Transgenders, partners now exploring fertility options
Before he completes his transition into a male, Emmanuel Robles is planning to have his eggs implanted in his wife’s uterus so that he can have a biological child.
The process isn’t cheap for the couple — about $20,000 — not including the cost of the donor sperm. But they are determined to do it.
Robles, 26, is among the growing number of transgender individuals who are looking into fertility assistance or preservation in order to have biological children.
But it’s not an easy endeavor. Despite transgender celebrities, the legalization of same-sex marriage and anti-discrimination provisions under the Affordable Care Act, the stigma remains.
Meanwhile, not all physicians
are willing to take on the treatment of transgender patients. Some may feel they don’t have enough training to handle the individuals’ hormone prescriptions, and others may refuse care because of personal beliefs.
But a few providers in Central Florida are trying to be a solution to the problem. For instance, Dr. Mark Trolice, director of Fertility CARE — The IVF Center in Winter Park, is working with Two Spirit Health Services, a nonprofit LGBT-friendly clinic in Orlando, which provides primary care and mental health services.
“Through our clinics partnering, we can refer clients to Dr. Trolice and he can refer patients to us for primary and mental health care. It’s a nice relationship we’ve developed,” said Dr. David Baker-Hargrove, president and CEO.
This collaboration could make it easier for people like Robles, who have had to chart their own course and find support and guidance mostly through social media.
“All responsible men and women deserve to be parents, and there’s no reason that a fertility clinic should withhold care,” Trolice said.
Robles was born a girl and like many transgender individuals, he knew from an early age that he was trapped in the wrong body.
At first he thought he was a lesbian. After high school, he cut his hair, changed his wardrobe and started wearing cologne.
But then on Facebook he came across transgender celebrities. “And I said, you can do that?” said Robles. “I told my partner [at the time] what do you think if I do this, because I won’t feel complete; just changing clothes wasn’t enough.”
Robles began his transition six years ago with testosterone shots.
He met his wife four years ago and eventually got married. Last year, he had his chest surgery. The two were also thinking about having children.
“That’s when we went and talked with Dr. Trolice, so we can see if there’s an option to use my eggs and implant it in her uterus,” Robles said.
There are still no practice guidelines for doctors who provide fertility preservation and reproductive care to transgender individuals.
But in a recent published opinion, the American Society for Reproductive Medicine said that providers should offer fertility preservation options to individuals before gender transition and treat all requests for assisted reproduction regardless of gender identity status. Programs that don’t have enough resources should refer the patients, the society said.
“Fertility is always on my radar. I discuss it with each patient at the first visit,” said Dr. Laura Ellis, medical director of Two Spirit and one of the few doctors in the area who specializes in caring for transgender individuals. “I let them know about the permanent effects that treatments can have on their fertility.”
Aside from assisted fertilization — what Robles is doing — the main fertility preservation options currently are sperm and egg freezing. The process is costly, but it’s an option for patients whose reproductive organs could be damaged by treatments like chemotherapy, or would be removed, as some transgender men and women do.
This was not an option a few decades ago, for people like Ellis, a transgender woman. “Nobody knew what transgender was,” said Ellis, 65. “I didn’t have a way to express myself.”
So Ellis suppressed her feelings, had a family and two kids and began her transition to female only after the kids went off to college.
“Most people who wanted biological kids had to put off transition,” she said.
But that’s slowly changing.
To prepare for his egg extraction, Robles is on the lowest dose of testosterone. The couple is also waiting to get a line of credit.
“I want to have the first child with me,” said Robles. “And then I’ll go ahead and complete my transition and get a hysterectomy.”