LGBTQ+ Production of Family
Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender identities (such as non-binary and asexual) abbreviated LGBTQ+, individuals often face, distinct challenges compared to cis-heterosexuals couples when deciding to create families. This is due often times because many queer relationships, depending on the type of relationship, creates social infertility.[1] There are many options for an aspiring queer family often separated into 2 categories, LGBTQ+ reproduction and LGBTQ+ parenting. LGBTQ+ reproduction encompasses, the use of assistive reproductive technologies (ART) such as In vitro Fertilization to produce biologically related children, dissimilar to LGBTQ+ parenting which includes such things as adoption and co-parenting. The analogy of a "grafted family tree" has been used to describe such forms of family making instead of the "family tree" to recognize the outside influences that impact family formation.[2]
Artificial insemination
Picking sperm
Prospective parents must carefully consider where they get their donor sperm from. Indvidual state's laws vary, but many U.S states have adopted a form of the Uniform Parentage Act (UPA).[3] Most, but not all states transfer parental rights from anonymous sperm donors to the intended parents as long as the recipient is a married woman, and a physician is involved.[3] Noncompliance with these laws can result in the failure to terminate sperm donor parental rights. There have been court cases where known sperm donors that privately donated directly were requested to pay child support.[3][4][5][6] For example, of these laws, see California assisted reproductive laws. In Australia, there has been legal precedent that sperm donor involvement with the ensuing child's life does grant them parental rights (Masson v Parsons).[7]
Alternative to direct private donation it is possible to purchase sperm from a sperm bank for personal use in fertility treatment. Sperm banks can vary widely, not only in terms of price, but of practice (i.e who is allowed to donate sperm, how many times, etc) and can offer a variety of services. Major U.S sperm banks include Fairfax Cryobank, California Cyrobank, Cryos International, Seattle Sperm bank, and Xytex, and many others.
Procedures
Timing of these procedures are critical for successful fertilization,[8] as the fertile window is the five days before ovulation, plus the day of and after ovulation.[9] To increase the chance of success, the menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of the cervix.[9] To improve the success rate of artificial insemination, drugs to create a stimulated cycle may be used called ovarian stimulation (OS).
Intrauterine insemination (IUI)
Before ovulation there is a surge of luteinizing hormone (LH) which can be used to time an IUI procedure. Data suggest that IUI should be performed 1 day after the detection of the LH surge.[8] Most clinics in the U.S perform IUI in the morning after a positive ovulation predictor kit test (which detects LH in urine).[8] An alternative to LH monitoring is ultrasound monitoring of ovarian follicle size followed by a trigger shot with exogenous human chorionic gonadotropin (hCG) which mimics the body’s LH surge and triggers final follicular maturation and rupture (36–48 hours later). The trigger shot is typically administered when the dominant follicle reaches 18–20 mm.[8] The recommended timing of IUI after hCG administration is 24–40 hours.[8] IUI cycles stimulated with classical doses of FSH have a high rate of have a multiple pregnancy with rates ranging from 10 to 40%.[10] A meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI.[8]
IUI can be done without the use of medication. IUI is not recommended in cases where the gestating individuals have cervical atresia, cervicitis, endometritis or bilateral tubal obstruction or when the sperm donor has amenorrhea or severe oligospermia.[10] Prior to IUI, the sperm is "washed" which is necessary to remove seminal plasma to avoid prostaglandin-induced uterine contractions.[10] Insemination with unprocessed semen is also associated with pelvic infection.[10]
Intrauterine insemination (IUI) involves the opening of the vagina using a speculum, then injecting washed sperm directly into the uterus with a catheter.[11] Insemination in this way means that the sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus.[12] Donor sperm is sometimes tested for mucus penetration capabilities if it is to be used for ICI inseminations, for if the sperm's chances of passing through the cervix is low, IUI would provide a more efficient delivery of the sperm than ICI [citation needed]. IUI fertilization takes place naturally in the external part of the fallopian tubes in the same way that occurs following intercourse.
