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Information for trans and non-binary people seeking fertility treatment

Fertility may be the last thing on your mind when you’re experiencing the distress of having a body that doesn’t express your identity. Understandably, some trans and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you have treatment without preserving your fertility and then realise later on that it is not possible or more difficult to have a biological family. Thinking through all these issues now and understanding your options will help you make an informed decision.

Fertility treatment for transgender people

How does medical treatment for gender dysphoria affect fertility?

I haven’t started hormone therapy or puberty suppressing medication yet – what are my options for preserving my fertility?

Before puberty

I’ve already started taking hormone therapies or puberty suppressing medication, what are my options for preserving my fertility?

I’ve been undergoing hormone therapy and am about to go for genital reconstructive surgery, what are my options for preserving my fertility?

How long can I store my eggs, sperm, embryos or reproductive tissue for use in treatment?

If your eggs, sperm or embryos are not used immediately in treatment, you may wish to store your eggs, sperm or embryos so they can be used for treatment in the future.  To be stored eggs, sperm or embryos are frozen. You will need to think about how far in the future you might want or be able to use stored eggs, sperm or embryos and the potential costs of storing. This is something you should discuss with your clinic. 

You should be aware that embryos can only be stored if both you and the egg or sperm provider have given consent.  This may be your partner or may be a donor (if donated eggs or sperm were used in treatment).

On 1 July 2022, the rules on how long you can store eggs, sperm or embryos changed. Before 1 July 2022, most people could normally only store their eggs, sperm or embryos for up to 10 years. Only if they had premature infertility or were going to be having medical treatment which could affect their fertility, could they store for up to 55 years.  

The law now permits you to store eggs, sperm or embryos for use in treatment for any period up to a maximum of 55 years from the date that the eggs, sperm or embryos are first placed in storage. However, crucially for storage to lawfully continue you will need to renew your consent every 10 years. You can give your consent on the relevant consent form.   You will be contacted by your clinic with relevant information and they should also provide you an offer of counselling before you give consent to storage of your embryos. Your clinic will contact you and provide the consent forms that you need to complete at the appropriate time. It is therefore essential that you keep your contact details up to date with your clinic as you will need to be contacted.  If your clinic is unable to contact you your eggs, sperm or embryos will be at risk of being removed from storage and disposed of.

You don’t have to match the length of storage to any contract for paying for the storage (whether you, or the NHS, is paying). However, if you don’t pay for storage as agreed, the clinic may be within its right to dispose your eggs, sperm or embryos. Your clinic should have explained this to your clearly when you stored yours, sperm or embryos.

I stored my eggs, sperm or embryos before 1 July 2022, what should I do?

If you stored your eggs, sperm or embryos before 1 July 2022 for up to 10 years but would like to store for longer (up to a maximum of 55 years from the date that the embryos are first placed in storage), you should contact your clinic to discuss whether this is possible and complete additional consent forms where necessary.

If you previously consented to store your eggs, sperm or embryos for longer than 10 years (up to a maximum of 55 years) because of premature infertility or because you were going to be having medical treatment which could affect your fertility you should contact your clinic as soon as possible as consent will now have to be renewed at each 10 years. You and the sperm or egg provider will need to complete additional consent forms in order for your clinic to legally continue to store your embryos (even if the clinic are still storing your eggs, sperm or embryos within the consent period you originally specified). Your clinic will know the date when you must complete and return the relevant consent form for storage to continue. If you do not renew your consent the eggs, sperm or embryos will be removed from storage and disposed of.

Keep your contact details up to date

Make sure you tell your clinic if any of your contact details change. Because your clinic needs to contact you about your consent to storage, you should always inform your clinic if your contact details change or if your circumstances change (eg, in the event of separation from your named partner). If your clinic is unable to contact you to obtain your consent, then your embryos will be removed from storage and disposed of when they can no longer be lawfully stored. If you're having NHS treatment you may need to pay to store your embryos.

What if I want my eggs, sperm or embryos to be used and stored after my death or in the event of my mental incapacity?

If you want your eggs, sperm or embryos to be used and stored after death, you’ll need to have given all the appropriate consents for this. You should speak to your clinic as this can be quite a complicated area.

