“Freeze for your Future”, “Eggs are a non-renewable resource”, “It’s time to take charge of your fertility”, say slogans aimed at millennials by fertility companies.
This is oocyte cryopreservation (egg freezing), described as the new “reproductive revolution”, and it is big business in many parts of the world.
In Aotearoa New Zealand, egg freezing is seen by medical professionals as a risk-management technology that provides the option to extend fertility later in life. First developed for women during cancer treatment and then those concerned about age-related fertility decline, egg freezing is increasingly used by trans men before commencing medical transition.
Egg freezing entails injecting synthetic hormones to stimulate the ovaries. The person then undergoes egg retrieval under conscious sedation to obtain mature eggs, which are frozen for future use. Storing the eggs involves cryopreservation at temperatures of minus 196°C.
Whether people are freezing their eggs in anticipation of future infertility or because they want to delay reproductive decision-making, egg freezing maintains the possibility of having genetically related children sometime in the future.
Unlike IVF (in-vitro fertilisation), treatment for people who are experiencing issues trying to conceive, egg freezing treats infertility before it happens.
As a preservation technology, egg freezing has expanded fertility treatment to new groups of potential patients. It is an option, for example, that service providers in Aotearoa New Zealand discuss as part of professional advice and counselling around gender-affirming healthcare.
This is in line with current guidelines, which recommend that before initiating hormone therapy or undergoing surgery as part of their transition, people make decisions about their fertility. While some people have strong views either way about having their own biological children, others are ambivalent or may not have considered it leading up to their transition.
Although access to fertility preservation is available to all people in Aotearoa New Zealand by law, costs differ significantly, depending on whether you are preserving sperm or eggs.
Basic fertility clinic costs for analysing and freezing sperm for six months are around $400, whereas egg freezing is approximately $10,000 for the first egg collection cycle, with an additional $5000 for future egg thawing and embryo transfer.
Access to publicly funded sperm and egg cryopreservation is available if you qualify for medical infertility. Medical infertility can occur if procedures or treatments, such as gender-affirming hormone treatment or surgery, irreversibly harm a person’s reproductive capabilities.
Medical infertility does not include people who are biologically able to conceive or carry a pregnancy to term, but do not engage in heterosexual sex. The fertility literature describes this as “social infertility”, which is regarded as a voluntary fertility outcome.
This division between medical and social infertility has implications for trans men, trans women, and gender non-binary people (neither male nor female) who want to freeze sperm or eggs. For instance, public funding for sperm cryopreservation is available for trans women and non-binary people assigned male at birth, because taking oestrogen is said to result in permanent infertility.
However, government-funded fertility preservation is not available for trans men or non-binary people assigned female at birth who seek to freeze their eggs, unless their ovaries are removed. The reason for this, says John Peek, Scientific Director from Fertility Associates, is that the effects of taking masculinising hormones such as androgens are reversible, so fertility can return if trans men suspend hormone therapy.
This means trans men and non-binary people assigned female at birth could interrupt or delay their hormone therapy to initiate fertility preservation. Should they choose to do so, as fertility specialists say, trans men could conceive “naturally” and “get pregnant by themselves”.
Trans men are, therefore, not eligible for public funding for egg freezing because hormone therapy is seen as reversible. This begs the question as to the effects of such disruption on a person’s projected gender identity and how they relate to and feel about their bodies.
Although gender fluidity or crossing gender boundaries may not be an issue for some trans and non-binary people, who are okay suspending hormone therapy to freeze eggs or carry a child, we cannot assume this will be the same for everyone. The temporal consequences for some people of going “backwards” to a former self in order to envisage a liveable future may precipitate anxiety, not to mention gender dysphoria – discomfort or distress due to incongruence between one’s gender identity and body.
Requiring people to get their ovaries removed before they are eligible for public funding for egg freezing may not be ideal either. As a young trans man in the Counting Ourselves Report remarked, this is a medicalised idea “of what makes a trans person trans, based on how far they transition”.
Not publicly funding egg freezing for trans men and non-binary people assigned female at birth may save the public health dollar, as fertility specialists and health policy analysts consistently comment, but is it equitable? And does it adequately consider the reproductive health and wellbeing of the whole person?
The Law Commission is currently reviewing compensation for surrogate mothers in Aotearoa New Zealand. Perhaps we could consider a “share” scheme for trans men who are interested: free egg freezing and storage costs for six months in return for donating half your eggs to another person.