The benefit of double IUI has not been found in patients with undocumented infertility using donor sperm, such as lesbian and single women.[13] Typically pregnancy success rates per IUI cycle is approximately 12.4%.[14] According to a study from 2021, lesbian women undergoing IUI had a clinical pregnancy rate of 13.2% per cycle and 42.2% success rate given the average number of cycles at 3.6.[14] IUI has been reported to be more effective than ICI[15][16] but this has been contested with some citing no strong evidence to confirm a significant difference between the birth rates of the two procedures.[17] It is speculated that IUI is more effective since IUI brings the sperm closer to the oocyte than ICI which might compensate for decreased sperm motility after freezing and thawing.[16] IUI includes risk of endometritis, cramping, bleeding, and anaphylaxis (rarely).[15] A systematic review and meta-analysis was not able to demonstrate that bed rest after intrauterine insemination effectively increases in pregnancy rate.[18]
Intracervical insemination (ICI)
Very similar to IUI, Intracervical insemination (ICI) is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into the vagina during sexual intercourse. ICI is the simplest method of artificial insemination and may also be performed privately in the home instead of at a private practice. ICI is the process of introducing semen into the vagina at the entrance to the cervix,[19] usually by means of a needleless syringe. Sperm used in ICI inseminations does not have to be 'washed' to remove seminal fluid so raw semen from a private donor may be used. Semen supplied by a sperm bank prepared for ICI or IUI use is also suitable for ICI. A retrospective cohort study showed that total motility and total motile count (TMC) after thawing were associated with ongoing pregnancy rate; with best ICI results at total motility of ≥20% and a total motile count (TMC) of ≥8 × 106 after thawing.[20]
During ICI, air is expelled from a needleless syringe which is then filled with semen. A specially-designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The recipient lies on their back and the syringe is inserted into the vagina so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of the syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is the replicate as closely as possible a natural deposit of the semen in the vagina[citation needed]. The syringe (and catheter if used) may be left in place for several minutes before removal. Following insemination, fertile sperm will swim through the cervix into the uterus and from there to the fallopian tubes in a natural way as if the sperm had been deposited in the vagina through intercourse. A conception cap instead of a syringe can be used as well.
In vitro fertilization
Standard IVF
Standard IVF is the process by which the egg is removed from the ovaries and fertilized outside of the body, and then the pre-embryo is implanted into a uterus[21]. There are many steps to ensure that this process works including ovary stimulation, egg collection, fertilization, and embryo transfer. To stimulate the ovaries to produce more eggs than usual, the person must take specific hormones prescribed by a doctor[21]. Then, the eggs are collected using an ultrasound-guided aspiration needle. Once the eggs are outside the body, they are mixed with sperm in a culture dish in the hopes of fertilization. The sperm used can come from any sperm donor (either from a sperm bank, or a known donor like a partner). If a pre-embryo forms, it remains in the incubator for two to five days while it continues to grow and divide. At this stage, the pre-embryo is often genetically tested to ensure that it will develop into a healthy baby. If the embryo is deemed healthy, the next step is implantation[21]. The embryos are transferred to the uterus which involves an ultrasound being used to guide a catheter through the cervix and into the uterine cavity.[21]
Reciprocal IVF
Also called partner IVF or co-IVF. This process can be done with 2 people who both possess female reproductive organs. The biological parent donates the eggs and the other partner, becomes the gestational parent who carries the pregnancy to term. In reciprocal IVF, one person takes hormones in order to undergo ovarian stimulation and egg retrieval.[22] The eggs are then fertilized with donor sperm to create embryos, one of which can then be transferred to the second person’s uterus. In this way, one partner contributes the genetic material and the second partner contributes the maternal environment, allowing both partners to have a profound impact on the development of the fetus and child[22]. The laws around parenthood when both partners do not contribute genetic material are complicated and vary by state, so it is imperative to do research before beginning the process.[22]Preserving fertility and gender-affirming medical care
Surrogacy
Surrogacy is a process in which a woman carries and delivers a child for a couple or an individual. This can be an arrangement supported by a legal agreement where the surrogate may or may not be compensated. Surrogacy is the most common form of accessing parenthood because it is less complicated due to the biological connection made between parent and child. LGBTQ+ individuals may seek surrogacy when they are in need for someone else to serve as the gestational carrier of their biological child. Recently, traveling for couples outside of the US to seek surrogacy is rising. Usually these commercial services cater only white, wealthy parents-to-be. In some countries it is illegal to pay surrogates, but the debate is that unpaid surrogacy can take place.
