assisted reproduction by transgender persons appear to be increasing. This chapter outlines relevant ethical considerations (autonomy, reproductive rights, child welfare, and non-discrimination) and provides guidance to clinicians regarding requests for medically assisted reproduction and fertility preservation for transgender persons. Those who advocate for inclusive access to fertility services note that transgender persons often express the desire to have children and should be afforded the human right of an opportunity to procreate. Cryopreservation of gametes or embryos is a viable option for assisted reproduction in transgender patients, however, knowledge about both the impact of long-term hormone therapy on gametogenesis and the recovery of reproductive function after stopping pubertal blockers and cross-hormone therapy is limited. Professional autonomy in deciding whom to treat is also limited by an obligation to consider all patients equally regardless of gender identity (non-discrimination). Those who oppose access to ART by transgender people do so out of concern for well-being of future children (beneficence/non-maleficence), though this concern is not supported by research results (Freedman, Clin Child Psychol Psychiatry 7:42, 2002; White and Ettner, J Gay Lesbian Psychother 8:129–145, 2008; Green, Int J Transgenderism 2:4, 1998). There is no ethical basis to deny transgender people access to assisted reproduction. Resources should continue to be allocated towards creating culturally sensitive educational materials, training providers to provide competent care for transgender patients and continuing to research fertility preservation and long-term outcomes of hormone therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 79.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 1.

    Editor’s note: See “Further Reading” section at end of the chapter for more on prepubertal fertility preservation.

Works Cited/Further Reading

  • Abir R, Ben-Aharon I, Garor R, Yaniv I, Ash S, Stemmer SM, et al. Cryopreservation of in vitro matured oocytes in addition to ovarian tissue freezing for fertility preservation in paediatric female cancer patients before and after cancer therapy. Hum Reprod. 2016;31(4):750–62.

    Article  Google Scholar 

  • American Academy of Child & Adolescent Psychiatry. (2019, May). Gay, lesbian, bisexual, or transgender parents. https://www.aacap.org/

  • American College of Obstetricians and Gynecologists. Code of professional ethics. (Last accessed May, 2020) ACOG, Washington, DC; 2011a http://www.acog.org/-/media/Departments/National-Officer-Nominations-Process/ACOGcode.pdf

  • American College of Obstetricians and Gynecologists. Health Care for Transgender Individuals. Committee Opinion No 512. Obstet Gynecol. 2011b; 118: 1454–1458

    Google Scholar 

  • American Medical Association. AMA Policies on LGBT Issues. (Last accessed May, 2020); 2010 http://www.ama-assn.org//ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.page

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Ed. Arlington, VA: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  • APA Task Force on Gender Identity and Gender Variance. Report of the Task Force on Gender Identity and Gender Variance. (Last accessed May 20, 2020) American Psychological Association, Washington DC; 2008

    Google Scholar 

  • Auer, M. K., Fuss, J., Nieder, T. O., Briken, P., Biedermann, S. V., Stalla, G. K., . . . Hildebrandt, T. (2018). Desire to Have Children Among Transgender People in Germany: A Cross-Sectional Multi-Center Study. J Sex Med, 15(5), 757–767.

    Article  Google Scholar 

  • Chen, D., Simons, L., Johnson, E. K., Lockart, B. A., & Finlayson, C. (2017). Fertility Preservation for Transgender Adolescents. J Adolesc Health, 61(1), 120–123.

    Article  Google Scholar 

  • Chiland C, Clouet AM, Golse B, Guinot M, Wolf JP. A new type of family: Transmen as fathers thanks to donor sperm insemination. A 12-year follow-up exploratory study of their children. Neuropsychiatrie de l’Enfance et de l’Adolescence, Volume 61, Issue 6, 2013.

    Google Scholar 

  • De Roo, C., Lierman, S., Tilleman, K., Peynshaert, K., Braeckmans, K., Caanen, M., . . . De Sutter, P. (2017). Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod Biomed Online, 34(6), 557–566.

    Article  Google Scholar 

  • De Wert G, Dondorp W, Shenfield F, Barri P, Devroey P, Diedrich K, Tarlatzis B, Provoost V, Pennings G. ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people†. Hum Reprod. 2014 Sep;29(9):1859–65. https://doi.org/10.1093/humrep/deu183. Epub 2014 Jul 22. PubMed PMID: 25052011.

  • Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril. 2015;104(5):1111–1115. https://doi.org/10.1016/j.fertnstert.2015.08.021

    Article  Google Scholar 

  • Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Ethics Committee of the American Society for Reproductive Medicine. Child-rearing ability and the provision of fertility services: an Ethics Committee opinion. Fertil Steril. 2017;108(6):944–947. https://doi.org/10.1016/j.fertnstert.2017.10.006

    Article  Google Scholar 

  • Factor, R. J., & Rothblum, E. D. (2007). A study of transgender adults and their non-transgender siblings on demographic characteristics, social support, and experiences of violence. J LGBT Health Res, 3(3), 11–30.

