The journey to build your family often runs parallel to your gender-affirming journey, and it’s completely normal to have questions about how they intersect. Understanding how hormone therapy and surgery can affect your fertility ahead of time helps you make informed decisions and map out a path that feels right for you. Whether you’re just starting to think about medical transition or have been on hormones for years, you have options. This guide will walk you through fertility preservation, what happens when you pause hormones, and how to create a treatment timeline that aligns with your family-building goals and your life. We’ll cover the key considerations for IVF for trans people.

Key Takeaways

• Preserve your fertility options before you transition: Speaking with a fertility specialist before starting hormones or having surgery is a powerful first step. Freezing eggs or sperm ahead of time keeps your options open and gives you more control over your future family-building journey.
• IVF is a toolkit, not a single procedure: Think of IVF as a collection of options that can be personalized for you. You can use your own eggs or sperm, work with a donor, involve a gestational carrier, or share the biological journey with a partner through reciprocal IVF.
• Assemble your team for total support: Your journey involves more than just medical care. It's essential to find an affirming clinic, talk to a lawyer to protect your parental rights, plan for the financial costs, and lean on mental health resources to care for your emotional well-being.

What is IVF for transgender people?

If you're transgender and want to build a family, you have options, and in vitro fertilization (IVF) is one of them. While the science behind IVF is the same for everyone, the path is deeply personal and can be tailored to fit your specific needs, body, and goals. Think of it less as a one-size-fits-all procedure and more as a collection of tools that you and your care team can use to create your family. The journey looks different for everyone, and that’s especially true for trans and gender-nonconforming people. Let’s break down what IVF is and how it can be personalized for you.

A quick look at how IVF works

At its core, in vitro fertilization is a process where an egg is collected from the ovaries and fertilized with sperm in a lab. This creates an embryo. After a few days of developing in the lab, the embryo is transferred into a uterus to hopefully grow into a pregnancy. It’s a multi-step process that involves medication to prepare the body, a procedure to retrieve the eggs, and another procedure to transfer the embryo. Each stage is carefully monitored by a medical team to give the embryo the best chance of implanting and developing.

How IVF is personalized for you

For transgender people, the IVF process is customized to your unique situation. Your treatment plan will depend on your body, your transition goals, and how you want to build your family. This might involve using your own eggs or sperm (if you preserved them before starting hormones), or you may choose to use donor eggs or sperm. If you don't have a uterus or can't carry a pregnancy, a gestational carrier can carry the embryo for you. For couples, options like reciprocal IVF allow both partners to be biologically involved—one partner provides the egg, and the other carries the pregnancy. The key is to choose an IVF plan that aligns with your personal journey.

How do hormones and surgery affect fertility?

Gender-affirming care is a deeply personal journey, and it’s completely normal to have questions about how it might intersect with your family-building goals. Both hormone therapy and surgery can play a significant role in your fertility. Understanding these effects ahead of time helps you make informed decisions and map out a path that feels right for you. Let’s walk through what you need to know.

Hormone therapy's effect on fertility

Hormone therapy can change your body’s ability to produce eggs or sperm. For many people, pausing hormone therapy can allow fertility to return, often within three to six months, but it’s not a guarantee. For trans men on testosterone, therapy usually stops ovulation, but this is often reversible after you stop taking it. In fact, pregnancies have been reported even after long-term testosterone use. The key takeaway is that while hormones have a major impact, pausing them is often a viable first step when you’re ready to start your IVF journey.

How gender-affirming surgery impacts your options

Unlike hormone therapy, some gender-affirming surgeries have a permanent effect on your ability to have biological children. If you have surgery to remove your ovaries or testes, you will no longer produce your own eggs or sperm. This doesn’t mean your path to parenthood is over—it just looks a little different. Many people in this situation build their families using donor eggs or sperm, and some work with a gestational surrogate to carry the pregnancy. It’s also important to know that transgender women cannot currently carry a pregnancy because they do not have a uterus.

