Trans and non-binary fertility options in the UK

Trans and non-binary people may have several options for preserving their fertility or building a family, both before and after gender-affirming treatment. What’s possible will depend on factors such as the eggs or sperm available, whether you hope to carry a pregnancy, any treatment you’ve already had or are planning, and whether a partner or donor may be involved.

At London Women’s Clinic, a fertility specialist can talk through these factors with you and help you understand which routes may be available now or in the future. This could include fertility preservation or treatments such as IUI and IVF, using your own or donor eggs or sperm.

Book a fertility consultation to begin your journey and discuss your options with a fertility specialist.

What fertility options are available for trans and non-binary people?

The short answer is that there isn’t one route for trans and non-binary fertility treatment. Depending on your circumstances, options may include fertility preservation such as freezing eggs, sperm or embryos for future use. Or treatments such as IUI, IVF or ICSI, using donor eggs or sperm, carrying a pregnancy yourself where possible, or exploring surrogacy.

You don’t need to know which route you want before speaking to a fertility specialist. A consultation can help you understand what may be possible based on your fertility, medical history, any previous or planned gender-affirming treatment and your future family-building plans.

Who this guide is for

This guide is for trans men, trans women and non-binary people who are considering fertility preservation or treatment, whether before or after gender-affirming care. It may also be helpful for partners and intended parents exploring how eggs, sperm, embryos, donor options or pregnancy may form part of their future family-building plans.

You don’t need to have decided what parenthood might look like for you. The sections below explain the main routes available and the factors that may shape your choices.

Fertility preservation before hormone therapy or surgery

Some gender-affirming hormone therapies and surgeries can affect fertility, although the impact varies depending on the treatment and the individual. If having a biological child in the future is something you may want, it can be helpful to discuss fertility preservation before starting treatment where possible. This gives you time to understand what can be preserved and how it might be used later.

There is no expectation that you should preserve your fertility, and you don't need to have firm plans for parenthood to have the conversation. A fertility specialist can work alongside your gender care team to explain the possibilities based on the eggs or sperm you produce.

Egg freezing and embryo freezing

For people who produce eggs, egg freezing provides a means of preserving fertility for possible future treatment. The process starts with a fertility health assessment and consultation with a specialist to review your results and discuss your goals. If you decide to proceed, you’ll then be invited for any necessary pre-treatment screening tests and given clear information about what to expect. Treatment involved taking medication to stimulate the ovaries, followed by a short procedure to collect mature eggs which are then carefully frozen and stored.

Embryo freezing follows a similar initial process, but the collected eggs are fertilised with sperm from a partner or donor before suitable embryos are frozen. This may be considered by people who already know whose sperm they would like to use, although the implications for future use and consent should be discussed before treatment.

If you decide to use frozen eggs later, they will need to be thawed and fertilised as part of IVF treatment. Frozen embryos can be thawed for embryo transfer, depending on your circumstances and the consent in place at the time. Learn more about how trans and non-binary egg freezing works with London Women’s Clinic.

Sperm freezing

Sperm freezing gives people producing sperm the option to store samples for use in future fertility treatment. Before providing a sample, you'll have routine screening tests for infectious diseases and complete consent forms covering how your samples can be used and stored.

After a short abstinence period, you’ll provide a semen sample in a private, comfortable setting at the clinic. Our embryologists will assess your sample to determine sperm count and motility to understand whether it’s suitable for freezing, or if additional samples are recommended. Samples are then frozen and securely stored in liquid nitrogen tanks.

If providing a sample isn't possible, your fertility specialist can discuss whether alternative collection methods, such as surgical sperm retrieval, may be an option.

Stored samples may later be used in IUI, IVF or ICSI, depending on factors such as the number and quality of sperm available and the circumstances of the person having treatment.

If you have already started hormone therapy

It may still be possible to preserve your fertility or have fertility treatment if you have already started gender-affirming hormone therapy. The effect of hormones on fertility varies between individuals and can depend on factors such as the medication you are taking, how long you have been taking it and your reproductive health.

You should not stop or pause hormone therapy without medical advice. A fertility specialist can work alongside your gender clinician to review your medication, assess your fertility and discuss what may be possible. If changes to your hormone treatment need to be considered as part of fertility preservation or treatment, this should be planned with the clinicians involved in your care.

An initial consultation can help establish what tests may be useful and which options are available based on your circumstances, without assuming that previous hormone therapy rules out future fertility treatment.

Using stored eggs, sperm or embryos later

Freezing eggs, sperm or embryos gives you the option to use them in fertility treatment at a later date. How they are used will depend on what you have stored, who will provide the other egg or sperm needed to create an embryo, and who, if anyone, plans to carry the pregnancy.

