Dr. Brent Monseur MD, ScM

Individuals who are transgender or transitioning face unique issues regarding fertility, family building, and fertility preservation. The term transgender describes individuals who do not identify with the sex they were assigned at birth. Gender identity is complex and exists on a spectrum. While some transgender people identify with a gender different than the sex they were assigned at birth (often referred to as genetic or biological sex), others do not identify as either of the traditional binary genders.  

Transgender men are individuals who were assigned female sex at birth but identify as male, while transgender women are those who were assigned male sex at birth and identify as female. Some transgender individuals prefer to be identified only as men/male or women/female, dropping the term transgender. Others prefer the terms trans man or trans woman. In this article we will discuss options for creating a family as a transgender individual as well as for those who are undergoing gender transition, and will use trans or transgender terminology for conciseness even as we recognize the differences in preferred language. We will also discuss pregnancy, the delivery process, and aspects of the postpartum course for these individuals.  

Transgender parenthood is fairly common. According to the U.S. Transgender Population Health Survey, 19 percent of transgender respondents were parents.ⁱ

In vitro fertilization (IVF) is an assisted reproductive technique where sperm and eggs are combined outside the body, and the resulting embryo or embryos are transferred into a uterus (embryo transfer). Performed at a fertility clinic, IVF can help women conceive if they are having trouble doing so, often after completing other, less invasive fertility interventions. It can also be an option for those without fertility issues, including single women, same-sex couples, and those with certain medical conditions such as cancer.  

IVF can be performed using a woman’s own eggs and her partner’s sperm, or with donor eggs or donor sperm. Embryos from IVF, whether donor embryos or created from a woman’s own eggs and partner’s sperm, may be transferred to either the intended parent’s uterus or into a gestational carrier’s (colloquially referred to as a “surrogate”) uterus.  Sometimes the term “IVF” is used to refer to the process of freezing eggs (oocyte cryopreservation) even if fertilization and creation of embryos does not take place.

A dilation and curettage (D&C) is a surgical procedure that is used to remove tissue from the uterus, and while it is performed for a variety of reasons including diagnostic purposes, it is typically used following a miscarriage or for elective termination of a pregnancy. An understanding of what to expect before, during, and after a D&C is beneficial for navigating this procedure, as well as to learn about potential risks and alternative treatments.

With regard to in vitro fertilization (IVF), potential success is highly dependent on being able to retrieve enough high-quality eggs that may subsequently go on to produce healthy embryos. Part of that process involves ovarian stimulation. In some cases, fertility doctors will suggest priming protocols. As patients seeking pregnancy review the various IVF protocols suggested, it is important to understand what priming protocol may be best for them. This includes knowing how these protocols can impact reproductive health, what the protocols are used for, what drugs will be required, and what the success rates are.

Conceiving through in vitro fertilization (IVF), or other assisted reproductive technology, is a multifaceted process that involves several steps. Once eggs have been retrieved, successfully fertilized, and the embryos have developed, the embryo transfer procedure is planned by the reproductive endocrinologist (REI, also called RE). IVF embryo transfer processes vary depending on factors that include whether fresh or frozen embryos are used and how many embryos are planned for transfer. Successful embryo implantation into the uterine cavity requires careful planning before the actual transfer procedure itself, and possibly a few lifestyle adjustments for the woman during the weeks immediately following the procedure.

A physician may recommend medicated ovulation induction, timed intercourse, intrauterine insemination (IUI), therapeutic donor insemination (TDI), and/or in vitro fertilization (IVF) to assist in becoming pregnant as part of a reproductive medical treatment plan. During treatment, a reproductive endocrinologist (RE) may prescribe ovarian stimulation in order to maximize the number of eggs produced.

Despite a commonly held perception, it is not always easy to get pregnant. Individuals can increase their chances of getting pregnant if they know when, how, and how often to have sex. There are also lifestyle tips and tricks that can be helpful in optimizing natural fertility, potentially leading to a positive pregnancy test and a viable birth. Most women who have been trying for only a few months to get pregnant should not be concerned if they have not yet conceived. However, after trying to get pregnant for a lengthier time (more than 6-12 months), it can be helpful to know what some of the indicators are that point towards consulting a health care professional who can provide medical advice regarding fertility issues.

Polycystic ovary syndrome (PCOS) is a condition that is often associated with having a negative impact on a woman's ability to conceive. This syndrome is characterized by a range of symptoms, from unwanted hair growth to challenges when trying to conceive, and can be difficult to diagnose and treat.

Getting pregnant may seem like a simple matter for most people, yet it is far from a simple process and in fact has a number of steps that require just the right timing. Many factors contribute to whether or not an egg will get fertilized, develop into an embryo, and result in a live birth. Whether an individual is trying for pregnancy or thinks she may already be pregnant, understanding the fundamentals of conception can help when seeking medical advice to ensure optimal reproductive health.