For LGBTQIA+ Parents

Sperm is put inside the person getting pregnant. This can be done at home, with sperm from a licensed fertility clinic, a sperm bank or someone you know.

If you choose donor insemination, it’s better to go to a licensed fertility clinic where the sperm is checked for infections and some inherited conditions. Fertility clinics can also offer support and legal advice.

If the sperm is not from a licensed fertility clinic, the person donating the sperm can get tested for sexually transmitted infections at a sexual health clinic.

In the UK, the Human Fertilisation and Embryology Authority (HFEA) makes sure licensed fertility clinics run safely and legally.

Find out more:

• HFEA: using donated eggs, sperm or embryos in treatment
• HFEA: home insemination with donor sperm
• HFEA: fertility clinic search

In IUI (intrauterine insemination) sperm is put in the womb of the person getting pregnant. This is done at a licensed fertility clinic. The sperm can be from someone you know or from a sperm bank.

A licensed fertility clinic will check the sperm for sexually transmitted infections and inherited conditions.

Find a licensed clinic with HFEA’s fertility clinic search.

This is when 2 or more people team up to conceive and parent children together.

As a co-parent, you will not have sole custody of the child. It’s advisable to get legal advice at an early stage of your planning.

There are many details to think about, such as how you’ll split financial costs.

You can apply to adopt or foster through a local authority, or an adoption or foster agency. You do not have to live in the local authority you apply to, and you can be single.

You’ll have to complete an assessment before adopting or fostering, with the help of a social worker and preparation training.

Find out more:

• New Family Social: charity for LGBT+ adoptive and foster parents
• GOV.UK: child adoption
• GOV.UK: becoming a foster parent

Surrogacy is when someone has a baby for people who cannot, or choose not to, get pregnant themselves.

In the UK either sperm or egg can be from a donor, but not both.

Surrogacy is legal in the UK, but it’s illegal to advertise for surrogates and the surrogate cannot be paid a fee.

Find out more:

• GOV.UK: having a child through surrogacy
• GOV.UK: legal rights of parents and surrogates

Some medical treatments for gender dysphoria, including hormone therapy and surgery, can have an impact on your fertility. If you’re considering starting treatment to physically alter your body, or you’ve already started, find out what your options are for preserving your fertility.

If you haven’t started hormone therapy or puberty suppressing medication yet

If you’ve already gone through puberty you may be able to freeze your eggs or sperm and store them until you’re ready to use them in treatment.

Egg freezing involves taking fertility drugs to stimulate your ovaries and then collecting the eggs by a surgical procedure whilst you’re sedated. It is mostly very safe, although there is a risk of ovarian hyperstimulation, which can need hospital treatment and in very rare cases can be fatal.

Find out more about egg freezing

Find out more about the risks of fertility treatment

Sperm freezing involves masturbating or undergoing vibratory stimulation to produce a sperm sample, which is then frozen and stored. If you do not feel comfortable producing sperm in this way, it is possible to extract the sperm in different ways (such as through surgical sperm extraction) although these involve more invasive surgical procedures.

Find out more about surgical sperm extraction

If you’ve already started taking hormone therapies or puberty suppressing medication

If you’ve already started hormone therapy or you’re taking puberty suppressing medication you should speak to a fertility specialist. They will probably recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. This means your ovaries may start to ovulate again or your body may start producing sperm, generally over a few months.

Some Trans and non-binary people find it distressing to come off their hormone therapy and may consider other options for having a family, such as using donated sperm or eggs in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family.

Using donated eggs, sperm or embryos

If you’ve been undergoing hormone therapy and about to go for genital reconstructive surgery

If you’re ready for genital reconstructive surgery, it may be possible for your surgeon to collect ovarian tissue or collect sperm via surgery which you can store for future fertility treatment. The only way in which the ovarian tissue can be used at the moment is by replacing it back in you: it cannot be put in another person, and eggs cannot be grown from it ‘in the lab’ at the moment, though this may become possible in the future. You should discuss this with a fertility specialist.

You can’t have children using your own sperm, eggs or embryos once you’ve had genital reconstructive surgery, unless you store your sperm, eggs or embryos prior to surgery.