Choosing who will be the biological parent can vary from couple to couple because couples get to decide where gametes can come from. Gametes can be purchased through commercial resources, arranged through an agreement from a genetic connection to both parents, or through a friend donation.
There is a long history of transnational surrogacy used by gay parents who seek surrogacy in India. They use gametes fertilized by one or both parents to inseminate local women who are employed through an agency. There is global criticism due to transparency around pay and the outcomes for the parties involved. Because of this surrogacy services in India are being recalled by gay parents because there is restricted access to pregnancy updates. Unable to communicate can create emotional distancing for gay parents and the pregnancy can be stressful for gay parents. Going through surrogate services can be a stressful journey because gay parents are caught up in between charts and graphs, instead of being able to have an emotional connection with the baby through the surrogate and the experiences they go through.
Transnational surrogacy can raise legal issues when the child is born. There is conflict about national legal rules on parentage and this complicates citizenship, which can often result in the child not having legal parents or citizenship in any country.
The World Profession Association for Transgender Health (WPATH) recommends that all transgender patients make decisions regarding their fertility before starting hormone therapy in their Standards of Care (2012) guidebook for medical professionals.[23]
Transgender men
Pregnancy is possible for transgender men who retain a functioning vagina, ovaries, and a uterus.[24][25] Exposure to hormonal testosterone treatment does not necessarily preclude the possibility live birth.[26] Testosterone therapy by itself is not a sufficient method of contraception, and trans men may experience unintended pregnancy[27][28] especially if they miss doses.[27] Many trans men who have become pregnant were able to do so within six months of stopping testosterone.[27] Another study conducted in 2019 found that transgender male patients seeking oocyte retrieval for either oocyte cryopreservation, embryo cryopreservation, or IVF were able to undergo treatment 4 months after stopping testosterone treatment, on average.[29] There have been no studies of transgender men attempting pregnancy after testosterone or on the health of offspring conceived from testosterone-exposed oocytes, so exact fertility rates are unknown.[30][24]
Masculinizing hormonal therapy in trans men will lead to irreversible amenorrhea, however androgen therapy does not deplete primordial follicles nor affects the developmental capacity of the follicles, but histologically hyperplasia of ovarian cortex and stroma has been found.[31] It has been debated if this is physiologically comparable to polycystic ovary syndrome.[31] Ovariectomies lead to irreversible fertility termination (if the eggs are not stored), but doesn't preclude gestational pregnancy with ART.[31][24] Hysterectomies will eliminate the option to gestate.[24]
For preservation of reproductive possibilities:
- Oocyte banking: Cryopreservation of oocytes requires hormonal stimulation and oocyte retrieval, as for IVF treatment, after which the oocytes are vitrified.[31] Vitrification of oocytes has been found to be more successful than slow freezing oocytes.[32] The success of oocyte banking declines significantly with increasing reproductive age[23] Ovarian stimulation will increase transgender men's serum estradiol levels, and in response transvaginal ultrasound monitoring may be necessary, strategies to minimize estradiol elevations include the concomitant use of aromatase inhibitors during stimulation.[30] There is no data on the success of ovarian stimulation in transgender men who previously had puberty halted with GnRH agonist, followed directly by testosterone administration.[30] There is also no data comparing the number of oocytes retrieved or the live-birth rate after fertility preservation stratified by time off testosterone.[26]
- Results with oocytes vitrification (viability, fertilization and pregnancy) have been improving.
