How UK transgender and non-binary people are building families through fertility treatment

In the same week that King Charles III dedicated the UK's first national memorial honouring LGBTQ+ members of the armed forces at the National Memorial Arboretum, our long-term, single-centre study reported how transgender and non-binary (TNB) people are using assisted reproductive technologies in the UK.

Published in Reproductive BioMedicine Online, the paper provides the first UK overview of fertility service use by this population. Together, these developments reflect growing visibility and inclusion for gender-diverse people, in both public life and within reproductive healthcare.

The retrospective study, conducted at a UK-licensed clinic over 14 years, involved 64 patients and documented the breadth of reproductive options used by TNB individuals and their partners. We found that they used various treatments, including intrauterine insemination (IUI), in vitro fertilisation (IVF), reciprocal IVF (R-IVF), oocyte cryopreservation (egg freezing), donation, and surrogacy, with 17 live births recorded across the cohort.

These findings highlight that when services are accessible and inclusive, TNB people and their partners can and do engage with the full spectrum of fertility treatment pathways, with satisfactory birth rates.

The study found that TNB individuals were undertaking fertility treatment in a range of relationships; those freezing their eggs most often did so without a partner, whereas those looking to conceive attended the clinic with mostly cisgender partners, and a minority with another TNB individual.

Importantly, the findings point to cryopreservation as pivotal in the fertility journeys of many TNB individuals, affording them the opportunity to achieve biological relatedness with their future children. Egg freezing was a popular option, including among those who had previously used testosterone.

At the same time, the results also emphasise the importance of access to donor gametes for TNB individuals, with most cycles of IUI, IVF, and R-IVF completed with donor sperm, suggesting many are happy to build their families outside of the bounds of genetic kinship.

Our findings show commonalities with those from studies from the USA and Spain, which have also indicated that TNB individuals use an array of fertility services to build their families, suggesting similarities in family-making practices of the trans community across borders. This new study also sits alongside an earlier UK case study, where we described family creation by a couple in which both partners were transgender, whose combined use of fertility treatment and surrogacy within the UK legal framework led to the birth of two healthy children.

In parallel, an anonymised clinic case, summarised here, illustrates community allyship. A trans woman who cryopreserved sperm before her medical transition returned to the clinic almost two decades later to create embryos with a known egg donor. Half the embryos were retained for her personal use in a future surrogacy arrangement, with the remainder donated back to the donor and her partner, who successfully had a live birth through R-IVF. The case thus reflects how LGBTQ+ individuals confidently use fertility treatments to create opportunities for mutual help and demonstrates growing allyship in family-making within the LGBTQ+ community.

Meanwhile, regulator data has documented a broader shift in who seeks fertility care: the Human Fertilisation and Embryology Authority has reported that single patients and female same-sex couples account for a growing share of fertility treatment, underscoring how family-building is diversifying.

While the demographics of patients seeking fertility treatment may be shifting, and LGBTQ+ visibility has increased, service design and culture have not kept pace everywhere. A nationwide audit of UK fertility providers published in Reproduction last year highlighted gaps in LGBTQ+ inclusion, particularly for transgender and gender-diverse patients, pointing to shortfalls in clinical knowledge and cultural competence and calling for targeted improvements. Specifically, practical steps in relation to standardised inclusive protocols, sensitive counselling, clear funding routes, and robust training are needed to ensure that gender-diverse patients experience reproductive care that is both equitable and evidence-based are required.

The memorial revealed this month recognises LGBTQ+ people within the military service, and our study provides the first UK overview of the TNB population's use of fertility treatment. Overall, the UK data show that when pathways are inclusive, TNB people engage with a range of fertility services to build their families.

We hope that future research, using a qualitative approach, will provide a more in-depth insight into the perspectives, decision-making, and emotional experiences of TNB individuals building their families at UK fertility clinics. This will also provide further insights into how fertility services can be made more accessible and inclusive.

Whilst legal reform to recognise non-binary individuals' identities and protect LGBTQ
individuals is needed (particularly to allow transgender men who give birth to be listed as something other than 'mother' on their child's birth certificate – see BioNews 1017), the recognition of LGBTQ+ individuals in these recent moments represents an encouraging change in relation to LGBTQ+ individuals and newer forms of family making becoming acceptable.