For example, if in the event of your death or mental incapacity you would like your partner to be able to use your eggs, sperm or embryos in their own treatment or with a surrogate, your partner must be named on the relevant consent form. If a surrogacy arrangement would be required, you will need to receive relevant information, be offered counselling, undergo further screening tests and complete additional consent forms before you die. It is therefore vitally important that you and your clinic discuss posthumous use and the different treatment options in those circumstances. Please ask your clinic about this.

How long can my eggs, sperm or embryos be used and stored for in the event of my death?

If you consent to your eggs, sperm or embryos being used for treatment after your death, the law permits your eggs or embryos to be stored for your named partner’s use for up to 10 years from the date of your death. You must consent to both use and storage of your eggs or embryos continuing after death. This storage period cannot be extended.  You can consent to storage and use for a shorter period than 10 years after your death if you wish on the relevant consent form.

If your named partner does not use your eggs or sperm within this 10 year period, then 10 years after your death, your clinic will be required to remove all your eggs or sperm from storage and dispose of them. 

If your named partner does not use your embryos, whether created before or after your death, within this 10 year period, then 10 years and 6 months after your death, your clinic will be required to remove all your embryos from storage and dispose of them.

Your embryos can only be used and stored during this 10 year period if there is also effective consent for use and storage from the egg or sperm provider. 

In the event of your death, you may have eggs or embryos that your named partner does not want to use (for example, because the eggs or embryos are not needed, or are not suitable, for treatment). You can consent to your eggs, sperm or embryos being used and stored after your death for potential use by designated healthcare professionals to practice the techniques involved in fertility treatment.

If you consent for your eggs or sperm being used for training in the event of your death, your sperm or eggs can be stored and used for training purposes for 55 years from the date of first storage.

If you consent for your embryos being used for training in the event of your death, your embryos can be stored and used for 10 years from the date you sign the relevant consent form. You should be aware that embryos can only be used and stored for training purposes if both the egg and sperm provider gives consent.

How long can my eggs, sperm or embryos be used and stored for in the event of my mental incapacity?

If you consent to your eggs, sperm or embryos being used for treatment in the event that you lose mental capacity, the law permits your eggs, sperm or embryos to be stored for your named partner’s use for 10 years from the date that a medical practitioner certifies in writing that you lack capacity.  You must consent to both use and storage of your eggs, sperm or embryos continuing after you lose capacity. This storage period cannot be extended. You can consent to storage and use for a shorter period than 10 years after you lose capacity if you wish on the relevant consent form.  

If you regain mental capacity within 10 years (or the shorter period if you have specified less than 10 years) of being certified as lacking capacity you will be able to renew your consent to storage of your eggs, sperm or embryos for your treatment. You will need to notify your clinic as soon as possible if you are certified as having regained mental capacity and wish to renew your consent to storage of your unused eggs, sperm or embryos. 

In the event of you losing capacity, you may have eggs, sperm or embryos that your named partner does not want to use (for example, because the eggs or embryos are not needed, or are not suitable, for treatment). You can consent to your eggs, sperm or embryos being used and stored after you lose capacity for potential use by designated healthcare professionals to practice the techniques involved in fertility treatment.

If you consent for your eggs or sperm being used for training in the event of you losing capacity, your sperm or eggs can be stored and used for 55 years from the date of first storage.

If you consent for your embryos being used for training in the event of you losing capacity, your embryos can be stored and used for 10 years from the date you sign the relevant consent form. You should be aware that embryos can only be used and stored for training purposes if both the egg and sperm provider give consent.

How will my eggs, sperm or reproductive tissue be used in treatment?

If you’ve stored eggs, they’ll need to be fertilised with sperm using intracytoplasmic sperm injection (ICSI) or IVF and then the resulting embryos will be transferred to a person’s uterus (this could be your partner, yourself if you’ve kept your uterus, or a surrogate).

If you’ve stored sperm, your sperm can be used in intrauterine insemination (IUI). Alternatively, your sperm can be mixed with eggs from your partner, or donor in an IVF or ICSI treatment. If you’ve had to stop hormone therapy in order to collect and store your sperm, the sperm quality may not be as good.