If your eggs, sperm or embryos are not used immediately in treatment, you may wish to store your eggs, sperm or embryos so they can be used for treatment in the future.  To be stored eggs, sperm or embryos are frozen. You will need to think about how far in the future you might want or be able to use stored eggs, sperm or embryos and the potential costs of storing. This is something you should discuss with your clinic.

You should be aware that embryos can only be stored if both you and the egg or sperm provider have given consent.  This may be your partner or may be a donor (if donated eggs or sperm were used in treatment).

On 1 July 2022, the rules on how long you can store eggs, sperm or embryos changed. Before 1 July 2022, most people could normally only store their eggs, sperm or embryos for up to 10 years. Only if they had premature infertility or were going to be having medical treatment which could affect their fertility, could they store for up to 55 years.

The law now permits you to store eggs, sperm or embryos for use in treatment for any period up to a maximum of 55 years from the date that the eggs, sperm or embryos are first placed in storage. However, crucially for storage to lawfully continue you will need to renew your consent every 10 years. You can give your consent on the relevant consent form.   You will be contacted by your clinic with relevant information and they should also provide you an offer of counselling before you give consent to storage of your embryos. Your clinic will contact you and provide the consent forms that you need to complete at the appropriate time. It is therefore essential that you keep your contact details up to date with your clinic as you will need to be contacted.  If your clinic is unable to contact you your eggs, sperm or embryos will be at risk of being removed from storage and disposed of.

You don’t have to match the length of storage to any contract for paying for the storage (whether you, or the NHS, is paying). However, if you don’t pay for storage as agreed, the clinic may be within its right to dispose your eggs, sperm or embryos. Your clinic should have explained this to your clearly when you stored yours, sperm or embryos.

If you do not renew your consent to storage your eggs, sperm or embryos will be removed from storage and disposed of  when they no longer can be lawfully stored.

If you do not wish to renew your consent to storage or to continue storing your eggs, sperm or embryos then you can withdraw your consent to storage . You will need to contact your clinic and complete the relevant withdrawal of consent form. At this point you may wish to consider donating the eggs, sperm or embryos that you do not wish to use for your own treatment for training purposes, or for use in someone else’s treatment. You would need to discuss this with your clinic and provide the additional consents where relevant. You can also consider donating your eggs, sperm or embryos for use in research, helping to increase knowledge about diseases and serious illnesses and potentially develop new treatments. Your clinic will need to give you more information about this and advise you whether this is an option for you.

If you stored your eggs, sperm or embryos before 1 July 2022 for up to 10 years but would like to store for longer (up to a maximum of 55 years from the date that the embryos are first placed in storage), you should contact your clinic to discuss whether this is possible and complete additional consent forms where necessary.

If you previously consented to store your eggs, sperm or embryos for longer than 10 years (up to a maximum of 55 years) because of premature infertility or because you were going to be having medical treatment which could affect your fertility you should contact your clinic as soon as possible as consent will now have to be renewed at each 10 years. You and the sperm or egg provider will need to complete additional consent forms in order for your clinic to legally continue to store your embryos (even if the clinic are still storing your eggs, sperm or embryos within the consent period you originally specified).

Your clinic will know the date when you must complete and return the relevant consent form for storage to continue. If you do not renew your consent the eggs, sperm or embryos will be removed from storage and disposed of.

Make sure you tell your clinic if any of your contact details change. Because your clinic needs to contact you about your consent to storage, you should always inform your clinic if your contact details change or if your circumstances change (eg, in the event of separation from your named partner). If your clinic is unable to contact you to obtain your consent, then your embryos will be removed from storage and disposed of when they can no longer be lawfully stored. If you’re having NHS treatment you may need to pay to store your embryos.

If you want your eggs, sperm or embryos to be used and stored after death, you’ll need to have given all the appropriate consents for this. You should speak to your clinic as this can be quite a complicated area.

For example, if in the event of your death or mental incapacity you would like your partner to be able to use your eggs, sperm or embryos in their own treatment or with a surrogate, your partner must be named on the relevant consent form. If a surrogacy arrangement would be required, you will need to receive relevant information, be offered counselling, undergo further screening tests and complete additional consent forms before you die. It is therefore vitally important that you and your clinic discuss posthumous use and the different treatment options in those circumstances. Please ask your clinic about this.

