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We recognise that undergoing transition from one gender to another presents many challenges, including the potential to have your own genetic children in the future. Thinking about having children may not be a high priority for you currently. However, considering storing sperm now may allow you the opportunity to have children in the future.

Having your own genetic children may not be possible, or the chances reduced, if you do not consider storing sperm before starting hormone drugs that can potentially irreversibly stop sperm production and / or before definitive gender affirming surgery. We will help you to make the right decisions for you as sensitively as we can.

Why am I being asked to consider storing my sperm?

For those assigned male at birth, the testes start to produce millions of sperm after puberty. Sperm are made continuously under the influence of FSH and LH hormones that are released by the pituitary gland at the base of the brain, and testosterone which is produced by the testes. A sperm contains half of the building blocks, or genetic material needed to develop into a baby. To make a baby the sperm needs to fertilize a human egg to complete the building blocks needed.

You are considering taking, or have already started drugs that will lead to the transition from your birth gender into the gender you identify with. The types of medications used could reduce, or prevent your own natural chance of having children (fertility). It is difficult to know exactly what the effect of your treatment will be, and fertility may therefore be temporarily or permanently affected. Depending on the type of treatment and the amount of time you have taken the medication. Both ‘blockers’ (gonadotrophin releasing hormone agonists e.g. Gonapeptyl / Decapeptyl) or cross-sex hormones e.g. Oestradiol (the hormone usually produced from the ovaries) switch off the pituitary gland (in the brain) which turns off the hormonal signal to the testes to produce sperm. The best time to store sperm is before any medication (‘blockers’ or cross-sex hormones) is started but it is possible to stop any of the transition drugs to attempt to store sperm at any time.

It may take months or occasionally years off medication for sperm to be produced again and unfortunately there are no guarantees that normal function will be restored.

Sperm banking can enable those who may not have completed (or even started) their families to have genetically- related children in the future. This is not to say that other ways of having a family cannot be equally rewarding such as using donated gametes (egg or sperm), adoption or fostering.

FSH and LH hormones are produced from the pituitary gland in the base of the brain.

Taking GnRH analogues (‘blockers’) or oestrogen will stop FSH and LH release.

FSH and LH control sperm production in the testes.

How is sperm collected?

If you wish to freeze sperm, you will need to produce a sample yourself through masturbation. We are not able to offer surgical procedures to retrieve sperm in Ä¢¹½tvÊÓƵ.

What happens next if I decide to store sperm?

1. An appointment will be made with a clinician at Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine who will take your medical history and explain in more detail about fertility preservation for those undergoing gender transition. If you are already on hormonal medication, we advise you to stop these for a minimum of 3 months before attempting storage. This will mean that you may temporarily regain some of the male features you had transitioned away from.
2. When the time is right to store your sperm (depending on your stage of transition and time off your medication), you will be referred to Care Fertility Ä¢¹½tvÊÓƵ once initial assessments and tests are complete, and funding arrangements are in place.
3. You will need to have a blood test to screen for infections (including Hepatitis B / C / HIV / Syphilis) as we can only provide storage for people who do not have these infections. Further tests may be required depending on the use of sperm in future and Care Fertility Ä¢¹½tvÊÓƵ will advise you appropriately. You may need to have a blood test to check your hormones that indicate sperm should be available and therefore storage will be possible. After your initial assessment, you will be referred from Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine to CARE Fertility Ä¢¹½tvÊÓƵ at Seacroft Hospital, Ä¢¹½tvÊÓƵ where sperm storage will be undertaken.
4. When you attend to give your sample at Care Fertility Ä¢¹½tvÊÓƵ, you will need to sign the required agreements (consent forms). You will be met by an embryologist (scientist who freezes the sperm) who will explain their role, before showing you to a private, lockable room where you will provide your first sperm sample by masturbation.
5. You may be advised to produce a second sample a few days later, to increase the number of sperm samples in storage to improve your chances of fertility treatment success in the future. If no sperm is found, we will talk to you about when to try again.
6. The sperm sample will be stored in small portions in the long-term storage freezer at CARE Fertility Ä¢¹½tvÊÓƵ.

What happens when I want to use the sperm?

When you want to discuss using the stored sperm, you should request that your GP sends a referral to Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine. Any issues that have arisen with your health or well-being since your initial contact with Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine will be discussed. We will also talk you through the chances of your sperm surviving after being frozen and thawed. We will explain how the sperm may be used and the chances of having a baby with it.

How the sperm is used will depend on the type of relationship you are in. If you have a female partner, depending on the circumstances, the sperm could be injected into her womb (intra-uterine insemination or IUI) or used to fertilise her eggs (with IVF or ICSI technology) to make an embryo (earliest stage of a baby), and be transferred in her womb cavity or be used in a surrogate (somebody who carries a pregnancy for you in their womb).

If you have a male partner, you will need to consider using a surrogate and donated eggs. These are delicate choices and ideas and will need to be carefully thought about by you and your partner (if you have one at that time).

The clinician will also advice you about fertility treatment options as a single parent or if your partner is a trans or non-binary individual.