Planning your treatment timeline

Timing is a big piece of the puzzle. If you’re thinking about starting gender-affirming hormones or having surgery, it’s a good idea to speak with a fertility specialist first. This conversation can help you explore fertility preservation options, like freezing eggs or banking sperm, before you begin medical transition. If you’ve already started hormones, your doctor will likely recommend pausing them before starting fertility treatment. For trans men, it’s often suggested to stop taking testosterone for at least three months before treatment to support egg health, though this is something you’ll decide on with your care team.

What are my fertility preservation options?

Thinking about your future family is a big step, and it’s smart to consider your options before or during your medical transition. Fertility preservation allows you to store your eggs, sperm, or embryos so you have more choices when you’re ready to have children. The best time to do this is often before starting hormone therapy or having gender-affirming surgeries, as these can impact your fertility. But even if you’ve already started your transition, you may still have options. It’s all about understanding what’s available and making a plan that feels right for you.

Freezing eggs

For trans men and non-binary people assigned female at birth, egg freezing is a common and effective option. The process involves taking medication to stimulate your ovaries to produce multiple eggs, which are then retrieved in a minor procedure and frozen for later use. Ideally, this is done before you start taking testosterone. When you’re ready to build your family, your frozen eggs can be thawed, fertilized with sperm from a partner or a donor, and transferred to a uterus to hopefully achieve a pregnancy. It’s a way to press pause, giving you the freedom to pursue your transition while keeping the door open for biological children in the future.

Banking sperm

For trans women and non-binary people assigned male at birth, banking sperm is the most straightforward way to preserve fertility. This involves providing a semen sample, which is then analyzed, frozen, and stored. It’s best to do this before starting hormone therapy, like estrogen or spironolactone, as these medications can reduce or stop sperm production. Your banked sperm can be used later for procedures like intrauterine insemination (IUI) if you have a partner with a uterus, or for in vitro fertilization (IVF) to create embryos with a partner’s or donor’s eggs. It’s a simple, low-impact process that can make a huge difference for your future family-building plans.

Freezing embryos

Freezing embryos is another powerful option for individuals or couples. This process involves using in vitro fertilization (IVF) to fertilize eggs with sperm, creating embryos that are then frozen and stored. You can use your own eggs and a partner’s or donor’s sperm, or your own sperm with a partner’s or donor’s eggs. For some couples, clinics may even offer a “split cycle,” where eggs are fertilized by sperm from both partners, creating a mix of embryos. This path requires more investment upfront than just freezing eggs or sperm, but it gives you a clear sense of how many viable embryos you have for the future.

What does the IVF process look like?

The path to building your family through IVF is a journey with several key stages. While every person's experience is unique, the process generally follows a clear structure, from initial planning and preparation to the final embryo transfer. Understanding these steps can help you feel more prepared and in control as you move forward. It’s all about taking it one phase at a time, with your care team guiding you along the way.

Your pre-treatment plan

Before you start any gender-affirming hormones or surgeries, it’s a good idea to have a conversation with your doctor about your family-building goals. If having biological children is important to you, discussing fertility preservation early on is key. This often involves freezing eggs or sperm for future use. Thinking about this ahead of time gives you the most options and allows you to create a plan that aligns with both your transition and your desire to have a family. It’s a proactive step that puts you in the driver's seat of your future.

Pausing hormones and restoring fertility

If you’ve already started hormone therapy, you may need to pause it before beginning fertility treatment. For many, stopping hormones can help restore fertility, with sperm or egg production often returning within three to six months. For those on testosterone, your doctor might recommend stopping for at least three months before treatment, as high levels can affect egg health. It’s important to know that this isn’t always a guarantee, as long-term hormone use can sometimes have a permanent impact. Your doctor will work with you to figure out the best and safest approach for your body.