If you consent to your eggs, sperm or embryos being used for treatment after your death, the law permits your eggs or embryos to be stored for your named partner’s use for up to 10 years from the date of your death. You must consent to both use and storage of your eggs or embryos continuing after death. This storage period cannot be extended.  You can consent to storage and use for a shorter period than 10 years after your death if you wish on the relevant consent form.

If your named partner does not use your eggs or sperm within this 10 year period, then 10 years after your death, your clinic will be required to remove all your eggs or sperm from storage and dispose of them.

If your named partner does not use your embryos, whether created before or after your death, within this 10 year period, then 10 years and 6 months after your death, your clinic will be required to remove all your embryos from storage and dispose of them.

Your embryos can only be used and stored during this 10 year period if there is also effective consent for use and storage from the egg or sperm provider.

In the event of your death, you may have eggs or embryos that your named partner does not want to use (for example, because the eggs or embryos are not needed, or are not suitable, for treatment). You can consent to your eggs, sperm or embryos being used and stored after your death for potential use by designated healthcare professionals to practice the techniques involved in fertility treatment.

If you consent for your eggs or sperm being used for training in the event of your death, your sperm or eggs can be stored and used for training purposes for 55 years from the date of first storage.

If you consent for your embryos being used for training in the event of your death, your embryos can be stored and used for 10 years from the date you sign the relevant consent form. You should be aware that embryos can only be used and stored for training purposes if both the egg and sperm provider gives consent.

If you’ve stored eggs, they’ll need to be fertilised with sperm using intracytoplasmic sperm injection (ICSI) or IVF and then the resulting embryos will be transferred to a person’s uterus (this could be your partner, yourself if you’ve kept your uterus, or a surrogate).

If you’ve stored sperm, your sperm can be used in intrauterine insemination (IUI). Alternatively, your sperm can be mixed with eggs from your partner, or donor in an IVF or ICSI treatment. If you’ve had to stop hormone therapy in order to collect and store your sperm, the sperm quality may not be as good.

Storing sperm is the only established way to preserve male fertility. Researchers are currently exploring testicular tissue freezing (i.e either as individual cells or as a piece of tissue) as a fertility preservation option. The cells or tissue could later be injected or transplanted back to potentially restore natural fertility. Alternatively, in the future, researchers may be able to produce sperm from these cells in a lab. This sperm could then fertilise an egg in a lab and be used in fertility treatment.  However, this research is at its very early stages and would need a change in UK legislation for it to be allowed for treatment. Currently no births have been reported, following testicular tissue freezing.

If you’ve stored ovarian tissue (i.e. a whole ovary or pieces of tissue from an ovary, containing eggs), it could later be transplanted back to potentially restore natural fertility. Currently only a few centres in the UK offer the service of storing ovarian tissue. The use of frozen ovarian tissue in fertility treatment is still relatively new.

To find clinics which store testicular or ovarian tissue, you can use this ‘Choose a fertility clinic’ search function.

If treatment is unsuccessful, you might want to consider using a donor in treatment.

Before your eggs, sperm or embryo(s) are frozen you need to be screened for various infectious diseases and genetic conditions by a blood test. Make sure you talk to your clinic about your plans for using your stored material so they can give you all the information you need.

Before you consent to storage or treatment you and, if applicable, your partner may also need to have blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.

If you wish for your embryos to be used in another person’s treatment (e.g. in a surrogacy arrangement), the same screening rules on donation apply. You and if applicable your partner will both be required to have further screening tests for cystic fibrosis, karyotype (chromosome analysis), cytomegalovirus, syphilis and gonorrhoea.  In addition, your blood groups will be checked. If surrogacy is something you may consider in the future discuss this with your fertility clinic before storage.

Find out more about screening

Funding for storing your eggs, sperm or embryos before having medical treatment for gender dysphoria varies depending on where you live, with Scotland, Wales and Northern Ireland all making their own decisions about funding.

In England, funding decisions about storage and fertility treatment are decided locally by Clinical Commissioning Groups (CCGs). Some CCGs will fund treatment and others will not. At present, the National Institute for Health and Care Excellence (NICE), which provides guidelines to CCGs and medical professionals on who should be treated on the NHS, does not provide guidance around fertility preservation for people with gender dysphoria.