- Embryo banking: Freezing of embryos is a possibility; but requires the use of available sperm for embryo creation. Preservation of embryos is common high efficiency procedure performed at fertility centers.[31]
- Banking of ovarian tissue: A surgical procedure is required to collect tissue samples, if undergoing a hysterectomy and/or ovariectomy, one can choose to cryopreserve some tissue at the same time to avoid an additional surgical procedure.[31] Ovarian tissue cryopreservation has been successful, but so far, there have been no pregnancies recorded after thawing and in-vitro maturation (IVM) of this tissue, successful pregnancies have only been recorded after auto-transplantation.[33][31] This method has a very low success rate of blastocyst development as in one study of 83 transgender males, 2 out of the 208 mature oocytes were recovered from thawed ovarian tissue created "good-quality" blastocysts.[26]
Transgender women
Some transgender women have reported a lower sexual desire on hormonal treatment.[34] It has been found that transgender patients undergoing feminizing hormonal therapy do have abnormal semen parameters.[35][36] Sustained hormonal treatment eventually leads to hypo-spermatogenesis and ultimately azoospermia which will become irreversible at an unknown point in time.[31][37][38] A 2015 study did demonstrate normal spermatogenesis in long term estrogen therapy patients.[23] Surgical removal of testicles also leads to irreversible sterility.[31][38] It is recommended for those pursing these options and interested in preserving fertility to cryogenically store their sperm before starting their treatment.[31]
Semen can be collected via masturbation, but there are alternatives for those who find masturbation or ejaculation distressing or may have erectile or ejaculatory dysfunction secondary to hypoandrogenism. Options for those with dysfunction include: penile vibratory stimulation and electroejaculation.[30] For those who do not want to ejaculate or have oligospermia or azoospermia can pursue testicular sperm aspiration or microsurgical sperm extraction although they are more invasive.[30] There are currently no studies evaluating the acceptability or success rates of the different options for sperm collection specifically in transgender women.[30] Furthermore, for transgender women on estradiol and/or antiandrogens, it is unclear the length of time needed to be off hormonal treatment medication before normal spermatogenesis resumes (if it occurs at all), during which time testosterone production will resume and may cause unwanted masculinizing effects.[30]
Body-feeding
The term body-feeding refers to the feeding of one's baby milk to an infant directly from one's body.[39] Body-feeding is essential for the development of infants.[40] Though there is a large transgender and gender diverse population, the quantitative and qualitative research regarding body-feeding is relatively small.[41] Though widely known as breastfeeding, new gender-affirming terms have developed: body-feeding and chest-feeding. These terms took note after transgender males (female to male) found discomfort in the terms "breastfeeding" and "lactation".
Studies done on the breastfeeding or chestfeeding practices of transgender or gender diverse parents are extremely limited. A study done focused on the socio-demographic characteristics among parents with different breastfeeding or chestfeeding practices shows that mixed/artificial feeding (the use of formula and breast (or chest) milk) is widely used for families with higher annual incomes (100-200k) with 73.0% utilizing mixed/artificial feeding.[42] Results from this study show that most transgender or gender diverse populations prefer mixed/artificial feedings instead of exclusive chestfeeding.[43]
Barriers to fertility care
Fertility treatment and preservation is expensive. The average IVF cycle can cost $12,000 to $17,000 (not including medication), with medication it can up to $25,000-$30,000 [44][45] and price often comes down to one's insurance which might come with come with stipulations. The cost of IUI ranges from $500-4,000 per cycle.[46] Cryopreservation of genetic material is also costly see table below and can vary greatly from place to place, state to state.[47]
| Fertility preservation Option | Service Cost Range ($) | Annual Storage Cost Range ($) |
|---|---|---|
| Egg Freezing | 7,000-15,000 | 300-1000[47][48] |
| Embryo freezing | 11,000-15,000 | 350-600[45] |
