There are an estimated 1.6 million transgender adults in the United States, of whom about 38% are parents. But until fairly recently, many trans people with biological children became parents prior to transitioning. Trans women who have undergone estrogen-based hormone replacement therapy, which doctors say can permanently reduce fertility, were largely out of luck.
Changing societal norms and better access to reproductive technology, however, have led to a growing number of trans people seeking fertility preservation treatment before, or early into, their transitions. Thanks, in part, to this, “addressing future fertility is an important part of the conversation now,” says Dr. Nina Resetkova, a reproductive endocrinologist at Boston IVF who regularly works with LGBTQ patients. “It seems increasingly common for [transgender health providers] to refer patients to fertility clinics.”
For most trans women, fertility preservation begins with a trip to a fertility clinic or a cryobank, which stores sperm and eggs for extended periods of time. Clients are asked to ejaculate into a sterile cup; the sperm is then analyzed for motility, tested for sexually transmitted diseases, and, if all goes well, is then frozen. “There’s no perfect guidance [for how much sperm should be banked], but if the sperm counts are good, there are typically two banking sessions,” says Resetkova.
The entire process, from an initial consultation to freezing, can be completed in a few weeks. (It isn’t available to trans women who have undergone gender-reaffirming surgery, since that leads to permanent fertility loss.)
But sperm banking and storage is financially inaccessible to many trans women: freezing a specimen and storing it for a year can cost as much as $2,250. And many will store it for much longer: Resetkova says that she has started to see more transgender girls freeze their sperm; teenage clients could have to pay storage fees for decades, if they chose to wait a while before having children.
Entities like the California Cryobank offer discounts for transgender patients, but even with reduced fees, transgender clients may still be required to shell out as much as $500 up front, says Trystan Reese, director of family formation at the Family Equality. And without that discount, costs regularly start at $1000. “That is nothing in the world of fertility, but for many in the trans community, $1,000 is a lot.”
To complicate things further, there is limited insurance coverage for trans women looking to bank sperm. While more than a dozen U.S. insurance providers have at least one policy with language that details coverage of trans fertility preservation, such provisions are not available for most trans clients. “Anecdotally, less than 40% of transgender people who lobby their insurance companies ever get reimbursement for some of the process,” says Reese.
Still, many have found ways to afford fertility preservation. Clinics like Boston IVF often have fertility financing partners like CapexMD and Future Family that promise a quick approval process. But make sure to shop around and compare their interest rates to those of personal bank loans. The current average personal loan rate for a borrower with a good credit score is about 15.32%.
Trans women with a longer time horizon and access to a health savings account or a flexible spending account may also choose to put away between $2,750 to $3,550 tax free for freezing and storage costs. Using such funds for fertility preservation comes with certain restrictions and requirements—a doctor’s letter, for instance, may be required—so be sure to speak to your HSA or FSA administrator.
Corporate America is also becoming increasingly trans-friendly, so it may be worth asking your employer for financial support, even if it doesn’t currently support fertility preservation. The HRC Foundation, for instance, found that 949 major U.S. companies offered at least one trans-inclusive healthcare plan in 2020, up from 278 in 2013. Consider asking your HR department to look into companies like Carrot, a trans-friendly fertility solutions provider. The startup, which has signed up employers like Slack, Box and Stitch Fix, says it can help clients avoid up to 70% of high-cost pregnancies.
“Ten years ago, IVF was seen as medically dangerous and light years away for heterosexual couples,” says Reese. “But the desire to build a family is nearly universal, and now there’s a great deal more excitement about trans people being able to parent. We have the right as much as anyone else.”
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Katerina Ang is a freelance writer and former editor at Vogue Business and The Wall Street Journal.