Non-binary or transgender people may preserve their fertility with the use of assisted reproductive technologies such as sperm or oocyte cryopreservation. This is important to do prior to starting gender-affirming hormonal therapy with testosterone or estrogen and before gonadectomy (removal of ovaries or testicles). When frozen properly, eggs and sperm can be thawed many years in future to add to your family.

The process of egg freezing is similar to cisgender females who undergo egg freezing for fertility preservation regardless of the cause. With the improvement in egg freezing technology (vitrification versus the older less reliable slow freeze method), females are now able to better preserve their fertility when they are younger. Fertilization rates and pregnancy rates with frozen thawed eggs (aka oocytes) are very similar to fresh eggs.

Remember that egg and embryo quality begin to decline after the ages of 33, 34, or more certainly after 35 years old. The process of egg freezing is similar to the first part of IVF. Typically biologic females at birth will have their ovaries stimulated with medications in a controlled manner for approximately 9 to 12 days. The patient will then undergo a small procedure under a light anesthetic where the oocytes will be retrieved under ultrasound guidance. Once the oocytes are retrieved, they will be “snap-frozen” or vitrified using very precise techniques. If stored properly, the oocytes should ideally last greater than 5 to 10 years if not more.

Transfeminine people can preserve their fertility through sperm cryopreservation prior to starting hormone therapy or gonadectomy. Typically specimens are produced via ejaculation or rarely using sperm retrieval techniques depending upon the patient’s unique medical history.

Freezing and thawing of sperm has been done successfully for decades. Using specialized sperm washing techniques along with specific cryo-protectants, the sperm sample can be put on hold or frozen until needed. This is especially important when working with egg donors and gestational surrogates in the future because the sperm needs to be FDA-cleared at the time of sperm freezing. This step adds flexibility when undergoing IVF in the future. If planning to use intrauterine insemination (IUI) in the future, more vials of sperm should be cryopreserved to better increase the likelihood of a live birth.