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Fertility Preservation Before Bottom Surgery

Medically reviewed by Nicole M, RN on September 8, 2024.

Reproductive considerations are often a central part of someone’s medical transition journey. Whether you are interested in having biological children or are just considering your options, we have compiled a guide on fertility preservation options for those who produce sperm or eggs. These options are particularly relevant for individuals who are interested in or undergoing gender affirming hormone replacement therapy (HRT) or bottom surgery. Surgeries like orchiectomy (removal of the testicles), vaginectomy (removal of the vaginal canal), hysterectomy (removal of the uterus), and oophorectomy (removal of the ovaries) can have an irreversible impact on a patient’s ability to have children in the future. 

Fertility preservation is the process of saving or protecting reproductive tissues (i.e., ovarian or testicular tissues) or cells (i.e., eggs or sperm) so they may be used in the future to have biological children. It is important to note that these processes may require stopping hormones, and that long-term exposure to hormone therapy could affect fertility.

If interested, we encourage you to consult with your endocrinologist or other hormone provider to discuss your fertility preservation options prior to undergoing bottom surgery. While our practice may not offer these services, there are professionals and organizations dedicated to supporting individuals in their journey towards having children, and can provide valuable advice and assistance.

If you are interested in further resources, you can consult these trusted guides on trans masculine fertility and trans feminine fertility. These materials are especially designed for trans and gender non-conforming people and have been vetted by medical experts in reproductive health.

Any fertilization process may require multiple attempts to achieve desired results. We encourage you to consult with your healthcare providers about your personal medical history, your goals and the risks and probabilities associated with each of these options. For trans and gender non-conforming patients in particular, fertility preservation and fertilization procedures have the possibility of bringing up feelings of gender dysphoria along with other unwanted symptoms of hormonal changes or withdrawal. We encourage you to lean on your social support network as you go through these processes.

Sperm and egg preservation for transgender and gender non-conforming patients

For people whose testicles produce sperm, sperm cryopreservation can be used. This procedure involves collecting and freezing semen for future use. It can be done anytime before undergoing bottom surgery.

On the other hand, oocyte cryopreservation involves collecting and freezing unfertilized eggs for future use. To maximize the number of eggs available for preservation, a patient is usually prescribed certain hormones to stimulate the ovaries before collection. It’s recommended to complete the oocyte cryopreservation process at least 6 weeks before having one or both ovaries removed. This way, any hormones used to stimulate the ovaries won’t interfere with the surgical outcomes. The success rate of cryopreservation depends on the individual’s age and the method of freezing used.

Another option is embryo cryopreservation. Here, the eggs are collected in the same way as in oocyte cryopreservation; then they are fertilized with sperm from a partner or donor. The resulting embryos are then frozen for later use. This method has the highest success rate for preserving fertility.

Fertilization options

It’s also important to know that there are other reproductive options available, and they may vary depending on the individual’s circumstances. Some reproductive options include intrauterine insemination (IUI) or in-vitro fertilization (IVF). 

For IUI, sperm from a partner or donor is drawn into a syringe. A flexible catheter is attached to the syringe and is inserted into the uterus where the sperm is injected to guide it in the right place and increase the chances of pregnancy.

For IVF, the process is a bit more involved but can be incredibly successful. In this method, both the sperm and the egg are collected and retrieved from either the partner or a donor. Then, the egg is fertilized by the sperm in the laboratory and this fertilized egg becomes an embryo. The next step is transferring or implanting the embryo into the uterus of a person who has the potential to carry the baby. This person can either be genetically related to the child (like a traditional surrogate) or unrelated (like a gestational carrier).