The egg retrieval and fertilization process

This is the core of the IVF process. It starts with taking medication to stimulate your ovaries to produce multiple eggs. Once the eggs are mature, they are collected in a short procedure called an egg retrieval. From there, the retrieved eggs are taken to a lab and fertilized with sperm to create embryos. These embryos are carefully monitored as they grow for a few days. Your clinic will keep you updated on their progress, helping you understand how many viable embryos you have for the next step.

What to know about embryo transfer

Once you have healthy embryos, the next step is deciding where they will be transferred. You have a few different paths you can take. The embryo can be placed in your own uterus, your partner’s uterus, or the uterus of a gestational surrogate. For couples where one partner is a trans man or both partners have uteruses, you might explore reciprocal IVF. This allows one partner to provide the egg while the other partner carries the pregnancy, creating a beautiful biological connection for both parents. It’s a wonderful way for you and your partner to share in the journey of bringing your child into the world.

IVF paths for trans men and trans women

Your path to parenthood is unique, and there are many ways to build a family using IVF. The right approach depends on your body, your goals, and your partner. It’s about finding the combination of options that feels right for you. Let’s walk through what the process can look like for trans men and trans women, and a popular option for couples looking to share the biological journey.

What IVF looks like for trans men

If you’re a trans man, you have several options for building your family. You can freeze your eggs or create and freeze embryos for future use with either a partner’s or donor’s sperm. Some choose intrauterine insemination (IUI) with partner or donor sperm. With IVF, you can use your own eggs, a partner’s, or donor eggs. Once embryos are created, they can be transferred into your uterus if you choose to carry the pregnancy. If you have a partner who can carry a pregnancy or prefer a surrogate, those are also wonderful family-building options. The path is entirely up to you.

What IVF looks like for trans women

For trans women, the journey often begins with freezing sperm before starting hormone therapy. This banked sperm can be used later in a few ways. If you have a cisgender female partner, she can undergo IUI, where sperm is placed directly into the uterus. Another path is IVF, using your sperm with a partner’s or donor’s eggs. The resulting embryo can then be transferred into your partner’s uterus or carried by a gestational surrogate. These different transgender pregnancy options give you the flexibility to plan a family on your terms.

Exploring reciprocal IVF as a couple

Reciprocal IVF is a way for both partners in certain relationships to be biologically involved. This process is a great option for many couples, including those with a trans man who produces eggs. In reciprocal IVF, one partner provides the eggs, which are fertilized in a lab with donor sperm. The resulting embryo is then transferred to the other partner, who carries the pregnancy. This allows one person to be the genetic parent and the other to be the gestational parent, creating a shared connection to the experience. It’s a powerful way to build a family together.

Taking care of your emotional health during IVF

Going through IVF is an emotional marathon for anyone, and it can bring up unique challenges when you’re trans. Between the hormone fluctuations, the waiting games, and the physical procedures, it’s a lot to handle. Your mental and emotional well-being is just as important as your physical health during this process, so it’s essential to have a plan to care for yourself. This journey can feel isolating, but you are not alone. Many people experience a mix of hope, anxiety, frustration, and joy. For trans folks, the process can also stir up feelings of gender dysphoria as your body goes through changes that might feel at odds with your identity. The key is to acknowledge these feelings without judgment and build a strong network of support to see you through. Prioritizing your emotional health isn’t just a nice-to-have; it’s a critical part of preparing for treatment and, hopefully, parenthood. It means checking in with yourself regularly, asking for help when you need it, and setting boundaries to protect your energy. Think of it as building an emotional toolkit that will help you feel more grounded and in control, no matter what comes your way.

Understanding the emotional side of treatment

It’s completely normal to feel a sense of grief or loss as you process the emotional side of infertility. The stress of managing expectations can be heavy, and the constant uncertainty is draining. Many people find comfort when they connect with others who get it. Support groups can be a great place to share your experience and hear from others who are on a similar path. Remember to give yourself grace. You’re going through a physically and emotionally demanding process, and it’s okay to not be okay sometimes. Acknowledging your feelings is the first step toward managing them.