The best thing to do is to talk to your GP as it can be tricky to find out exactly what’s available in your local area and if you’re eligible. Also bear in mind that even if you can have your eggs, sperm, embryos or tissue stored on the NHS, you may need to pay to use them in treatment later on.

Find out more about access to equitable NHS funded fertility treatment from Fertility Network UK

We recommend that anyone thinking about having fertility treatment, for whatever reason, gets plenty of support, whether from family and friends, social networks, organisations or a professional.

Treatment can be a very emotional experience so it’s important you’re getting the right support before, during and after treatment.

British Infertility Counselling Association (BICA) provide counselling to people of all ages who are considering fertility treatment and preservation.

Fertility Network UK campaign for equitable access to NHS funded fertility treatment.

Gendered Intelligence works with trans people and those who impact on the lives of trans people, specialising in working with young trans people.

GIRES is a charity that hears, helps, empowers and gives a voice to trans and gender non-conforming individuals.

Mermaids support families with children and young people with gender dysphoria.

Testosterone therapy uses an artificial version of the testosterone hormone.

It’s given to people for a number of reasons, including as a treatment for gender dysphoria in people who want to change how their body looks and works.

Testosterone can reduce breast tissue, stop periods, and make hair grow on your face.

It is possible to get pregnant if you’re taking testosterone, but it’s not recommended. This is because taking testosterone in pregnancy may affect the baby’s development.

If you are taking testosterone and want to get pregnant, talk to the doctor who is prescribing you testosterone.

IMPORTANT:

You can get pregnant while taking testosterone.

You need to use contraception if you do not want to get pregnant.

Taking testosterone in pregnancy is not recommended.

Do not stop taking testosterone before talking with the doctor who is prescribing it for you.

If you stop taking testosterone you’ll probably start to have periods. You may also notice changes in your body shape around your hips, chest and thighs.

You should not notice any changes to your tone of voice or facial hair.

If you get pregnant, you may have mood swings, such as suddenly feeling very irritable or tearful. These are common in most pregnancies.

You may find being pregnant triggers feelings of gender dysphoria.

Find out about mental health in pregnancy.

Contact the doctor who is prescribing your testosterone immediately if you are taking testosterone and think you might be pregnant.

If you have taken testosterone in the past then your milk supply may be affected. So you may not be able to chestfeed your baby.

If you can chestfeed and you also decide to start taking testosterone again, your milk will have small amounts of testosterone in it.

It is unclear what, if any, effect this could have on your baby.

It is also important to consider your own wellbeing if you are finding that not taking testosterone is triggering dysphoria.

Talk to your midwife or doctor about any concerns you may have.

Chestfeeding is feeding your baby with milk from your chest.

If you’re able to chestfeed, it’s your decision whether you do and you can change your mind at any time. You will be fully supported in any decisions you make.

If you’ve had top surgery to remove soft tissue, you may still be able to chestfeed or express your milk.

It is not possible to know how much milk you will produce and if it will be enough for your baby. You may need to offer your baby supplementary feeds.

Your baby may find it difficult to latch on to your nipple if there is less soft tissue available. In this case, talk to your midwife.

Speak to your midwife or GP if you want to take testosterone while chestfeeding. Testosterone can decrease your milk supply. Your midwife or a GP can advise you.

If you bind (reduce the appearance of soft tissue by flattening your chest) and are chestfeeding, there may be a higher chance of you getting an infection called mastitis.

Mastitis is when your chest becomes swollen, hot and painful. You may want to try wearing a larger size binder than before.

Speak to your midwife or a GP if you think you may have mastitis.

Skin-to-skin contact with your newborn is a great way to bond with your baby.

Skin-to-skin means holding your baby naked or dressed only in a nappy against your skin.

It’s good to do at any time and will help to comfort you and your baby over the first few weeks as you get to know each other.

• Brighton and Sussex University Hospitals Gender Inclusion has a support leaflet and resources, which might be helpful for you to take to appointments
• La Leche League GB: Support for Transgender & Non-binary Parents