Frozen eggs need to be thawed and fertilised using IVF, usually with ICSI, where a single sperm is injected directly into the egg. Stored sperm may be used for IUI, IVF or ICSI, depending on sperm quality and the circumstances of the person having treatment. If you have frozen embryos, these can be thawed and transferred to the uterus of the person planning to carry the pregnancy, subject to the consent in place.

You may plan to carry a pregnancy yourself, have a partner who hopes to carry, or consider surrogacy. You don't need to make all of these decisions when you first preserve your fertility, but understanding how your stored eggs, sperm or embryos could be used later can help you make informed choices about storage and consent now.

Donor sperm, donor eggs and donor embryos

Donor sperm, eggs or embryos may form part of your treatment if you don't have the eggs or sperm needed to create an embryo, aren't able to use your own, or decide that using a donor is the route you would prefer. Your fertility specialist can explain how donor conception could fit into your plans, including the treatment involved and any counselling or consent considerations.

London Women’s Clinic works closely with our partners at London Sperm Bank and London Egg Bank, where you can explore available donors and find detailed information about donor screening and selection. Your clinical treatment will always continue to be planned and managed by your London Women’s Clinic team throughout the process.

Donor embryos may also be an option in some circumstances. Whichever route you are considering, you'll have the opportunity to discuss what using donated eggs, sperm or embryos could mean for you and any future child before making a decision. Fertility counselling is available to help you explore these considerations and understand the implications of donor conception.

Surrogacy and carrying a pregnancy

Some trans and non-binary people with a uterus may be able to carry a pregnancy themselves, while others may have a partner who plans to carry. Whether this is possible will depend on individual factors such as reproductive health, medical history and any previous or current treatment, which can be reviewed with your fertility specialist.

For people who cannot or do not plan to carry a pregnancy, surrogacy may be another route to parenthood, either through a trusted family member or friend, or an independent surrogate found through an agency. Surrogacy can work in a number of ways including using embryos created using your own stored eggs or sperm, a partner's eggs or sperm, or donor eggs or sperm, depending on your circumstances.

Surrogacy involves additional legal, practical and emotional considerations, so it is important to seek specialist legal advice alongside clinical guidance before proceeding. London Women’s Clinic has a long history of working with leading surrogacy agencies, lawyers and researchers, and can provide expert-led guidance as you explore this route. Counselling is also available, providing a confidential space to explore what surrogacy or donor conception may mean for you, your partner or surrogate, and any future child.

Consent, storage and legal considerations

Before eggs, sperm or embryos are stored, you'll be asked to complete consent forms setting out how long they can be kept and how they may be used in the future. They can be safely stored for up to 55 years in the UK from the date they went into storage. However you’ll need to renew or update your consent every 10 years.

Consent can become more complex when embryos are created using eggs or sperm from a partner, or when donor eggs or sperm are involved. Where embryos are created using both partners’ eggs and sperm, both people must provide consent for continued storage and use, including renewing their consent every 10 years. Different consent requirements apply when donated eggs or sperm are used, which your clinic will explain before treatment.

You’ll also be asked to consider what should happen to any stored eggs, sperm or embryos if your circumstances change, including your wishes for their use after your death where relevant.

It's important to keep your contact details up to date with your clinic throughout the storage period so they can contact you when consent needs to be renewed. These decisions can have important personal and legal implications, and your clinical team can explain the consent process and arrange fertility counselling if you'd like additional space to consider your choices. Specialist legal advice may also be recommended for more complex circumstances.

What to expect at your first fertility consultation

Your first consultation is a chance to talk openly about what you hope to achieve, whether you're thinking about preserving your fertility for the future or are ready to explore treatment now. If you’re unsure, don’t worry. You don't need to have made any decisions about how you might build your family before the appointment.

Your fertility specialist will usually ask about your medical history, any gender-affirming treatment you've had or are planning, current medications and previous fertility tests or treatment. They'll also discuss the reproductive organs you have where clinically relevant, using the language you feel comfortable with.

If a partner, donor or surrogate may be part of your plans, you can discuss this too. This helps your specialist understand what further tests may be useful and which fertility preservation or treatment routes could be considered.

Fertility decisions can involve practical and emotional considerations as well as clinical ones. If you'd find it helpful, counselling is available to give you space to explore your choices and any concerns you may have.

Questions to ask your fertility specialist

It can be useful to prepare a few questions before your appointment, particularly if you're weighing up fertility preservation alongside current or planned gender-affirming care. You don't need to cover everything at once, but you may want to ask:

●      When would be the best time to preserve my fertility in relation to any gender-affirming treatment I'm having or considering?

●      How might my current or previous hormone therapy affect my fertility assessment and the options available?

●      What would egg freezing, ovarian stimulation or egg collection involve in my circumstances?

●      What happens if I'm unable to provide a sperm sample, and are alternative collection methods available?

●      How long can my eggs, sperm or embryos be stored, and what consent will I need to provide or renew?

●      If I want to use my stored eggs, sperm or embryos in the future, what treatment might be needed?

