Increased support for transgender fertility preservation

Dr James Barrett of the Tavistock and Portman Gender Identity Development Service says he refers about six people for transgender fertility preservation every week and there are 17 clinicians in the practice.

He says that greater awareness of what is possible and also the promise of more appropriate treatment has opened up the opportunities for more transgender people to have families in the future.

He says “ Ask anyone in their late teens if they want children and their eyes will glaze over, but a decade later and it is a different story. “There is no reason to believe that transfolk will be any different and that is why we recommend at least having the discussion so they know their options.”

Dr Barrett says equal numbers of trans men and trans women are being referred and their sexuality (and therefore future partner) has little impact on their decision. “The interest has grown over the last two years, particularly where NHS funding is available. People are having fertility preservation treatment to keep their options open.”

Many of his referrals are to Bourn Hall, a fertility clinic that provides advice, fertility testing, fertility treatment and preservation of eggs, sperm and embryos.

It was a Senior Embryologist at Bourn Hall, Charlotte Taylor, who recognised that there was a need to change the clinic’s protocols to reflect the increase in demand from transgender people.

She says “In recent years we have noticed an increase in the number of patients freezing sperm or eggs prior to treatment for gender dysphoria. “In order to ensure we provide the best quality of care for all patients, I undertook a review of our patient pathway for transgender patients’ fertility preservation and treatment.

“To help with this I invited Dr James Barrett to host a seminar for us at Bourn Hall. This focused on how fertility services can best help transgender people create their own families – providing our team with further knowledge and understanding for this patient group.

Dr Barrett says “I was delighted to get the opportunity to present a review of our learning points and the changes we have made at the UK Fertility Society conference Fertility 2017. I hope that sharing this knowledge will make it easier for transgender people to access medical treatment.” Charlotte says

“We are grateful to Dr Barrett for helping to raise awareness of Bourn Hall staff to the sensitivities of this group of patients. We aim to provide patient centric care and for this group of patients extra careful attention should be given to our communication.

For example checking at an early stage how the person wants to be addressed and making sure that they are treated accordingly throughout their treatment and supplied with relevant literature.

“This resulted in the development of a new pathway of care, improved protocols and new information for our transgender patients via the website and patient information leaflets.

Support for transgender fertility preservation

Dr Barrett says that by working closely with the clinic many of the potential areas of concern are avoided: “Many trans women are worried they may have to masturbate in an environment designed for heterosexual men. Knowing that this will not be the case, or giving the option of surgical sperm retrieval under sedation can overcome this fear.

“Trans men gain reassurance from knowing that most of the ultrasound scans are external and the egg collection can also be under general anaesthetic. “Also many people are relieved that it is a quick process, taking only a few weeks.” This is important if you are about to start hormone therapy and Dr Barrett recommends that individuals seek advice about their fertility options before starting treatment.

If someone has not had surgical treatment then it may be possible to reverse the affects of hormone treatment but this is depends on the individual and the length of time on hormone therapy.

Charlotte explains that counselling is an important part of any fertility journey at Bourn Hall. She says, “Transgender people often receive counselling through their gender identity clinic and at Bourn Hall our dedicated fertility counsellors are also available and equipped to provide support”

Once they have been frozen, eggs and sperm can be kept for decades until they are ready for use in fertility treatment with a partner or surrogate, depending on the individual circumstances.

Sources of information about transgender fertility options

Consents are required for all treatment and the UK regulatory body The Human Fertilisation and Embryology Authority (HFEA) has recently updated its literature to be gender neutral and this includes information about transgender fertility preservation.

Some Clinical Commissioning Groups provide funding for fertility preservation ahead of medical treatment that will impact fertility but there are currently no National Institute for Health and Care Excellence (NICE) guidelines for the provision of fertility services for individuals with gender dysphoria.

Dr James Barrett is in the process of writing a book to provide advice to transgender people – the working title is “Trans-formation: practical tips for living more authentically”

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