Episode 45: Fertility Preservation and Gender-Affirming Care

Fertility preservation for those undergoing gender-affirming transition is an important area of reproductive medicine. In this episode, Anne and Ruby are talking with Dr. Lynn Davis about how fertility options may be dependent on age, the gametes involved (i.e. sperm or eggs) and the stage of gender-affirming care.

Dr. Davis started her educational journey with a double major in Biology and Psychology from the University of Virginia, followed by her MD from the University of Colorado and OB/GYN residency from Harvard. She concluded her training with her REI Fellowship at Stanford University, where she also completed a postdoctoral Fellowship at the Stanford Agency for Healthcare Research & Quality, and served as Clinical Instructor in the Department of OB/GYN.

Dr. Davis developed and now leads SRM’s Fertility Preservation Program, a specialized approach that assists those who need assisted reproductive technology to efficiently delay family building.

Sometimes it’s a question of timing. For example, those born with testicles do not begin producing sperm until puberty (a process known as spermatogenesis). So if an individual with testes chooses to go on gender-affirming puberty blockers, they may not yet produce sperm. While puberty blockers can prevent bodies from undergoing unwanted physical changes (development of facial hair, lower voice, etc.), it may also mean little or no sperm to freeze for fertility preservation.

For those who have undergone natal puberty, it is possible to interrupt gender-affirming hormones in an attempt to resume spermatogenesis and freeze sperm for later use. However, there is a chance the process may not result in viable sperm. The experience coming off gender-affirming hormones also needs to be considered; for some, it can be a distressing, dysphoric experience.

Options for those with ovaries are also dependent on puberty and stage of gender-affirming treatment. Dr. Davis discusses the options for ovary stimulation, egg retrieval, ovarian tissue cryopreservation, and all the nuanced considerations along the way.

Be sure to tune in for this important and fascinating conversation.