Freezing before transitioning
We believe that all trans and non-binary people who are considering hormone therapy or surgery should be given the option to preserve their fertility if they wish. More importantly, we believe they should feel empowered with the knowledge to make these important decisions.
We also appreciate that, for those considering hormone therapy or surgery, thinking about and discussing fertility can be difficult and complex. For this reason, we have set up a specialised service to support trans and non-binary people who would like to learn more about their fertility options.
What does egg freezing involve?
Egg freezing involves having female hormone injections for 12 -14 days before having eggs collected from your ovaries. We understand the sensitive nature of reproductive anatomy in relation to gender dysphoria. Our staff will be with you at every stage to support you during what can be invasive procedures. They’ll talk you through each of the steps involved and provide you with a complete support program tailored to your needs.
We have staff who are highly experienced in addressing the particular needs of trans and non-binary people. We also have a Trans Coordinator Megan Davies to ensure you receive all the information and support you need, every step of the way.
What are the steps to freeze eggs?
Going through an egg freezing cycle is not as complicated as you might think. It involves a number of steps (see our patient journey diagram):
1. Fertility MOT and Consultation
2. Nurse Consultation
3. Ovarian stimulation
4. Egg collection
5. Laboratory process to freeze eggs
Fertility MOT and consultation
You’ll first be invited in to have an ovarian reserve assessment and medical consultation to review your fertility and discuss your needs. Following this, your Consultant will prepare an individualised program for you. You’ll be offered counselling as well as other support options.
At this appointment, we’ll map out your treatment journey and agree on your start dates. It’s a good idea to attend with your partner if you are having treatment together, or to bring a friend or relative for support if you’re single.
You’ll have two Nurse Consultations; one to set dates and a further one where we show you how to take your medication, including self-administering your injections. Some people worry about this, but our experienced staff will make sure you feel confident that you can take your medication safely. We also have demonstration videos that you can view at home in case you want to go over anything again. All your medication will be delivered to your home (or other address of your choice) via our home-delivery pharmacy.
Most of our treatment plans require you to fill out some detailed, and sometimes complicated, consent forms to comply with regulations of the Human Fertilisation and Embryology Authority (HFEA). To help you do this, we use an online fertility consent portal. That means you can complete your consent forms from the comfort of your own home (or wherever you happen to be) using a computer or mobile device.
We’ll ask you to watch some online videos about your proposed treatment before you attend your Nurse Consultation. The nurse will then check you’ve understood all the information in the consent forms and ask you (and your partner if they’re involved in the treatment) to sign these in the clinic.
During your consultations, you’ll also be given more information about our patient support options.
Before you leave, we’ll give you a fertility treatment identity card and a treatment schedule, which we’ll ask you to bring to every appointment.
You will need to take daily hormone injections that stimulate your ovaries to produce eggs. You take these for around 12 days. We’ll show you how to do these injections yourself, so you don’t need to make unnecessary trips to the clinic.
You’ll have three or four ultrasound monitoring scans and blood tests during your treatment cycle. These check the development of your follicles (the fluid sacs that contain the eggs).
Your results are reviewed by our medical team. They’ll advise you about whether you need to adjust the dose of your hormone injections. Once your follicles have reached the correct size, your Consultant will advise you to have an injection to mature your eggs ready for egg collection.
This is carried out at the Agora by one of our Consultants. You’ll be given sedation to help you sleep through the procedure which usually takes 15 to 20 minutes.
During the egg collection, a fine needle, attached to an ultrasound scanning probe, is passed through the vagina into each ovary to collect the eggs.
Once you have had the egg collection you will be transferred to our recovery bay where you will be cared for by our specialist nursing team. You will be given something to eat and drink and then you can go home. You should not drive or exert yourself unduly and just relax at home.
Egg collection is not usually a painful procedure but some patients find they need to take some paracetamol later in the day as they experience mild period like pains. You can go back to work the next day if you wish.
Laboratory processes to freeze eggs
During egg freezing, all the eggs that have been collected are rapidly frozen during a process called vitrification. The eggs are frozen in liquid nitrogen and carefully stored in tiny straws each labelled with your details.
Freezing eggs fertilised with sperm
If you’re certain about how you would want to use your eggs in the future, we may advise you to consider having them fertilised with donor sperm or your partner’s sperm to create embryos which are then frozen. We might suggest donor sperm if, for example, your partner or future partner is unlikely to be able to provide a sperm sample.
If you plan to have your eggs treated with sperm before they are frozen, the sperm needs to be available on the same day as the egg collection. This can be a fresh sample provided by a partner or a frozen sample if you are using donor sperm or previously frozen partner sperm. During sperm preparation in the IVF laboratory, the healthiest sperm are selected following a special process that is carried out in our on-site laboratory.
Your eggs are placed in a dish with sperm from your partner or sperm donor and allowed to fertilise. If the sperm is low in numbers or of poor quality, we may advise the eggs to be treated with intracytoplasmic injection (ICSI). This is a form of IVF where a single healthy sperm is injected directly into the centre of each egg to assist fertilisation. The treated eggs are then placed in an incubator. This provides the optimum conditions to allow fertilisation to take place.
Our embryologists will be in contact with you the next morning to let you know how many of your eggs have been fertilised. They will then keep you updated on how your fertilised eggs (now called embryos) are developing and to answer your questions. We normally freeze the embryos once they have reached the blastocyst stage which is 5 days after the egg collection.
Sperm can be stored from ejaculated samples taken over a series of visits to the Agora. These can be produced at the clinic, although you can produce these at home, provided the samples can be delivered to the clinic within one hour.
What does sperm freezing involve?
You’ll be given an appointment for a semen assessment and medical consultation to review your fertility and discuss your needs. Then your Consultant will prepare an individualised program of care, and you’ll be offered counselling as well as other support options. We generally recommend two or three visits to the clinic to store sperm as part of the sperm freeze program.
What if I have already started hormone therapy?
If you’ve already started hormone therapy or you’re taking puberty suppressing medication you’ll need to have a Consultation with one of our doctors. This is to discover whether fertility preservation is possible. Hormone treatment suppresses egg and sperm production so you might need to stop taking hormone treatment for a while if you wish to go ahead. Before making this decision, a Consultant will guide you through the possible consequences of temporarily stopping hormone treatment. Please note that stopping hormone medication doesn’t guarantee a return to normal fertility.
The Clinical Commissioning Groups (CCGs) in Sussex will fund fertility preservation if you are attending an NHS Gender Identity Clinic. We advise you to speak to your GP in case they aren’t aware of these recent changes in policy regarding fertility preservation.
If you’re having treatment privately, you won’t be able to get NHS funding. Please see our price list for the costs of egg or sperm freezing.
Next Open Evenings
Wednesday 22nd of April (Postponed)
Wednesday 8th of April (Postponed)
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or phone: 01273 229410
We look forward to welcoming you.
“As a transperson, I felt like I had already missed out on enough rites of passage and starting a family was not one I was willing to add to that list. For a long time I thought that wasn’t going to be an option for me but The Agora changed that.”