Transgender people wanting to have biological children need to follow the same equation as any other potential parents: egg + sperm + uterus = baby, says obstetrician-gynecologist Emily Jungheim, MD, MSCI, and director of the Fertility and Reproductive Medicine Center at Barnes-Jewish Hospital. In some cases, a transgender person can bring those three elements together unassisted by reproductive specialists. But, like other parents, sometimes they need fertility and reproductive specialists to help with the baby equation.
“While some of the challenges for transgender patients are the same as any individual or couple having a problem conceiving, there are questions and concerns unique to trans males and females,” says Jungheim. “We answer those questions and address concerns in a supportive and comfortable environment. We have the same goal for all of our patients: a healthy baby.”
She adds, “Barnes-Jewish Hospital has been recognized as a leader in LGBTQ health care equality by the national Human Rights Campaign organization. We are dedicated to supporting members of the LGBTQ community in their efforts to become parents.”
Unique questions and concerns
For a trans male with a uterus and ovaries intact who wants to carry his own child, a first question often relates to hormones.
“Some trans males are concerned about what will happen once they stop taking testosterone and experience a sudden increase in estrogen. They want to know how that transition will affect the characteristics they have achieved through testosterone therapy,’” says Jungheim. “Others want to know whether taking testosterone for a significant length of time prior to pregnancy will affect the baby.” Jungheim says that taking testosterone prior to conception won’t affect the baby, but it may take the body a while to regain ovulatory cycles once testosterone treatment is stopped. “One way we can help patients is by offering general education on monitoring ovulation, by helping them achieve conception and by telling them when it’s time to seek additional help if conception doesn’t take place. And we can help those needing donor sperm.”
For trans females who have had surgery as part of their transition process and who did not bank sperm prior to surgery, conception will require surgical retrieval of sperm and in vitro fertilization. “If the patient has a female partner, that partner could provide the egg and uterus. But if the trans female is single or has a male partner, she’s going to need a donor egg and a gestational carrier,” says Jungheim. “There are myriad scenarios, and our role is to look at each patient’s situation and find the best means of supplying the missing components of the basic equation.”
Often the help provided by Jungheim and her colleagues includes recommending legal expertise. “When a gestational carrier is involved, there needs to be a legal document protecting that third party, and the parents and baby, in the event something happens to the intended parents or to the carrier during pregnancy,” she explains. “Each situation is different, and individualized legal counsel is essential.”
Prospective trans parents treated at the Fertility and Reproductive Medicine Center also meet with social workers, who can help identify the “what ifs” for them: If you use a gestational carrier, how are you going to talk to your child about it? When and how will you explain it? Will you ask a friend or family member to be a gestational carrier? How do you approach her?
“The goal is to find a gestational carrier who has the good of the baby at heart and then ensure she receives the best medical care during the pregnancy,” says Jungheim.
Increasingly, preparing for parenthood may mean taking steps well before conception occurs. Trans males have the option of freezing their eggs and trans females their sperm to ensure that, when having children becomes a goal, they are prepared.
“However, unless patients are planning on surgery that will result in sterilization, banking eggs or sperm is not necessarily needed. Simply stopping hormones therapy and regaining original function will mean conception is possible if the other two components of the equation are available,” says Jungheim. “But banking sperm and eggs is an option for those who do not want to stop taking hormones.” She notes that trans males have an additional complication that comes with aging. “If people in this population want to wait until their late 30s or early 40s to have children, banking their eggs is a good decision.”
Learn more about LGBTQ+ family building.
A reputation for excellence
Jungheim notes that any individual or couple who wants to have a baby but has barriers to conceiving should seek counseling at a center such as the Fertility and Reproductive Medicine Center. In the St. Louis region, this center is the only center that is a member of the Society for Assisted Reproductive Technology (SART), which requires member institutions to adhere to the highest level of assisted-reproductive-technology (ART) standards and to report ART outcomes.
“This level of transparency is important to those seeking help, because they can see the success rate we achieve for our patients. That information is not always easily available from fertility clinics that are not members of SART,” she says.
According to Jungheim, the center’s pregnancy rates are the highest in the St. Louis region and are consistently and significantly higher than national averages. Jungheim cites several factors contributing to that success.
“Our status as a university-based center means we have the flexibility and resources required to think creatively to find solutions for our patients. We’ve seen a significant number of complex cases of infertility and have a range of solutions to offer,” she says.
The center also focuses on maximizing patients’ chances of pregnancy while reducing the risk of multiple gestations. “The fact that our in vitro fertilization lab is able to culture healthy embryos has allowed us to dramatically reduce the number of embryos we transfer into our patients. In 2016, approximately 25 percent of our patients received just one embryo, which means better birth outcomes,” says Jungheim.
The center’s physicians are board certified in obstetrics and gynecology, and in reproductive endocrinology and infertility. Fertility and Reproductive Medicine Center’s obstetrician-gynecologist, Randall Odem, MD, is a member of the Practice Committee of the American Society of Reproductive Medicine and is active in writing clinical guidelines for the field of reproductive medicine. The university’s fellowship training program—one of only about 35 in the country—means future practitioners of reproductive medicine are learning their craft from a leading fertility program.
“One of our strengths is that we are respectful of our patients. We offer recommendations for the social and financial resources they may need, and we offer experienced medical support – all of which is designed to help them achieve excellent outcomes. And those outcomes are healthy babies,” says Jungheim.