How to handle gender dysphoria during the process

For many trans people, the physical aspects of IVF can trigger or worsen gender dysphoria. Pausing hormone therapy, undergoing exams, or experiencing bodily changes can feel deeply uncomfortable. It’s important to know that these feelings are valid. The physical changes associated with fertility treatments and potential pregnancy can be particularly challenging, and it's essential to be proactive about your mental health. Research on transgender pregnancy highlights the importance of support during this time. Find a gender-affirming therapist, connect with other trans parents, and lean into self-care practices that make you feel grounded in your body and identity. Your emotional safety matters.

Building your support system

You don’t have to carry the emotional weight of IVF by yourself. Building a solid support system is one of the most important things you can do. This can include your partner, trusted friends, family, and mental health professionals. Many clinics offer psychological support and can connect you with counselors who specialize in fertility. Don't hesitate to ask your care team what resources are available. There are also organizations that provide workshops and support groups tailored to the LGBTQ+ community. Finding your people can make all the difference in feeling seen, heard, and supported throughout your journey.

How to find LGBTQ+-affirming fertility care

Finding the right fertility clinic is a huge decision for anyone, but for trans people, it comes with an extra layer of complexity. You deserve a care team that not only understands the science of fertility but also respects your identity and experiences. The right clinic will make you feel seen, heard, and safe throughout the entire process. This isn’t just about finding a doctor who is “okay” with treating you; it’s about finding a team that is knowledgeable, affirming, and enthusiastic about helping you build your family.

Think of this process as an interview where you’re in the driver’s seat. You’re looking for a partner in your care, and it’s completely okay to have high standards. A truly inclusive clinic will have experience with transgender fertility options and will have built their practice around serving diverse families. Your comfort is paramount. If a clinic doesn’t feel right, trust your gut and keep looking. The goal is to find a space where you can focus on your treatment without the added stress of having to educate your providers or advocate for your basic dignity.

What to look for in a provider

Your search for an affirming provider can start online. Look for clinics that explicitly state their commitment to serving LGBTQ+ patients on their website. Do their intake forms have fields for pronouns and chosen names? Do they offer gender-neutral bathrooms? These small details often reflect a larger, more inclusive culture. It’s also important to find a provider who is knowledgeable about the unique needs of trans individuals and families. Check out their staff bios and see if anyone mentions specialized training or experience in LGBTQ+ health. Many clinics, including Gaia’s partner clinics, are vetted for their inclusive practices, which can be a great place to start your search.

Questions to ask your potential clinic

When you have a consultation, come prepared with questions. This is your opportunity to gauge their experience and approach to care. Ask them directly about their experience with trans patients and what their policies are on inclusivity. You might ask, “What kind of training has your staff had on LGBTQ+ health issues?” or “Can you walk me through how your clinic supports trans patients who may experience gender dysphoria during treatment?” Their answers will tell you a lot about their level of understanding and commitment. A great clinic will welcome these questions and provide clear, confident answers that make you feel at ease.

Red flags to watch out for

Pay close attention to how a clinic makes you feel from your very first interaction. A lack of clear policies on LGBTQ+ inclusivity or staff who seem uncomfortable discussing your identity can be significant red flags. If you’re repeatedly misgendered, if the paperwork is not inclusive, or if you feel like you have to educate the staff on basic trans issues, that’s a sign that this may not be the right environment for you. Feeling dismissed or misunderstood can add unnecessary emotional weight to an already challenging process. Remember, you can find broader community support and you have the right to walk away and find a care team that celebrates you.