| Ovarian Tissue Freezing | 10,000-12,000 | 300-500 |
| Sperm Banking | 250-1,000[49] | 100-500[50] |
| Testicular Sperm Extraction | 7,500-10,000 | 300-500 |
| Electroejaculation | 10,000-12,000 | 300-500 |
Another barrier is knowledge. These procedures are not well known and discussion of fertility preservation are uncommon. In a study of 133 transgender women 61% stated that no health care provider discussed sperm banking prior to their hormone therapy or surgery.[51] In another study, 70 transgender males cited barriers such as the perceived cost of treatment (36%), need for discontinuation or delay of hormonal therapy (19%), and worsening gender dysphoria with treatment and pregnancy (11%).[26]
Future technology
There is theoretical potential for same sex reproduction using stem cells to derive gametes to produce biologically related children,[52] but this has been contentious[53] and has been considered to be possibly "impossible".[52] However, scientists have successfully created eggs from male mice to produce offspring with 2 biologically male genetic donors and have been optimistic that human application could come within the next 10 years.[54][55]
Another possibility for transgender women would come from a successful uterus transplant that can carry a pregnancy to term in a transgender women.[56] There have been successful births with uterus transplantation in cis-women, but currently non in transwomen[56] as currently there have been no successful uterus transplants in transgender women.[57] Theoretical problems arise in the sexual dimorphism of the human pelvis, drug regime risk (post-transplant immunosuppression and hormone therapy to sustain implantation and pregnancy), and risk of neovaginal anastomosis.[56][57][58] The same studies that identified these risks also came to the conclusion that despite the considerations uterine transplant shouldn't be confined to cis-women,[56][57][58] with one journal article unable to find any increase in theoretical procedural risk compared to cis-women.[58] There is no expectation that transwomen would give birth through the neo-vaginal canal.[59]
For prepubertal transgender girls, testicular tissue cryopreservation (TTC) is currently the only fertility preservation option.[30] An experimental surgical procedure to remove and cryopreserve testicular tissue for a later date when the spermatogonial stem cells can be matured into sperm. To date no spermatogenic recovery has been reported and TTC technologies enabling this are currently only being studied in animal models[30]
References
- ↑ Sussman, Anna Louie (2019-06-18). "The Case for Redefining Infertility". The New Yorker. ISSN 0028-792X. Retrieved 2023-11-16.
- ↑ Patton-Imani, Sandra (2020-06-09). Queering Family Trees. New York University Press. doi:10.18574/nyu/9781479865567.001.0001. ISBN 978-1-4798-6659-5. Unknown parameter
|s2cid=ignored (help) Search this book on
- ↑ 3.0 3.1 3.2 Luetkemeyer, Lisa; West, Kimela (2015). "Paternity Law: Sperm Donors, Surrogate Mothers and Child Custody". Missouri Medicine. 112 (3): 162–165. ISSN 0026-6620. PMC 6170122. PMID 26168582.
- ↑ Narayan, Chandrika (2014-01-23). "Kansas court says sperm donor must pay child support". CNN. Retrieved 2023-11-16.
- ↑ "Court voids ruling that sperm donor must pay child support". AP News. 2021-06-16. Retrieved 2023-11-16.
- ↑ "Do Sperm Donors Pay Child Support?". Boyd Law. 2018-07-16. Retrieved 2023-11-16.
- ↑ Seery, Cassandra (2019-06-19). "Can a sperm donor be a legal parent? In landmark decision, the High Court says yes". The Conversation. Retrieved 2023-11-16.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Potapragada, Nivedita R.; Babayev, Elnur; Strom, Danielle; Beestrum, Molly; Schauer, Jacob M.; Jungheim, Emily S. (2023-06-07). "Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge". Obstetrics & Gynecology. 142 (1): 61–70. doi:10.1097/aog.0000000000005222. ISSN 0029-7844. Unknown parameter
|s2cid=ignored (help) - ↑ 9.0 9.1 "Calculating Your Monthly Fertility Window". www.hopkinsmedicine.org. 2022-03-10. Retrieved 2023-12-04.
- ↑ 10.0 10.1 10.2 10.3 The ESHRE Capri Workshop Group (2009-01-16). "Intrauterine insemination". Human Reproduction Update. 15 (3): 265–277. doi:10.1093/humupd/dmp003. ISSN 1355-4786. PMID 19240042.
- ↑ "Intrauterine insemination (IUI) - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-11-26.
- ↑ "IUI (Intrauterine Insemination): What It Is & What To Expect". Cleveland Clinic. Retrieved 2023-11-26.
