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LGBTQ + Fertility and Family Planning Information

LGBTQ + Fertility and Family Planning Information

In this nifty info sheet, you’ll find the best scientific evidence and data about the topics in the survey––fertility, family planning, and reproductive health. Keep in mind that advancements in reproductive science are happening all the time, so the information is subject to change. You'll also find additional fertility and family planning resources.

Here's to learning more about our own bodies on our own terms.

Modern Fertility

Age and Fertility

After a person with ovaries is over 35 years old, the risk of genetic problems in the baby decreases. (1)

This statement is false. A person with ovaries is born with all the eggs they’ll ever have, and they tick down to zero by the time they hit menopause. As people with ovaries get older, the risk of genetic issues, like Down Syndrome or miscarriage, increases.

After age 35, a person who carries a baby is more likely to have medical problems during pregnancy. (2)

This statement is true. People with ovaries who are older than 35 are more likely to have medical problems during their pregnancy, including gestational diabetes, preeclampsia, and miscarriage.

A person transitioning into menopause has a higher chance of becoming pregnant with their own eggs. (3)

This statement is false. The average age of menopause in the US is 51 and the process of menopause actually begins 5-8 years before a person has their last period (it's a funky window called perimenopause). This time is marked by a decrease in egg quality, as well as egg quantity, which means people with ovaries transitioning to menopause have a lower rate of becoming pregnant.

When a person carrying a baby is over 35 years old, cesarean section is more common. (4)

This statement is true. People carrying a child who are older than 35 are more likely to birth their baby via cesarean section (also referred to as a c-section).

When a person with ovaries is over 35 years old, overall health is a better indicator of fertility than age. (5)

This statement is false. There is a common misconception that overall health and fitness (i.e. a healthy weight or a healthy diet) mean "better" fertility. This is not necessarily the case. Research suggests that your age and hormones may be a more useful indicator to predict fertility.

When a person with testes is over 45 years old, there is a decline in the ability to fertilize an egg with their own sperm. (6)

This statement is true. After age 45, people with testes are at risk for low sperm concentration, poor sperm motility (how well sperm move) and abnormal sperm morphology (shape). These factors make it more difficult for a person with testes to fertilize an egg.

Hormones and Fertility Tests

Hormone levels provide information about fertility. (7)

This statement is true. In people with ovaries, AMH (along with FSH and E2) is a hormone involved in measuring egg quantity-or ovarian reserve. In people with testes, measures of testosterone and FSH can be used to investigate cases of low sperm concentration.

Hormone blood tests can be used to estimate the number of eggs a person with ovaries has. (7)

This statement is true. Hormone blood tests can measure AMH, which is a hormone released by follicles and is the most important hormone for testing ovarian reserve, or the quantity of eggs a person with ovaries has left.

Hormone blood tests can be used to understand potential outcomes for egg-freezing, intrauterine insemination (IUI), and in-vitro fertilization (IVF). (7)

This statement is true. Doctors use ovarian reserve hormone testing (specifically AMH, FSH, and E2) to determine success rates for egg freezing, IUI, and IVF.

LGBTQ+ Assisted Reproductive Technologies and Family Planning Options

Individuals and couples in the LGBTQ+ community now have more fertility preservation and family planning options than ever before. Medical interventions or procedures used to help a person or couple have a child are called “assisted reproductive technologies,” or ART. ART procedures include in vitro fertilization (IVF), intrauterine insemination (IUI), surrogacy, and fertility preservation, such as egg or sperm freezing, among others. Importantly, prior to hormonal treatment, national guidelines recommend informing individuals about fertility preservation options.

Up to a year after initiating testosterone therapy, trans men with ovaries may still have viable eggs. (8)

This statement is true. Recent research on trans-men has demonstrated a well-preserved ovarian reserve after one year of testosterone therapy.

Roughly 25-50% of transgender U.S. Americans report being parents. (9)

This statement is true. Importantly, a parent's sexual orientation or gender identity does not adversely affect the development of a child.

For people with ovaries, genital surgery does not, by itself, impair future reproductive options. (10)

This statement is true.

The average cost of one cycle of egg freezing is less than $5,000 USD. (11)

This statement is false. Many people are not aware that egg freezing and other fertility treatments are expensive. Egg freezing typically costs $10,000 to $15,000 USD per round preservation, and this does not include the costs of storage or eventual IVF.

Generally, U.S. insurance will not cover the cost of assisted reproductive treatment for a person under 35 years of age unless they have had 12 failed intrauterine insemination attempts. (12)

This statement is true.

More than 20% of female same-sex households in the U.S. report having children. (13)

This statement is true. As mentioned, a parent's sexual orientation or gender identity does not adversely affect the development of a child.

The cost of one vial of sperm for donor insemination is less than $400. (14)

This statement is false. One vial of sperm for donor insemination ranges from $400 to $1,000 USD.

References and Additional Resources

(1) Mai, C. T., Isenburg, J., Langlois, P. H., Alverson, C. J., Gilboa, S. M., Rickard, R., ... & Stallings, E. B. (2015). Population‐based birth defects data in the United States, 2008 to 2012: Presentation of state‐specific data and descriptive brief on variability of prevalence. Birth Defects Research Part A: Clinical and Molecular Teratology, 103(11), 972-993.

(2) Liu, K., Case, A., Cheung, A. P., Sierra, S., AlAsiri, S., Carranza-Mamane, B., ... & Lee, F. (2011). Advanced reproductive age and fertility. Journal of Obstetrics and Gynaecology Canada, 33(11), 1165-1175.

(3) Leridon, H. (2004). Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Human Reproduction, 19(7), 1548-1553.

(4) Bayrampour, H., & Heaman, M. (2010). Advanced maternal age and the risk of cesarean birth: a systematic review. Birth, 37(3), 219-226.

(5) Bunting, L., & Boivin, J. (2008). Knowledge about infertility risk factors, fertility myths and illusory benefits of healthy habits in young people. Human Reproduction, 23(8), 1858-1864.

(6) Harris, I. D., Fronczak, C., Roth, L., & Meacham, R. B. (2011). Fertility and the aging male. Reviews in Urology, 13(4), e184.

(7) Dewailly, D., Andersen, C. Y., Balen, A., Broekmans, F., Dilaver, N., Fanchin, R., ... & Mason, H. (2014). The physiology and clinical utility of anti-Müllerian hormone in women. Human reproduction update, 20(3), 370-385.

(8) Yaish, I., Malinger, G., Azem, F., Sofer, Y., Golani, N., Tordjman, K., ... & Greenman, Y. (2019, May). Evidence for preserved ovarian reserve in transgender men receiving testosterone therapy: Anti-mullerian hormone serum levels decrease modestly after one year of treatment. In 21st European Congress of Endocrinology (Vol. 63). BioScientifica.

(9) Stotzer, R. L., Herman, J. L., & Hasenbush, A. (2014). Transgender parenting: A review of existing research.

(10) Hoffkling, A., Obedin-Maliver, J., & Sevelius, J. (2017). From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC pregnancy and childbirth, 17(2), 332.

(11) Fertility IQ. Cost of Egg Freezing. Link

(12) Aetna Insurance. Infertility. Link

(13) U.S. Census Bureau (2017). American Community Survey 1-year data file.

(14) American Pregnancy Association. Donor Insemination. Link