How to plan for the cost of IVF

Let’s talk about the financial side of things. The cost of IVF can feel like a huge hurdle, and it’s completely normal to feel overwhelmed when you first see the numbers. It’s one of the biggest sources of stress for anyone considering treatment, and it adds another layer of complexity to an already emotional process. But you don't have to let the financial questions stop you. Planning for the expense is a critical step in your journey, and having a clear picture of what to expect can make the entire process feel more manageable. Think of this as your starting point for creating a financial roadmap. We’ll walk through the typical costs, how to figure out insurance, and where to find financial support so you can focus more on your treatment and less on the bills. Getting a handle on the finances early on gives you back a sense of control and allows you to move forward with confidence. This is about making informed decisions that work for you, so you can put your energy where it matters most: building your family.

Breaking down treatment costs

IVF isn’t a single line-item expense. The total cost is made up of several different parts, and prices can vary a lot between clinics. An initial consultation can cost a few hundred dollars, while a single IVF cycle with fresh eggs can range from $15,000 to over $20,000. If you’re using frozen embryos, a transfer is typically less expensive. It’s also important to ask about the costs that aren’t included in the base price, like fertility medications, anesthesia for procedures, genetic testing, and annual fees for storing eggs, sperm, or embryos. Getting a detailed cost breakdown from your clinic is the best way to avoid surprises.

What to know about insurance coverage

Insurance can be tricky. While more states are mandating some level of fertility coverage, many standard health plans still don’t cover treatments like IVF. Even if your plan covers maternity care, it might not extend to the treatments needed to get there. The best first step is to call your insurance provider directly. Ask them specific questions about your benefits: Is IVF covered? What about diagnostic testing or medication? Are there any specific requirements or limitations for LGBTQ+ individuals or couples? Understanding exactly what your insurance policy covers will help you plan for any out-of-pocket expenses.

Finding financial assistance and support

If insurance doesn’t cover everything, you still have options. Many people use financing plans, grants, or loans to help manage the cost of treatment. This is also where having a dedicated partner can make a real difference. At Gaia, we help you plan and pay for your treatment with more protection and support. We offer flexible ways to afford care, including refund-backed plans that give you a portion of your money back if your treatment doesn’t result in a baby. You’re not on your own—we’re here to help you make sense of the entire process, from the first consultation to building your family.

What to know about the legal side of IVF

Going through the medical side of IVF is a huge undertaking, but the legal side is just as important for protecting the family you’re working so hard to build. Laws around parentage haven’t always kept up with all the beautiful ways families are formed, which means it’s smart to be proactive. This is especially true for trans and LGBTQ+ people, where legal recognition as a parent isn't always automatic. Depending on where you live, the law may not immediately recognize both partners as parents, especially if one of you isn't genetically related to your child.

Before you get too far into your treatment plan, it’s a good idea to understand the legal steps you’ll need to take. It might feel like one more thing to add to your list, but getting clear on your rights and responsibilities from the start can prevent a lot of stress and heartache down the road. The two biggest areas to focus on are securing your parental rights and formalizing any donor agreements. Thinking about these things now ensures your family is protected from day one, and lets you focus on the journey ahead with more peace of mind.

Securing your parental rights

The most important piece of advice we can give is this: talk to a lawyer who specializes in family or reproductive law before you start treatment. This is a critical step to make sure your parental rights are fully protected. Laws about who is considered a legal parent can be tricky and vary a lot from state to state, especially when one or both partners are not genetically tied to the child. A lawyer can help you understand the best path forward, whether that’s through a second-parent adoption after the baby is born or a pre-birth order that establishes your parentage before. This isn't just paperwork—it ensures you both have the legal authority to make medical decisions, enroll your child in school, and be recognized as a family in every sense of the word.

Understanding donor agreements

If you’re using donor sperm, eggs, or embryos to build your family, a legal donor agreement is essential. This contract clarifies the rights and responsibilities of everyone involved. It formally establishes you and your partner as the child’s legal parents and confirms that the donor has no parental rights or financial obligations. This is true whether you’re using an anonymous donor through your clinic or a known donor, like a friend or family member. Even when a friend offers to help, putting a formal agreement in place is a healthy step that protects your relationship and prevents any future misunderstandings. A lawyer can help you draft an agreement that covers all the bases, giving you peace of mind so you can focus on your fertility treatment journey.