    Article  Google Scholar 

  • Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States. Williams Institute; 2016. Available at: https://williamsinstitute.law.ucla.edu/research/how-many-adults-identifyas-transgender-in-the-united-states/. Accessed May, 2020.

  • Freedman, D., Tasker, F., and Di Ceglie, D. Transsexual Parents Referred to a Specialist Gender Identity Development Service: A Brief Report of Key Developmental Features. Clin Child Psychol Psychiatry. 2002; 7: 423

    Article  Google Scholar 

  • Golombok, S. New Families, old values: considerations regarding the welfare of the child. Hum Reprod. 1998; 3: 2342–2347

    Article  Google Scholar 

  • Grant, J. E., Flynn, M., Odlaug, B. L., & Schreiber, L. R. (2011). Personality disorders in gay, lesbian, bisexual, and transgender chemically dependent patients. Am J Addict, 20(5), 405–411.

    Article  Google Scholar 

  • Green, R. Transsexuals’ Children. (Last accessed May, 2020) The international journal of transgenderism. 1998; 2: 4 http://www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/ijtc0601.html

    Google Scholar 

  • Grimstad, F. W., Fowler, K. G., New, E. P., Ferrando, C. A., Pollard, R. R., Chapman, G., . . . Gray, M. (2019). Uterine pathology in transmasculine persons on testosterone: a retrospective multicenter case series. Am J Obstet Gynecol, 220(3), 257.e251–257.e257.

    Article  Google Scholar 

  • Grynberg M, Fanchin R, Dubost G, et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod Biomed Online. 2010; 20: 553–558.

    Article  Google Scholar 

  • Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94: 3132– 3154.

    Article  Google Scholar 

  • Hunger S. Commentary: Transgender people are not that different after all. Camb Q Healthc Ethics 2012;21:287–9.

    Article  Google Scholar 

  • Ikeda K, Baba T, Noguchi H, Nagasawa K, Endo T, Kiya T, et al. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod 2013;28:453–61.

    Article  Google Scholar 

  • James SE, Rankin H, Keis-ling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality; 2016.

    Google Scholar 

  • Jiang, D. D., Swenson, E., Mason, M., Turner, K. R., Dugi, D. D., Hedges, J. C., & Hecht, S. L. (2019). Effects of Estrogen on Spermatogenesis in Transgender Women. Urology, 132, 117–122.

    Article  Google Scholar 

  • Jindarak S, Nilprapha K, Atikankul T, et al. Spermatogenesis abnormalities following hormonal therapy in transwomen. Biomed Res Int. 2018; 2018: 7919481

    Article  Google Scholar 

  • Jones, B. P., Williams, N. J., Saso, S., Thum, M. Y., Quiroga, I., Yazbek, J., . . . Smith, J. R. (2019). Uterine transplantation in transgender women. Bjog, 126(2), 152–156.

    Article  Google Scholar 

  • Kent, M. A., Winoker, J. S., & Grotas, A. B. (2018). Effects of Feminizing Hormones on Sperm Production and Malignant Changes: Microscopic Examination of Post Orchiectomy Specimens in Transwomen. Urology, 121, 93–96.

    Article  Google Scholar 

  • Leavy M, Trottmann M, Liedl B, et al. Effects of Elevated beta-estradiol levels on the functional morphology of the testis – new insights. Sci Rep. 2017; 7: 39931.

    Article  Google Scholar 

  • Lefkowitz. (2012). https://pubmed.ncbi.nlm.nih.gov/22356169/

  • Leung, A., Sakkas, D., Pang, S., Thornton, K., & Resetkova, N. (2019). Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Fertil Steril, 112(5), 858–865.

    Article  Google Scholar 

  • Light, A. D., Obedin-Maliver, J., Sevelius, J. M., & Kerns, J. L. (2014). Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol, 124(6), 1120–1127.

    Article  Google Scholar 

  • Loverro, G., Resta, L., Dellino, M., Edoardo, D. N., Cascarano, M. A., Loverro, M., & Mastrolia, S. A. (2016). Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol, 55(5), 686–691.

    Article  Google Scholar 

  • Nahata, L., Tishelman, A. C., Caltabellotta, N. M., & Quinn, G. P. (2017). Low Fertility Preservation Utilization Among Transgender Youth. J Adolesc Health, 61(1), 40–44.

