“The choice to be happy yourself”: Fertility Regrets Among Transgender Adults
The journey through fertility and family planning is uniquely complex for transgender and gender-diverse individuals. A 2024 study by J.D. Asseler and colleagues sheds light on how transgender people view their past fertility decisions and their current experiences with infertility.
Here’s a summary tailored for our community.
Study Overview
The study involved in-depth interviews with 21 transgender and gender-diverse (TGD) individuals who are infertile due to gender-affirming treatments they received during adolescence at a time when sterilization was legally required for gender recognition in the Netherlands. The participants shared their thoughts on past fertility decisions, current feelings about infertility, and future family planning.
Key Findings
Prioritizing Gender Affirmation: Many participants highlighted that during their adolescence, the need for gender-affirming treatment outweighed considerations for future fertility. They viewed gender affirmation as essential for their well-being, even if it meant permanent infertility. One participant expressed, "I wanted to be a boy, and if that meant I couldn't have children, so be it."
Barriers Due to Dysphoria: For some, the thought of preserving fertility was fraught with dysphoria. Procedures like semen cryopreservation were too psychologically taxing. One trans woman noted, "Even the thought of semen coming out of me was unbearable."
Lack of Desire for Biological Children: Some participants didn't desire biological children, which simplified their decision-making process. Others were uncertain about their future desires but prioritized gender affirmation at the time.
Counseling and Support: Participants recalled that while healthcare providers mentioned the impact of gender-affirming treatments on fertility, the discussions were often brief and lacked depth. Comprehensive counseling on fertility preservation options was not always provided.
Current Reflections: Looking back, many participants would still prioritize gender-affirming treatment over fertility preservation. However, some wished they had been given the option to freeze gametes.
Emotional Impact of Infertility: Emotions varied widely among participants. Some were indifferent to their infertility, while others experienced significant distress, particularly when confronted with the pregnancies of others. Coping strategies included acceptance, seeking support from loved ones, and professional counseling.
Future Family Building: While most participants felt they didn’t want to be parents at the time they were sterilized, many found that the desire grew over time. Many now want children and are considering adoption or using a donor. A genetic link was often seen as less important than the parental bond.
Advice for Healthcare Providers and Youth: Participants stressed the need for personalized fertility counseling for TGD youth. They advised healthcare providers to offer comprehensive information and support tailored to each individual's needs. They also encouraged TGD youth to get informed and consider fertility preservation, even if it feels challenging at the time.
Conclusion
This study highlights the critical importance of comprehensive fertility counseling for transgender and gender-diverse individuals. While transgender individuals may still choose sterilizing procedures, opting for transition over fertility, it is still essential to provide TGD youth with the information and support they need to make informed decisions about their reproductive futures.
At Trans Fertility Co., we are here to support you on your journey, offering resources and a community that understands your unique experiences. Remember, your path to parenthood is valid, whether it involves biological children or building a family through other means.
Article Reference: Asseler, J.D., de Nie, I., van Rooij, F.B., Steensma, T.D., Mosterd, D., Verhoeven, M.O., Goddijn, M., Huirne, J.A.F., & van Mello, N.M. (2024). "Transgender persons’ view on previous fertility decision-making and current infertility: a qualitative study." Human Reproduction.
