A recent study at Mayo Clinic analyzed the utilization rates and experiences regarding transgender fertility preservation among gender-diverse adults. The researchers observed that only 6.62% of patients at the Transgender and Intersex Specialty Care Clinic (TISCC) utilized these services. This finding highlights a significant gap between the desire for biological children and the actual pursuit of preservation options. Consequently, clinicians must improve the way they initiate these critical discussions before starting gender-affirming medical treatments.

The Current State of Transgender Fertility Preservation

The retrospective cohort study included 589 patients with a median age of 28 years. Although many individuals express an interest in future biological parenthood, actual completion of preservation remains low. Specifically, patients with testes were more likely to choose sperm cryopreservation compared to those with ovaries opting for oocyte or embryo freezing. This disparity often stems from the less invasive nature and lower costs associated with sperm banking. Furthermore, the study noted that a small portion of patients completed their preservation at other institutions before seeking specialized gender care.

Barriers to Transgender Fertility Preservation

Patients face numerous challenges when navigating reproductive health options. Financial constraints and a lack of insurance coverage are the most prominent hurdles. In addition to economic factors, many individuals report experiencing discrimination or a lack of understanding from healthcare providers. These psychosocial barriers make it difficult to discuss family planning openly. Moreover, the pressure of making permanent reproductive decisions at a young age often adds to the psychological burden for TGD individuals.

The qualitative phase of the research revealed that the desire for biological children remains a powerful motivator. However, many participants had to plan their gender-affirming care around their fertility goals, sometimes delaying transition. Addressing these issues requires a more inclusive healthcare environment and structured counseling protocols. Thus, increasing the affordability and accessibility of these services is essential for equitable care.

Frequently Asked Questions

1. Why is the utilization of fertility preservation low among TGD patients?

Utilization is low due to a combination of high costs, lack of insurance coverage, and the invasiveness of certain procedures. Additionally, societal stigma and a lack of specialized provider knowledge can discourage patients from seeking these services.

2. When should clinicians discuss fertility options with gender-diverse patients?

Clinicians should ideally initiate conversations about fertility preservation before the start of any gender-affirming hormone therapy or surgical interventions. This allows patients to make informed decisions before their reproductive potential is potentially affected.

3. Are there differences in preservation methods based on anatomy?

Yes. Transgender women or non-binary individuals with testes typically utilize sperm cryopreservation. Transgender men or individuals with ovaries may pursue oocyte, embryo, or ovarian tissue cryopreservation, though these methods are often more expensive and invasive.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Dsouza KN et al. Fertility preservation trends, perspectives, and reflections in gender diverse adults across the life course. Hum Reprod. 2026 Apr 26. doi: undefined. PMID: 42035457.

T'Sjoen G, et al. Fertility Preservation in Transgender Persons: An Update. Nature Reviews Endocrinology. 2022.

Indian Council of Medical Research (ICMR). Assisted Reproductive Technology (Regulation) Act, 2021.