Trans fertility dilemma

July 11, 2020 11:37 PM

My partner is trans, need help thinking about fertility options.

Okay, this is a brain dump-- all of this is pretty new to me and I basically know nothing about fertility so looking for guidance.

My partner and I are 31 and 32. I am a cis woman. My partner recently came out to me as trans, mtf. They would like to begin hormone therapy asap, which likely will make them permanently infertile.

Neither of us are sure if we want to have kids, although I have been leaning that way more and more (welcome to your 30s, I guess.) I am also not 100% sure this relationship is going to survive long term so that's an added wrinkle.

However, in the somewhat panicky month since my partner came out, we decided to bank their sperm just in case. They went to a urologist a few days ago and did so. Great, bets hedged, right?

Nope. The clinic called back and their sperm count was low. IVF would be the only option. They can go back this week and give another sample (which they plan to do) but otherwise the option is a fertility workup.

Neither of us have ever given much thought to fertility before-- I have no idea what a fertility workup entails. It seems bananas to both of us to go through that for a hypothetical child that neither of us are sure they even want (?!) And yet, I picture myself in a few years wishing that we'd pursued this at least a little further while we had the chance--the prospect of IVF is daunting. I'm not opposed to adoption but that also seems daunting.

This is not something I've ever had to think about. Any info that we should know? Or just outside perspectives? My gut is that we should just let this one go but honestly I know so little about this that maybe my gut is wrong? (My partner is inclined to let it go but also wants to make sure I'm feeling comfortable with that).

posted by anonymous to Grab Bag (11 answers total)

My wife and I continued to want kids a little more each year in our late twenties and early thirties and now have one (and probably more later). I have no experience with IVF and the experience and expense may well end up being too daunting, but speaking only as a random outside perspective, and not as someone in your particular situation, I do think I'd regret not pursuing it a little further. The more legwork you do now when it's a possibility, the less vague/unmoored regret you'll have if it doesn't end up working out for whatever reason but you still feel a pang.

Just me, though, and our situation was different in a few ways that I'm sure matter—there was no point-of-no-return in our immediate future, and we were already married and 100% sure of the relationship when our feelings on kids started to change.
posted by Polycarp at 11:47 PM on July 11, 2020

Ask your doctor, but I would think if they bank enough sperm, there's no reason why you later can't choose to do IVF with that sperm if that's the direction you want to/need to go. IVF success chances aren't always super high, so bank more sperm than you would otherwise, but I don't really understand why you'd need to make decisions about this and do a full fertility work up now if your partner is producing some viable sperm, but just with low counts.
posted by lollusc at 1:00 AM on July 12, 2020 [9 favorites]

is your partner tucking or otherwise wearing tight underwear? because that could easily increase the temperature in the testicles and kill off sperm.
posted by Acheman at 2:24 AM on July 12, 2020 [4 favorites]

Cis-Woman who has done fertility treatment here. When they say they want to do a “full fertility work up” do they mean on you? Or your partner?

For my partner (cis-man) a fertility work up consisted of analyzing his sperm with the potential for a blood draw for a lab.

For me, it was a blood draw, a sonogram to look at my uterus, and an HSG test where they push fluid into your uterus to X-ray it. All out patient procedures.

Here are some questions to ask:
Do they understand your timeline? That you are banking for the future to conceive later? How would a work up affect your decisions about banking?
What actionable information will you gain from either a work up on your partner or yourself?
A walk through of all potential test, what info you gain from the tests, and an overall timeline.

You have a right to know (From your doctor):
- what diagnostic test your provider is proposing and why?
- what those tests might lead to (more test?)
- what the cost would be and if they have anyone in the office who helps navigate insurance with the patient
- what the timeline is for these tests
- any physical restrictions you or your partner might have to do with undergoing testing (fasting etc)
- and pretty much anything else you want to know!
posted by CMcG at 4:27 AM on July 12, 2020 [9 favorites]

Since you say you're not opposed to adoption, might that also mean you wouldn't be opposed to using donor sperm? Because if having biological kids isn't terribly important to you or your partner, that can be your fallback so you don't need to devote a lot of time and energy to hypotheticals right now.
posted by metasarah at 6:03 AM on July 12, 2020 [4 favorites]

Is the clinic a full fertility treatment center, or just a sperm bank? If it’s the latter, I would arrange for a consultation with a fertility center in your area. These are often free, depending on the center, where you’ll sit with a doctor and talk about your options. lollusc is right that if you do IVF, especially ICSI-IVF, which uses one sperm per egg, you don’t need as many. Also important to know is the quality - is the sperm count low but the sperm themselves normal? Are they low with low mobility?

If you’re not sure this is a long-term relationship anyway, and your partner is even slightly open to children, I would think having them bank several samples, just for future possibilities, might be a good idea.
posted by umwhat at 6:17 AM on July 12, 2020

My partner experienced low sperm count. His was high enough that Intra-uterine insemination was an option - unfortunately IUI has a really low probability of success, only a bit higher than timed intercourse.

My partner also had blood tests in addition to his sperm count. They showed his testosterone level was low, and he was prescribed clomid, a medication that increases both testosterone and estrogen levels. This worked for us! His sperm count went up into the high normal range. However, I am thinking this would not be an option for your partner.

As you embark on these tests, you will want to ask at the outset what the treatment options might be that would allow you to avoid IVF. The options may not be very good or may not work for you I am sorry to say. And in that case IVF might be your best option if you want to use your partner’s sperm.

One final note - infertility is really stressful. Take care of yourself and seek emotional support when you need it.
posted by mai at 8:01 AM on July 12, 2020

.. I am also not 100% sure this relationship is going to survive long term...

*Nobody* should be 100% sure about that.

Can you imagine it lasting 16 more years?

Have you ever had a sudden vision of you and your partner together, and much older, or a sudden similiar realization, without an accompanying wave of negative emotion?
posted by the Real Dan at 11:15 AM on July 12, 2020 [1 favorite]

I have a slightly different angle. I, a cis woman, am 43 with no children, and while I do not regret not having children, I do regret not freezing my eggs. So ESPECIALLY if you're not 100% sure about the long term, maybe take this opportunity to freeze some eggs.
posted by 8603 at 11:18 AM on July 12, 2020

When I banked during transition I gave four samples over the course of a month or a bit longer. At the time it felt like torture to put off HRT for that month. But I'm very glad I did it, and having more samples means that if my partner, who has a family history of infertility, wants to get pregnant with me, we have more options.

I agree with other folks that there's no point getting worked up about your own fertility right now. But if your partner thinks she might want to get someone pregnant with her own sperm in the future — you or someone else, honestly — she might as well take the time to try and get a decent amount banked.

(On the third hand, as someone else pointed out, the alternatives include donor sperm as well as adoption. If your partner doesn't mind being in the same boat as most other women who date women and using donor sperm in whatever future pregnancy she wants to be involved in, then there's less need to jump through all these hoops.)
posted by nebulawindphone at 11:32 AM on July 12, 2020 [1 favorite]

I don’t really understand why a fertility workup is necessary at this point. Your partner has sperm, maybe not enough for insemination, but enough to do IVF. Is there a reason she can’t skip the workup and just bank some vials anyway?

Then, later, if you two (or she and a future partner) want to have kids, that’s when you decide whether to do IVF, or use donor sperm, or look into adoption, etc. Banking keeps your options open.
posted by insectosaurus at 12:32 PM on July 12, 2020 [2 favorites]