Storing sperm is the only established way to preserve male fertility. Researchers are currently exploring testicular tissue freezing (i.e either as individual cells or as a piece of tissue) as a fertility preservation option. The cells or tissue could later be injected or transplanted back to potentially restore natural fertility. Alternatively, in the future, researchers may be able to produce sperm from these cells in a lab. This sperm could then fertilise an egg in a lab and be used in fertility treatment.  However, this research is at its very early stages and would need a change in UK legislation for it to be allowed for treatment. Currently no births have been reported, following testicular tissue freezing.

If you’ve stored ovarian tissue (i.e. a whole ovary or pieces of tissue from an ovary, containing eggs), it could later be transplanted back to potentially restore natural fertility. Currently only a few centres in the UK offer the service of storing ovarian tissue. The use of frozen ovarian tissue in fertility treatment is still relatively new.

To find clinics which store testicular or ovarian tissue, you can use our ‘Choose a fertility clinic’ search function.

If treatment is unsuccessful, you might want to consider using a donor in treatment.

What kind of tests will I need?

Before your eggs, sperm or embryo(s) are frozen you need to be screened for various infectious diseases and genetic conditions by a blood test. Make sure you talk to your clinic about your plans for using your stored material so they can give you all the information you need. 

Before you consent to storage or treatment you and, if applicable, your partner may also need to have blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.

If you wish for your embryos to be used in another person’s treatment (e.g. in a surrogacy arrangement), the same screening rules on donation apply. You and if applicable your partner will both be required to have further screening tests for cystic fibrosis, karyotype (chromosome analysis), cytomegalovirus, syphilis and gonorrhoea.  In addition, your blood groups will be checked. If surrogacy is something you may consider in the future discuss this with your fertility clinic before storage.

Find out more about screening

What paperwork will I need to complete?

Your clinic will ask you to complete consent forms depending on the type of storage or treatment you’re having. If you’re planning on using a donor or surrogate later on, you’ll need to give separate consent for this.

If you’re not sure whether you’ll need to use your eggs, sperm or embryos with a donor or surrogate, you may want to initially consent to storage only. You can then update your consent later on – although make sure you’re aware of the additional screening requirements when storing eggs, sperm or embryos for use with a donor or surrogate (see question above).

Find out more about consent to treatment

Can I have fertility preservation treatment on the NHS?

This is not straightforward to answer, and is subject to change and may depend on where you live. Funding for storing your eggs, sperm or embryos before having medical treatment for gender dysphoria varies depending on where you live, with Scotland, Wales and Northern Ireland all making their own decisions about funding.

In England, funding decisions about storage and fertility treatment are decided locally by Integrated Care Boards (ICBs). Some ICBs will fund treatment and others will not. At present, the National Institute for Health and Care Excellence (NICE), which provides guidelines to CCGs and medical professionals on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria.  

The best thing to do is to talk to your GP as it can be tricky to find out exactly what’s available in your local area and if you’re eligible. Also bear in mind that even if you can have your eggs, sperm, embryos or tissue stored on the NHS, you may need to pay to use them in treatment later on.

Find out more about access to equitable NHS funded fertility treatment from Fertility Network UK

Where can I go to get support, or discuss these issues further?

We recommend that anyone thinking about having fertility treatment, for whatever reason, gets plenty of support, whether from family and friends, social networks, organisations or a professional.

Treatment can be a very emotional experience so it’s important you’re getting the right support before, during and after treatment.

British Infertility Counselling Association (BICA) provide counselling to people of all ages who are considering fertility treatment and preservation.

Fertility Network UK campaign for equitable access to NHS funded fertility treatment.

Gendered Intelligence works with trans people and those who impact on the lives of trans people, specialising in working with young trans people.

GIRES is a charity that hears, helps, empowers and gives a voice to trans and gender non-conforming individuals.

Mermaids support families with children and young people with gender dysphoria.

In terms of funding, what are the next steps to having eggs, sperm or embryos stored or to have fertility treatment?

If you want to explore storage or getting fertility treatment on the NHS, your GP will need to make a referral to a local fertility service for investigation and discussion around the available options in your area. The GP will need to have details of your diagnosis and treatment plan from the Gender Identity Service you are under the care that will show if the treatment plan includes treatments that could impact on your future fertility.

If you’re paying for your own treatment you can contact a fertility clinic directly. We provide advice on how to choose the best clinic on our website as well as search for a clinic that's right for you with our Choose a Fertility Clinic tool.

Find out more about gender identity clinics

Review date: 15 April 2027