●      Could donor eggs or sperm form part of my plans, and at what point would I need to consider a donor?

●      If I hope to carry a pregnancy, or have a partner or surrogate who may carry, how could this affect treatment planning?

●      What counselling or emotional support is available if I want to talk through my choices?

Your questions may change as your plans develop. Your fertility specialist can help you understand the decisions that matter now and those that can be made later.

Why choose London Women’s Clinic?

At London Women’s Clinic, we combine decades of unmatched fertility expertise with personalised, inclusive care. Our experienced clinical and embryology teams can help you explore fertility preservation and future treatment based on your individual needs, with access to advanced laboratories and established treatments including egg, sperm and embryo freezing, IVF and ICSI.

We understand that fertility care can involve different considerations for trans and non-binary patients. Our aim is to create a space where you feel comfortable discussing your plans, including the language you prefer us to use, while giving you clear information to make informed decisions about your fertility.

From your first consultation through to preservation or treatment, you’ll have access to the same care team of specialist clinicians throughout, with clear communication and emotional support every step of the way.

FAQs

Can trans and non-binary people have fertility treatment in the UK?

Yes, trans and non-binary people can access fertility treatment in the UK. The options available will depend on factors such as your reproductive health, the eggs or sperm available, any previous treatment and whether a partner, donor or surrogate may be involved.

Should I preserve my fertility before starting hormone therapy?

If you think you may want a biological child in the future, it is worth discussing fertility preservation before hormone therapy where possible. Some gender-affirming treatments can affect fertility, and speaking to a specialist beforehand gives you an opportunity to explore options such as egg, sperm or embryo freezing without assuming that preservation is something you must pursue.

Can I freeze eggs if I am trans or non-binary?

Yes, egg freezing may be available to trans and non-binary people who produce eggs. Treatment involves medication to stimulate the ovaries, followed by a short egg collection procedure, after which mature eggs are frozen and stored for possible future use.

Can I freeze sperm before gender-affirming treatment?

Yes, sperm freezing can allow you to store samples before gender-affirming treatment that may affect fertility. You'll usually have screening tests and complete consent forms before your sample is assessed and frozen; if providing a sample isn't possible, a specialist can discuss whether alternative collection methods may be available.

Can I preserve fertility if I have already started hormones?

Having already started hormone therapy does not necessarily mean fertility preservation is no longer possible, but this needs to be assessed individually. A fertility specialist and your gender clinician can review your medication and reproductive health, and advise on what may be possible. You should not make changes to hormone therapy without medical advice.

Can stored eggs or sperm be used in IVF later?

Yes, depending on what has been stored and your future treatment plan. Frozen eggs can be thawed and fertilised through IVF, usually using ICSI, while stored sperm may be used in IUI, IVF or ICSI. Frozen embryos can also be thawed for embryo transfer.

Can a trans man or non-binary person carry a pregnancy?

Some trans men and non-binary people with a uterus may be able to carry a pregnancy. Whether this is possible will depend on factors including reproductive health, medical history and current or previous medication. A fertility specialist will need to assess your individual circumstances to advise on whether it is possible.

When might donor sperm or donor eggs be needed?

Donor sperm or eggs may be considered when you don't have the sperm or eggs needed to create an embryo, aren't able to use your own, or choose donor conception as part of your family-building plans. London Women’s Clinic can advise on the clinical treatment involved, while London Sperm Bank provides specialist information about choosing donor sperm and London Egg Bank can help with donor egg selection.

How long can eggs, sperm or embryos be stored in the UK?

Eggs, sperm and embryos can be stored for up to 55 years in the UK, provided the relevant consent requirements continue to be met. Legally you will need to renew your consent every 10 years, so it is important to keep your contact details up to date with your clinic.

What support is available during fertility treatment?

London Women’s Clinic provides fertility counselling to talk through fertility preservation, treatment, donor conception or other decisions in a confidential setting. Your clinical team can also help you find relevant support groups or external organisations where additional gender-informed or peer support would be helpful.

Next steps

If you’re considering fertility preservation or treatment, a consultation is the best place to start. Your fertility specialist can review your medical and treatment history, discuss your plans for the future and explain which options may be available based on your circumstances.

You can also explore fertility preservation, including sperm freezing and egg freezing for trans and non-binary people, or learn more about future treatment routes such as IVF and IUI. If you’d like space to talk through the emotional or practical considerations involved, fertility counselling is available at any point.

Book a fertility consultation with London Women’s Clinic to discuss your next steps with an experienced specialist, or learn more about the fertility options available to LGBTQIA+ community.

References / Further reading

Egg freezing - HFEA (2016)

Embryo freezing - HFEA (2016)

Sperm freezing - HFEA (2016)

Consent to treatment and storage - HFEA (2016)

BICA (British Infertility Counselling Association)

Gendered Intelligence