Fa­mily plan­ning and trans­gender

In re­cent years, the topic of trans­gender has in­cre­asingly come into the spot­light media. At the same time, me­di­cine has made great ad­vances, which in turn should cer­tainly be of in­te­rest to the world­wide trans scene. Even if we in­iti­ally and tra­di­tio­nally tend to as­so­ciate pregnancy and birth with sta­tions in a wo­man’s life, a broa­de­ning of the per­spec­tive is called for here.

Trans men with be­ards and round pregnancy bel­lies — this sight may be new and unu­sual for some. Ho­wever, since the Briton Freddie Mc­Con­nell made his pregnancy pu­blic in the ci­ne­matic do­cu­men­tary “Se­ahorse”, the sub­ject of pa­ren­thood has been al­lowed to open up to new pos­si­bi­li­ties.

Ba­si­cally, we speak of “trans­gender people” when a person does not iden­tify with the gender that was re­gis­tered at birth. Trans­gender people can, for ex­ample, be born with a uterus and ova­ries but feel they be­long to the male gender. They may take hor­mones and/or have gender-mo­di­fying sur­gery to ap­pro­xi­mate the male gender. So-called transmen can, but do not have to, have a uterus and ova­ries.

Trans­women are those who iden­tify as women even though they were as­si­gned the male sex at birth. In ad­di­tion, there are a va­riety of trans­gender people, such as non-bi­nary people or people with a fluid gender.

There are no re­liable fi­gures yet on how many trans­gender people carry out pregnan­cies. A study from Bel­gium in 2020 called “De­sire to be­come par­ents and fer­ti­lity pre­ser­va­tion among trans­gender people li­ving in Bel­gium who were clas­si­fied as fe­male at birth” showed that: 39% of the people sur­veyed had the de­sire to be­come par­ents. What keeps them from doing so? Apart from fears such as the fear of dis­cri­mi­na­tion against the child, as­sumed ex­pense and dif­fi­cul­ties in ad­op­tion pro­ce­dures, the legal si­tua­tion alone looks com­plex. For in many count­ries, legal gender re­as­sign­ment often goes hand in hand with forced ste­ri­li­sa­tion. This is the case in 24 count­ries in Eu­rope alone, for ex­ample in Bel­gium, Italy, Switz­er­land or France.

In 2011, the Fe­deral Con­sti­tu­tional Court ruled that the forced ste­ri­li­sa­tion of trans­gender people was not con­form with fun­da­mental rights. Be­fore­hand, an­yone who had de­cided to ch­ange their first name and marital status had had to re­nounce the right to pa­ren­thood. Since 2011, Ger­many has the­r­e­fore ex­pe­ri­enced a gro­wing number of life plans that also in­clude the de­sire to have children and be­come par­ents.

For trans­gender people who wish to have children, there are a few things to con­sider. For ex­ample, in its of­fi­cial bro­chure „Trans* He­alth Guide“ under the hea­ding „De­sire to have children“, the Trans* Fe­deral As­so­cia­tion states that the de­sire to have children and being trans* are not mu­tually ex­clu­sive. Ho­wever:

“Since some body-mo­di­fying tre­at­ments limit the ability to re­pro­duce, a pos­sible de­sire to have children should be dis­cussed in the pre­pa­ra­tion. Per­haps sperm pre­ser­va­tion or the pre­ser­va­tion of re­pro­duc­tive or­gans is wished. In ad­di­tion, in­for­ma­tion should be given about the pos­si­bi­li­ties of foster care and ad­op­tion.”

In German-spea­king count­ries, there has been no re­se­arch on the topic of trans pregnancy so far. Ho­wever, there have been fre­quent re­ports about pregnan­cies of transmen. Nevert­heless, the mis­in­for­ma­tion per­sists that bio­lo­gi­cally fe­male people may be­come in­ca­pable of con­cie­ving once tes­to­ste­rone is con­sumed. What is im­portant here in the first place is whe­ther or not the uterus and ova­ries have been sur­gi­cally re­moved in the course of a de­sired mas­cu­li­ni­sa­tion. For as long as the uterus and ova­ries re­main, the pos­si­bi­lity of fer­ti­lity is gua­ran­teed. This is also the case if hor­mone pre­pa­ra­tions based on tes­to­ste­rone are taken.

One of the first stu­dies de­di­cated to the topic of ar­ti­fi­cial in­se­mi­na­tion in fe­male-male trans­gender pa­ti­ents came to a po­si­tive con­clu­sion. The study com­pared, the egg yield with that of cis pa­ti­ents (people who were re­gis­tered with the fe­male sex at birth and who also iden­tify with this sex). Ac­cor­ding to the study, ar­ti­fi­cial in­se­mi­na­tion me­thods can achieve ex­cel­lent re­sults.

An intact uterus and func­tio­ning ova­ries are ne­ces­sary for pregnancy. But does this have to be un­al­terably pre­sent in a woman? Me­di­cine is now able to trans­plant wombs. Theo­re­ti­cally, a trans woman could not only be a “fa­ther”, but also a mo­ther of her own baby. Even if it is a long way to go, the first steps have al­ready been taken. Back in 2013, the Swe­dish gy­nae­co­lo­gist Mats Bränn­ström trans­planted a wo­man’s uterus from a donor for the first time. A dozen children have al­ready been born after a uterus trans­plant so far.

For people born with a uterus the pos­si­bi­lity of so-called cryo­p­re­ser­va­tion is in­te­res­ting. Here, egg or sperm cells are deep-frozen using li­quid ni­trogen and reused for fer­ti­li­sa­tion at a later date.

The Fe­deral Mi­nistry for Fa­mily Af­fairs, Se­nior Ci­ti­zens, Women and Youth (BMFSFJ) ad­vises on its in­for­ma­tion pages of the rainbow portal to al­ways con­sider the op­timal time for pre­ser­ving one’s own germ cells be­fore any planned phy­sical gender re­as­sign­ment. En­do­cri­no­lo­gists are the first point of contact here.

Für Men­schen mit einer an­ge­bo­renen Ge­bär­mutter da­gegen ist die Mög­lich­keit der so­ge­nannten Kryo­kon­ser­vie­rung in­ter­es­sant. Hier werden Ei- oder Sa­men­zellen mit­tels flüs­sigem Stick­stoff tief­ge­froren und zu einem spä­teren Zeit­punkt für die Be­fruch­tung wie­der­ver­wendet.

Das Bun­des­mi­nis­te­rium für Fa­milie, Se­nioren, Frauen und Ju­gend (BMFSFJ) rät auf seinen In­fo­seiten des Re­gen­bo­gen­por­tals dazu, vor jeder ge­planten kör­per­li­chen Ge­schlechts­an­glei­chung in jedem Fall den op­ti­malen Zeit­punkt der Kon­ser­vie­rung ei­gener Keim­zellen mit­zu­denken. Hier sind vor allem En­do­kri­no­lo­ginnen und En­do­kri­no­logen die ersten An­sprech­per­sonen.

In the long term, it may be pos­sible at some point to com­ple­tely de­couple re­pro­duc­tion from bio­lo­gical sex. A Ja­pa­nese re­se­ar­cher is al­ready working on tur­ning body cells into stem cells in order to grow germ cells (i.e. sperm and eggs). He has al­ready been suc­cessful in ex­pe­ri­ments with mice and was able to ob­tain em­bryos.

There is still a long way to go. It is hoped that the pos­si­bi­li­ties for trans­gender people to have their own bio­lo­gical children will in­crease with me­dical re­se­arch. On top oft that we hope that the so­cietal and so­cial stig­ma­tis­a­tion for trans­gender people de­creases in the long run.

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.