- ↑ Monseur, Brent C.; Franasiak, Jason M.; Sun, Li; Scott, Richard T.; Kaser, Daniel J. (2019-10-01). "Double intrauterine insemination (IUI) of no benefit over single IUI among lesbian and single women seeking to conceive". Journal of Assisted Reproduction and Genetics. 36 (10): 2095–2101. doi:10.1007/s10815-019-01561-3. ISSN 1573-7330. PMC 6823402 Check
|pmc=value (help). PMID 31410635. - ↑ 14.0 14.1 Johal, Jasmyn K.; Gardner, Rebecca M.; Vaughn, Sara J.; Jaswa, Eleni G.; Hedlin, Haley; Aghajanova, Lusine (2021-04-28). "Pregnancy success rates for lesbian women undergoing intrauterine insemination". F&S Reports. 2 (3): 275–281. doi:10.1016/j.xfre.2021.04.007. ISSN 2666-3341. PMC 8441558 Check
|pmc=value (help). PMID 34553151 Check|pmid=value (help). - ↑ 15.0 15.1 Chen, Xiao-Jun; Wu, Li-Ping; Lan, Hai-Lian; Zhang, Li; Zhu, Yi-Min (2012). "Clinical Variables Affecting The Pregnancy Rate of Intracervical Insemination Using Cryopreserved Donor Spermatozoa: A Retrospective Study in China". International Journal of Fertility & Sterility. 6 (3): 179–184. ISSN 2008-076X. PMC 3850307. PMID 24520436.
- ↑ 16.0 16.1 Kop, P A L; van Wely, M; Nap, A; Soufan, A T; de Melker, A A; Mol, B W J; Bernardus, R E; De Brucker, M; Janssens, P M W; Pieters, J J P M; Repping, S; van der Veen, F; Mochtar, M H (2022-04-23). "Intracervical insemination versus intrauterine insemination with cryopreserved donor sperm in the natural cycle: a randomized controlled trial". Human Reproduction. 37 (6): 1175–1182. doi:10.1093/humrep/deac071. ISSN 0268-1161. PMC 9789751 Check
|pmc=value (help). PMID 35459949 Check|pmid=value (help). - ↑ Kop, Petronella AL; Mochtar, Monique H; O'Brien, Paul A; Van der Veen, Fulco; van Wely, Madelon (2018-01-25). "Intrauterine insemination versus intracervical insemination in donor sperm treatment". Cochrane Database of Systematic Reviews. 2018 (2): CD000317. doi:10.1002/14651858.cd000317.pub4. ISSN 1465-1858. PMC 6491301. PMID 29368795.
- ↑ Cordary, D.; Braconier, A.; Guillet-May, F.; Morel, O.; Agopiantz, M.; Callec, R. (2017-12-01). "Immobilization versus immediate mobilization after intrauterine insemination: A systematic review and meta-analysis". Journal of Gynecology Obstetrics and Human Reproduction. 46 (10): 747–751. doi:10.1016/j.jogoh.2017.09.005. ISSN 2468-7847. PMID 28964965.
- ↑ "Intracervical insemination (ICI) -". 2022-10-08. Retrieved 2023-11-28.
- ↑ Kop, Petronella; van Wely, Madelon; de Melker, Annemieke; van der Veen, Fulco; Mochtar, Monique (2022-02-04). "Donor sperm treatment: the role of semen parameters in intracervical insemination, a retrospective cohort study". Human Fertility. 26 (5): 964–970. doi:10.1080/14647273.2022.2032407. ISSN 1464-7273. PMID 35114884 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ 21.0 21.1 21.2 21.3 MarketingInsights. "Standard IVF". The IVF Center | Assisted Reproduction and Endocrinology. Retrieved 2023-12-04.
- ↑ 22.0 22.1 22.2 "Reciprocal IVF | UCSF Center for Reproductive Health". UCSF. Retrieved 2023-12-04.
- ↑ 23.0 23.1 23.2 Jones, C. A.; Reiter, L.; Greenblatt, E. (2016-04-02). "Fertility preservation in transgender patients". International Journal of Transgenderism. 17 (2): 76–82. doi:10.1080/15532739.2016.1153992. ISSN 1553-2739. Unknown parameter
|s2cid=ignored (help) - ↑ 24.0 24.1 24.2 24.3 Obedin-Maliver, Juno; Makadon, Harvey J (March 2016). "Transgender men and pregnancy". Obstetric Medicine. 9 (1): 4–8. doi:10.1177/1753495X15612658. ISSN 1753-495X. PMC 4790470. PMID 27030799.
