New research highlights barriers to fertility preservation for transgender people
Trans peoples’ interest in reproduction and fertility preservation: A cross-sectional, descriptive study into barriers to reproductive care. (Des Roches, 2025)
Des Roches, L., Ziegler, B., & Deniz, S. (2025). Trans peoples’ interest in reproduction and fertility preservation: A cross-sectional, descriptive study into barriers to reproductive care. Journal of Obstetrics and Gynaecology Canada, 47(12), 1-7. https://doi.org/10.1016/j.jogc.2025.103125
Resource: The 2SLGBTQ+ Special Interest Group at the Canadian Fertility and Andrology Society recently released a Resource Guide for 2SLGBTQ+ Fertility and Family Building for healthcare providers and professionals working in perinatal care.
Geographic Region: Canada
Research Question: What are trans peoples’ interests in reproductive choices, and what barriers do they face in meeting their reproductive goals?
Design: Cross-sectional design using a one-time anonymous survey. The survey ran from May 2021 to May 2022. Participants were recruited through LGBTQ2S+ groups across Canada. The 66-item survey asked about: personal information (age, income, etc.), interest in having biological children, use of donor sperm or eggs, use of surrogates, barriers to fertility care, plans for gender-affirming treatments, and experience with fertility services.
Sample: 299 transgender individuals across Canada, aged 16 years or older, and self-identified as trans or gender other than cisgender. The sample was asymmetrical, with 79% assigned female at birth and 28% assigned male at birth, plus 1% identifying as intersex. Most participants (79%) said they realized their gender identity was different from their birth sex by age 20. About two-thirds (68%) were taking or planning to take hormones to affirm their gender. About half (49%) had undergone or planned to have surgery that would affect their ability to have biological children. Not everyone answered every question. At most, 266 people answered any single question, and 197 people completed the entire survey.
Key Findings
82% (N=169) of participants expressed interest in pursuing some form of reproductive options (e.g., biologically related children, donor gametes, gestational carriers, or fertility preservation).
Cost was the most frequently named barrier to accessing fertility services (33%, N=37), with trans people noting that fertility preservation fees were prohibitive, especially when competing with other transition-related expenses.
21% (N=23) reported barriers accessing trans-appropriate reproductive care: : providers who lack knowledge about trans bodies, clinics where they fear mistreatment, and waiting lists that ignore the time-sensitive nature of fertility preservation.
65% (N=91) reported fertility discussions before starting transition care, and 35% (N=49) received no fertility counseling at all. It is unclear if the conversations were perceived as informed consent or coercive prerequisites.
Trans people identified additional barriers including: gender dysphoria triggered by fertility procedures or the prospect of pregnancy (N=17), being forced to interrupt their transitions by stopping hormones (N=16), and uncertainty about how hormones affect fertility (N=10). These barriers are caused by how medicine is currently practiced, not inherent to being trans.
13% (N=38) of participants stated they were not interested in future fertility, citing reasons such as not wanting children, not desiring genetically related children, or having lifestyle preferences incompatible with parenting.
Participants reported that barriers to accessing fertility services were often multifaceted, involving a combination of financial, logistical, psychological, and healthcare access challenges.
Limitations: Because people volunteered to take the survey, those who cared more about fertility issues might have been more likely to participate. The researchers used social media to find participants, which might have reached mostly younger people and missed those who don’t use social media. There were more participants who were assigned female at birth than assigned male at birth. The study might not have captured the experiences of people who had already given up on fertility preservation because of barriers.
Applications: The current system often manufactures a false choice between accessing hormones and preserving fertility—both should be guaranteed rights. For clinicians, this study highlights the importance of ensuring all trans patients receive informed, non-coercive fertility counseling that presents preservation as optional, not mandatory. This counseling should occur early but never function as a gatekeeping barrier to transition care. Fertility clinics must fundamentally redesign their practices around trans patients, not expect trans people to adapt to cisnormative procedures. This means: gender-neutral intake forms and language, visual representation of trans families in waiting rooms, staff training that goes beyond tokenistic "cultural competency," and examining which aspects of current procedures unnecessarily trigger dysphoria.
Funding Source: No specific funding source was mentioned in the article.
Lead Author: Dr. Lara Des Roches is a physician in the Department of Obstetrics and Gynecology at McMaster University in Hamilton, Ontario, with expertise in reproductive healthcare for transgender populations. No personal connection to the donor conception was disclosed.
Regulatory Context
In 2004, Canada passed the Assisted Human Reproduction Act (AHRA), one of the most comprehensive pieces of legislation in the world concerning reproductive technologies and related research. In 2010, the Supreme Court of Canada struck down parts of the AHRA, leaving responsibility to provinces, which have largely not acted.
Currently, there is no central system for storing donor information accessible to donor-conceived persons and no legislation protecting their right to know donor identity.
Industry guidelines suggest limits of 25 people per population of 800,000; however, there is no national registry to track the number of births by individual egg and sperm donors.
In 2024, Canada removed restrictions on gay and bisexual sperm donors.
Commercial payment to donors is prohibited - donations must be altruistic. Donors can receive reimbursement for legitimate expenses but not payment for gametes themselves.
Single people, same-sex couples, and heterosexual couples all have equal legal rights to access assisted reproduction treatments.
Gamete and embryo donation can be known or anonymous. When a child is born using anonymously donated gametes, that child does not have a right to know the identity of their donor.
In 2024, Quebec became the first province to recognize the right to know one’s origins. They launched a provincial donor registry, allowing donor-conceived people over 14 to access certain donor information if available.
Over 90% of donor sperm used in Canada comes from the United States due to regulatory burden and lack of donor incentives.
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