    Article  Google Scholar 

  • National Center for Lesbian Rights. State by state guide to laws that prohibit discrimination against transgender people. (Available at:) (Last accessed May, 2020); 2010 http://www.lgbtagingcenter.org/resources/pdfs/StateLawsThatProhibitDiscriminationAgainstTransPeople.pdf

  • Pache TD, Chadha S, Gooren LJ, et al. Ovarian morphology in long-term androgen-treated female to male transsexuals. A human model for the study of polycystic ovarian syndrome? Histopathology. 1991; 19: 445–452.

    Article  Google Scholar 

  • Proclamation of Teheran, Final Act of the International Conference on Human Rights, Teheran, 22 April to 13 May 1968, U.N. Doc. A/CONF. 32/41 at 3; 1968.

    Google Scholar 

  • Reisman, T., & Goldstein, Z. (2018). Case Report: Induced Lactation in a Transgender Woman. Transgend Health, 3(1), 24–26.

    Article  Google Scholar 

  • Riggs, D. W., & Bartholomaeus, C. (2018). Fertility preservation decision making amongst Australian transgender and non-binary adults. Reprod Health, 15(1), 181.

    Article  Google Scholar 

  • Schneider, F., Neuhaus, N., Wistuba, J., Zitzmann, M., Heß, J., Mahler, D., . . . Kliesch, S. (2015). Testicular Functions and Clinical Characterization of Patients with Gender Dysphoria (GD) Undergoing Sex Reassignment Surgery (SRS). J Sex Med, 12(11), 2190–2200.

    Article  Google Scholar 

  • Segers I, Mateizel I, Van Moer E, Smitz J, Tournaye H, Verheyen G, et al. In vitro maturation (IVM) of oocytes recovered from ovariectomy specimens in the laboratory: a promising “ex vivo” method of oocyte cryopreservation resulting in the first report of an ongoing pregnancy in Europe. J Assist Reprod Genet. 2015;32(8):1221–31.

    Article  Google Scholar 

  • Sister Song. Reproductive Justice. Accessed July 14, 2022. https://www.sistersong.net/reproductive-justice

  • Stotzer, R. L, Herman, J. L, & Hasenbush, A. (2014). Transgender Parenting: A Review of Existing Research. UCLA: The Williams Institute. Retrieved May, 2020 from https://escholarship.org/uc/item/3rp0v7qv

  • Tishelman AC, Sutter ME, Chen D, et al. Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey. J Assist Reprod Genet. 2019;36(3):579–588. https://doi.org/10.1007/s10815-018-1395-y

  • White, T. and Ettner, R. Disclosure, Risk and Protective Factors for Children Whose Parents Are Undergoing a Gender Transition. J Gay Lesbian Psychother. 2008; 8: 129–145

    Google Scholar 

  • Wierckx K, Van Caenegem E, Pennings G, Elaut E, Dedecker D, Van de Peer F, Weyers S, De Sutter P, T’Sjoen G. Reproductive wish in transsexual men. Hum Reprod. 2012 Feb;27(2):483–7.

    Article  Google Scholar 

  • World Professional Association for Transgender Health. Standards of Care. Version 7. https://www.wpath.org. 2011 Retrieved May, 2020.

  • Yin H, Jiang H, Kristensen SG, Andersen CY. Vitrification of in vitro matured oocytes collected from surplus ovarian medulla tissue resulting from fertility preservation of ovarian cortex tissue. J Assist Reprod Genet. 2016;33(6):741–6.

    Article  Google Scholar 

Further Reading on Prepubertal Fertility Preservation

  • McDougall RJ, Gillam L, Delany C, et al. Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven? Journal of Medical Ethics 2018;44:27–31.

    Article  Google Scholar 

  • Johnson EK, Finlayson C, Rowell EE, Gosiengfiao Y, Pavone ME, Lockart B, Orwig KE, Brannigan RE, Woodruff TK. Fertility preservation for pediatric patients: current state and future possibilities. The Journal of urology. 2017 Jul 1;198(1):186–94.

    Article  Google Scholar 

  • Mattawanon N, Spencer JB, Schirmer DA, Tangpricha V. Fertility preservation options in transgender people: a review. Reviews in Endocrine and Metabolic Disorders. 2018 Sep;19:231–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Oregon Health & Science University, Portland, OR, USA

    Paula Amato

Authors
  1. Paula Amato
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Center for Bioethics, Harvard Medical School, Boston, MA, USA

    Louise P. King

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Isabelle C. Band

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Amato, P. (2023). Medically Assisted Reproduction and Transgender Persons. In: King, L.P., Band, I.C. (eds) Case Studies in the Ethics of Assisted Reproduction. Springer, Cham. https://doi.org/10.1007/978-3-031-41215-8_13

Download citation

Publish with us

Policies and ethics

Search

Navigation