Currently, on an average just over one in four IVF treatments where an embryo is transferred to an individual with a womb result in a pregnancy. This is likely to get better in the future.

Who pays for sperm storage?

At the beginning, the NHS may fund the hospital appointments and sperm freezing process, but this depends on your local health authorities which are called Integrated Care Boards (ICB). As per the current local policy in West Yorkshire you must be receiving NHS England funded gender transition hormone treatment for you to access NHS funded sperm freezing.

If you do not meet the criteria for NHS funded sperm freezing, in exceptional cases, a special individual funding request can be made by your GP or the specialist on your behalf. If this is not successful you will have the option to pay for it yourself. Please visit Care Fertility Ä¢¹½tvÊÓƵ website for the current charges if you are interested.

It is important to realise that if you wish to use the stored sperm in the future, the fertility treatment required may not be paid for by the NHS, as different rules apply for NHS funded fertility treatment using frozen sperm. For example, there is currently no funding in Yorkshire and Humber region for fertility treatment as a single parent.

Ending sperm storage

Once the samples are no longer required by you, we expect you to advise CARE Fertility Ä¢¹½tvÊÓƵ and Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine to discard them. We can discuss this with you at any time but also expect you to keep in regular contact with CARE Fertility Ä¢¹½tvÊÓƵ or Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine.

Together with your transition doctors, we may advise you to discard the sperm samples in the future if you have completed your family or decide to stop the transition process.

What happens if I don’t want to store sperm or I’m unable to produce a sample?

This is your decision to make with the support of those close to you and ourselves if needed. Nothing will change in your transition journey if you decide not to store any sperm. We can still see you at a future time if you wish to explore your fertility options again.

If you are not able to produce a sample on that day then we could rearrange the appointment, if this is your choice. If on repeated occasions you are unable to produce semen or no sperm is present in the semen sample, you will have to be referred to a further Specialist Centre in London.

Is there anyone else I can talk to?

We know that there is a lot of information to take in. Some people find it helpful to talk to someone who is not a close family member, friend or doctor / nurse involved in their treatment about how they feel and the decisions they are being asked to take.

Fertility counselling is currently not available at Ä¢¹½tvÊÓƵ Centre for Reproductive Medicine, but appropriate information can be given if you wish to access counselling privately.

Important legal information

Storage of sperm for your own use

The following information is for your guidance.

• Your right to confidentiality under the HFE Act of parliament prohibits the normal exchange of information between clinicians without specific written consent unless it is deemed necessary for your continuing medical care.
• Before consenting to the storage of sperm you will receive verbal and written information and may wish to receive further counselling regarding the implications of taking the proposed steps.
• Anyone consenting to storage of their sperm must give their consent in writing prior to the storage.

Consent

The consent must specify one or more of the following:

• Whether the treatment is provided for yourself, or yourself and a named partner.
• Whether any sperm obtained can be used for research.
• The legal maximum period of storage is 55 years, allowed only with regular follow-up with a reproductive medicine medical practitioner.
• What is to be done with the sperm in the event of your death or you become incapable of changing or withdrawing your consent. This is a legal requirement.
  A. You may request that the sperm is allowed to perish.
  B. You may donate the sperm for research.
  C. Your named partner could be able to use it.
  If you have a female partner and they wish to use your stored sperm in the event of your death, you must have nominated that person to use your sperm beforehand. Without your written, legal consent, your partner will not be able to use it.
  D. You cannot donate it for the treatment of anyone else.

Glossary

• Eggs: A woman’s lifetime supply of eggs is present in the ovary at birth. They reduce in number and quality with time. They pass on the half of the genetic instructions to the baby.
• Embryo: Once the egg is fertilised with sperm, it begins to cleave (multiply its cells) and is called an embryo.
• Fertilisation: Fertilisation is when the genetic material from the egg and sperm combine to create a new and unique cell which may go on to develop into an embryo and then a baby.
• FSH: Follicle Stimulating Hormone helps sperm production in the testis.
• GnRH agonist (‘Blocker’): A hormonal drug that first stimulates and then inactivates the pituitary gland e.g. Prostap, Buserelin; these can be used to block sperm production.
• Gonadotrophins: Hormones produced naturally by the pituitary gland to stimulate the testis to produce and release sperm e.g. FSH, LH.
• ICB: An Integrated Care Board decides on how treatment should be funded in local areas.
• Oestrogen: This hormone is naturally produced by the ovary. It helps give female features.
• Pituitary gland: A small gland situated in the base of the brain, behind the nose, which, produces many hormones including those that control the ovary and testis.
• Sperm: The sperm develop in testis and continue to do so throughout adult life. They do not suffer the same deterioration with age as eggs, as they are constantly being replaced. They pass on half of the genetic instructions to the baby.
• Surrogate: A woman who carries a pregnancy in her womb for another person.
• Testis: Where sperm production and storage takes place.
• Testosterone: The hormone mainly produced from the testes, that helps give male features e.g. facial hair, deeper voice whilst being involved in sperm production.

Useful resources

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