- ↑ Leung, Angela; Sakkas, Denny; Pang, Samuel; Thornton, Kim; Resetkova, Nina (2019-11-01). "Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine". Fertility and Sterility. 112 (5): 858–865. doi:10.1016/j.fertnstert.2019.07.014. ISSN 0015-0282. PMID 31594633.
- ↑ 26.0 26.1 26.2 26.3 Douglas, Christopher R.; Phillips, Destiny; Sokalska, Anna; Aghajanova, Lusine (2022-05-02). "Fertility Preservation for Transgender Males". Obstetrics & Gynecology. 139 (6): 1012–1017. doi:10.1097/aog.0000000000004751. ISSN 0029-7844. PMID 35675598 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ 27.0 27.1 27.2 Berger, Anthony P.; Potter, Elizabeth M.; Shutters, Christina M.; Imborek, Katherine L. (2015-09-01). "Pregnant transmen and barriers to high quality healthcare". Proceedings in Obstetrics and Gynecology. 5 (2): 1–12. doi:10.17077/2154-4751.1285. ISSN 2154-4751.
- ↑ Light, Alexis; Wang, Lin-Fan; Zeymo, Alexander; Gomez-Lobo, Veronica (2018-10-01). "Family planning and contraception use in transgender men". Contraception. 98 (4): 266–269. doi:10.1016/j.contraception.2018.06.006. ISSN 0010-7824. PMID 29944875. Unknown parameter
|s2cid=ignored (help) - ↑ Leung, Angela; Sakkas, Denny; Pang, Samuel; Thornton, Kim; Resetkova, Nina (2019-11-01). "Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine". Fertility and Sterility. 112 (5): 858–865. doi:10.1016/j.fertnstert.2019.07.014. ISSN 0015-0282. PMID 31594633.
- ↑ 30.0 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 Moravek, Molly B. (June 2019). "Fertility preservation options for transgender and gender-nonconforming individuals". Current Opinion in Obstetrics and Gynecology. 31 (3): 170–176. doi:10.1097/GCO.0000000000000537. ISSN 1040-872X. PMID 30870185. Unknown parameter
|s2cid=ignored (help) - ↑ 31.00 31.01 31.02 31.03 31.04 31.05 31.06 31.07 31.08 31.09 T'Sjoen, Guy; Van Caenegem, Eva; Wierckx, Katrien (December 2013). "Transgenderism and reproduction". Current Opinion in Endocrinology, Diabetes & Obesity. 20 (6): 575–579. doi:10.1097/01.med.0000436184.42554.b7. ISSN 1752-296X. PMID 24468761. Unknown parameter
|s2cid=ignored (help) - ↑ Herrero, Leyre; Martínez, Mónica; Garcia-Velasco, Juan A. (August 2011). "Current status of human oocyte and embryo cryopreservation". Current Opinion in Obstetrics and Gynecology. 23 (4): 245–250. doi:10.1097/GCO.0b013e32834874e2. ISSN 1040-872X. PMID 21734500. Unknown parameter
|s2cid=ignored (help) - ↑ Donnez, J; Dolmans, MM; Demylle, D; Jadoul, P; Pirard, C; Squifflet, J; Martinez-Madrid, B; Van Langendonckt, A (October 2004). "Livebirth after orthotopic transplantation of cryopreserved ovarian tissue". The Lancet. 364 (9443): 1405–1410. doi:10.1016/s0140-6736(04)17222-x. ISSN 0140-6736. PMID 15488215. Unknown parameter
|s2cid=ignored (help) - ↑ Wierckx, Katrien; Van Caenegem, Eva; Schreiner, Thomas; Haraldsen, Ira; Fisher, Alessandra; Toye, Kaatje; Kaufman, Jean Marc; T'Sjoen, Guy (August 2014). "Cross-Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short-Time Follow-Up: Results from the European Network for the Investigation of Gender Incongruence". The Journal of Sexual Medicine. 11 (8): 1999–2011. doi:10.1111/jsm.12571. hdl:2158/1060207. ISSN 1743-6095. PMID 24828032.
