Clinical Takeaways

• The Golden Rule: The optimal time to preserve fertility is before starting gender-affirming hormone therapy (GAHT) or undergoing surgeries that remove reproductive organs.
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• The Impact of Hormones: Estrogen can reduce sperm production. Testosterone stops ovulation, but this is often reversible with a temporary suspension of therapy.
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• For Those Producing Sperm: Sperm banking is non-invasive and is best done prior to starting Estrogen or Anti-androgens.
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• For Those With Ovaries: Egg freezing is the standard of care. It requires a temporary stimulation cycle, but the short-term elevation of estrogen levels does not reverse transition progress.

At Ovom Care, we view fertility preservation as a fundamental part of gender-affirming care. We recognize that medically transitioning is a spectrum focused on aligning your body with your identity. Fertility preservation is simply about ensuring your future self has choices.

Historically, trans individuals were often forced to choose between transition and biological parenthood. Fortunately, assisted reproductive medicine has evolved to support every family structure. Today, we have protocols that allow you to preserve your gametes (eggs or sperm) and then proceed with your transition with the peace of mind that your family-building options are secure.

We understand that this process can be emotionally complex. The idea of undergoing a fertility procedure involving your reproductive anatomy might feel daunting or dysphoric. We are here to navigate that with you — safely, privately, and with medical precision.

The Science: How Gender Affirming Hormone Therapy Affects Fertility

A common misconception is that Gender Affirming Hormones act as birth control. This is incorrect. However, they do impact fertility potential.

• Testosterone: Testosterone, or ‘T’, generally suppresses ovulation and menstruation. While long-term use can affect the ovaries, many individuals can successfully retrieve eggs after temporarily pausing T to allow the ovaries to recover.
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• Estrogen: Estrogen and anti-androgens significantly reduce sperm count and motility (movement).
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• The Best Practice: The safest measure to ensure a biological child is to freeze gametes (eggs and sperm) before your first dose of hormones.

For Individuals Producing Sperm: Sperm Cryopreservation

Preserving fertility for those who produce sperm is generally straightforward and non-invasive.

The Process

We typically recommend freezing 3 to 5 sperm samples to ensure enough biological material for future IUI or IVF attempts.

• Timing: Ideally done before starting estrogens and and anti-androgens.
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• If you have already started HRT: It may still be possible. Typically, hormones are paused for approximately 3 months to allow spermatogenesis (sperm production) to recover before performing a semen analysis.

Dysphoria Support

‍We understand that producing a sperm sample may be a source of distress. At Ovom, we offer private, clinical environments, and in some cases, at-home collection kits (depending on location and logistics) to minimize discomfort. In addition, on our App and in our clinic, we will always call you by your correct name and fully respect your pronouns.

For Individuals with Ovaries: Egg Freezing

For those with ovaries, the process is more medically involved. It requires ovarian stimulation to mature multiple eggs for retrieval.

Addressing the Fear: "Will this reverse my transition?"

‍Many trans patients worry that the hormones required for egg freezing (follicle stimulating hormone (FSH) and  and luteinizing hormone (LH)) will "feminize" their body or undo the effects of testosterone.

The Medical Reality: The stimulation phase lasts only 10–12 days. While your estrogen levels will temporarily rise, this is short-term. It will not reverse voice deepening, hair growth, or other permanent changes from testosterone.

Navigating the Exam (Transvaginal Ultrasound)

‍Standard monitoring involves vaginal ultrasounds to check follicle growth. We know this can be a major trigger for gender dysphoria.

The Ovom Protocol: We can utilize abdominal ultrasounds for monitoring when anatomy permits. If an internal exam is medically necessary for safety/visibility, we proceed with trauma-informed care including self-insertion options, minimal staff present, and clear communication at every step. You can discuss this with your doctor.

The Timeline:

1. Preparation: If you are on testosterone, we typically pause it for 2–3 months to allow the ovaries to "wake up."
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2. Stimulation: Daily injections with small needles for ~10-14 days.
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3. Retrieval: A 15-minute procedure under light sedation (you are asleep and feel no pain).
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4. Resume testosterone: You can usually restart your testosterone therapy almost immediately after the procedure.

Comparison of Options

Sperm Banking (Assigned Male at Birth)

• Invasiveness: Non-invasive (ejaculation)
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• Time Required: 1-2 weeks (to collect multiple sperm samples)
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• Gender Affirming Hormone: Must be done before starting or after stopping estrogen
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• Future Use: Sperm will be frozen in cryostorage can be thawed for IUI or IVF

Egg Freezing (Assigned Female at Birth)

• Invasiveness: Minimally invasive (injections and retrieval)
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• Time Required: ~2 weeks (for one egg freezing cycle)
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• Gender Affirming Hormone: Can be done before starting or after pausing testosterone
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• Future Use: Thawed for IVF/ICSI or Reciprocal IVF/ICSI (ROPA)

Future Technologies: Ovarian Tissue Freezing

For prepubertal trans youth or those who cannot undergo hormonal stimulation, there is an emerging option called Ovarian Tissue Cryopreservation (OTC). This involves surgically removing a portion of the ovary and freezing the tissue itself. In the future, this tissue can be re-implanted or (potentially) used to mature eggs in a lab.

FAQ: Common Questions on Trans Fertility

I’ve been on Gender Affirming Hormones for years. Is it too late?

‍Not necessarily. Long-term hormone use does not always mean infertility. The best way to know is to have a medical consultation and diagnostic testing.

Can I use these eggs/sperm with a partner?

‍Absolutely. Your frozen genetic material can be used in the future with a partner via IVF, Reciprocal IVF (ROPA).

Is my treatment covered by insurance?

This varies significantly by country and according to your insurance plan. Ovom can provide the required documentation to help you fight for insurance reimbursement or utilize a health spending account.

Will your team respect my identity and pronouns?

Yes, absolutely. We provide a safe, affirming space where your identify and pronouns are respected, your body is treated with dignity, and your medical care is world-class.

The Ovom Commitment

Whether you want children now, in ten years, or aren't sure yet — you deserve the option.

Secure your options before your next step. Book a Fertility Preservation Consultation.

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