Where to find support and resources

Going through IVF is a huge undertaking, and having the right support system can make all the difference. From finding a clinic that truly gets it to connecting with people who are on a similar path, building your network of care is a critical step in the process. You don’t have to figure everything out on your own.

Finding specialized clinics and programs

Finding a clinic that understands your specific needs is a huge part of this process. At Gaia, we help you find the right partner clinic and understand your treatment options, offering IVF and ICSI services tailored to you. You can also look for programs specifically designed for trans individuals who want to build their families. Organizations like Gay Parents To Be offer resources and help with both fertility preservation and treatment for the trans community. Taking the time to find a provider who is not just competent but also affirming can create a much more positive and supportive experience.

Connecting with online communities

You don’t have to go through this journey alone. Connecting with people who have similar experiences can be incredibly validating and supportive. Online communities can be a great place to start. For example, RTZ HOPE offers support groups and workshops that focus on the LGBTQ+ experience with reproductive journeys, including loss. RESOLVE: The National Infertility Association also provides professionally-led support groups where you can talk through the stress and expectations that come with fertility treatment. Hearing from others can help you feel less isolated and more understood.

Accessing mental health support

IVF can be an emotional roller coaster, and taking care of your mental health is just as important as your physical health. Many fertility centers, like the UCSF Center for Reproductive Health, offer counseling sessions to help you process your feelings and connect with supportive resources. For peer support specifically for the trans community, Trans Lifeline has a hotline for trans and questioning callers. It’s a safe space to find emotional and financial support from people who understand what you’re going through. Prioritizing your well-being will help you manage the ups and downs of treatment.

Related Articles

• IVF - Our Guide To Treatment
• The Reciprocal IVF Timeline: A 7-Step Guide
• IVF with donor eggs
• IVF with Donor Sperm: What You Need to Know

Frequently Asked Questions

Is it too late to think about fertility if I've already started hormone therapy? Not necessarily. For many people, fertility can return after pausing hormone therapy, often within a few months. The first step is to have a conversation with a fertility specialist. They can run some tests and help you understand your specific situation and what your options look like. While it's ideal to preserve fertility before starting hormones, there are still paths to explore even after you've begun your medical transition.

How can my partner and I both be recognized as legal parents? This is a really important question, as laws vary quite a bit by location. The best thing you can do is speak with a lawyer who specializes in reproductive or family law before you even start treatment. They can guide you through the right process for your situation, which might involve a pre-birth order or a second-parent adoption after your child is born. Taking this step early ensures your family is protected from the very beginning.

What can I do to manage gender dysphoria during treatment? It's completely valid to be concerned about this, as the physical aspects of IVF can be challenging. Building a strong support system is key. This should include a gender-affirming therapist who can help you process your feelings. It's also helpful to be upfront with your fertility clinic about your concerns so they can make the experience as comfortable as possible. Connecting with other trans parents in support groups can also provide a sense of community and understanding.

I'm interested in IVF, but where do I even begin? The best first step is to schedule a consultation with a fertility specialist at an LGBTQ+-affirming clinic. This initial meeting is a chance to ask all your questions, discuss your family-building goals, and get a sense of the clinic's environment. You can talk about everything from fertility preservation to the potential costs and timelines. Think of it as an information-gathering session that will help you map out your next steps without any pressure.

What are my options if I can't or don't want to carry a pregnancy myself? You have a few great options. If you have a partner who can carry a pregnancy, you can explore paths like reciprocal IVF, where one partner provides the egg and the other carries the pregnancy. Another wonderful option is working with a gestational carrier, or surrogate, who can carry the embryo for you. Your fertility clinic can help you understand the medical and legal processes involved with using a surrogate to build your family.