- ↑ Li, Kai; Rodriguez, Dayron; Gabrielsen, J. Scott; Centola, Grace M.; Tanrikut, Cigdem (November 2018). "Sperm Cryopreservation of Transgender Individuals: Trends and Findings in the Past Decade". Andrology. 6 (6): 860–864. doi:10.1111/andr.12527. ISSN 2047-2919. PMC 6301129. PMID 30094956.
- ↑ Adeleye, Amanda J.; Reid, Garrett; Kao, Chia-Ning; Mok-Lin, Evelyn; Smith, James F. (2019-02-01). "Semen Parameters Among Transgender Women With a History of Hormonal Treatment". Urology. 124: 136–141. doi:10.1016/j.urology.2018.10.005. ISSN 0090-4295. PMID 30312673. Unknown parameter
|s2cid=ignored (help) - ↑ Rowlands, Sam; Amy, Jean-Jacques (2018-01-02). "Preserving the reproductive potential of transgender and intersex people". The European Journal of Contraception & Reproductive Health Care. 23 (1): 58–63. doi:10.1080/13625187.2017.1422240. ISSN 1362-5187. PMID 29323576. Unknown parameter
|s2cid=ignored (help) - ↑ 38.0 38.1 Amir, Hadar; Yaish, Iris; Oren, Asaf; Groutz, Asnat; Greenman, Yona; Azem, Foad (2020-09-01). "Fertility preservation rates among transgender women compared with transgender men receiving comprehensive fertility counselling". Reproductive BioMedicine Online. 41 (3): 546–554. doi:10.1016/j.rbmo.2020.05.003. ISSN 1472-6483. PMID 32651108 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ "It's time to add "chestfeeding" to your vocabulary". Today's Parent. 2021-06-09. Retrieved 2023-12-04.
- ↑ [sciencedirect.com/science/article/pii/S258953702300024X "Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study"] Check
|url=value (help). - ↑ Yang, Haibing; Na, Xiaona; Zhang, Yanwen; Xi, Menglu; Yang, Yucheng; Chen, Runsen; Zhao, Ai (2023). "Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study". eClinicalMedicine. 57. doi:10.1016/j.eclinm.2023.101847. PMC 9971548 Check
|pmc=value (help). PMID 36864982 Check|pmid=value (help). - ↑ Yang, Haibing; Na, Xiaona; Zhang, Yanwen; Xi, Menglu; Yang, Yucheng; Chen, Runsen; Zhao, Ai (2023). "Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study". eClinicalMedicine. 57. doi:10.1016/j.eclinm.2023.101847. PMC 9971548 Check
|pmc=value (help). PMID 36864982 Check|pmid=value (help). - ↑ Yang, Haibing; Na, Xiaona; Zhang, Yanwen; Xi, Menglu; Yang, Yucheng; Chen, Runsen; Zhao, Ai (2023). "Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study". eClinicalMedicine. 57. doi:10.1016/j.eclinm.2023.101847. PMC 9971548 Check
|pmc=value (help). PMID 36864982 Check|pmid=value (help). - ↑ Klein, Amy (2020-04-18). "I.V.F. is Expensive. Here's How to Bring Down the Cost". The New York Times. ISSN 0362-4331. Retrieved 2023-12-04.
- ↑ 45.0 45.1 "How Much Does IVF Cost?". Forbes Health. 2021-09-28. Retrieved 2023-12-04.
- ↑ Snider, Susannah (September 29, 2020). ""How Much Does IUI Cost and How Do I Pay for It?"". U.S. News.
- ↑ 47.0 47.1 "Paying For Treatments". Alliance for Fertility Preservation. Retrieved 2023-12-04.
- ↑ PFCLA. "Cost of Egg & Embryo Freezing in the U.S. | PFCLA". www.pfcla.com. Retrieved 2023-12-04.
- ↑ "How Much Does It Cost To Freeze Sperm?". Forbes Health. 2022-12-01. Retrieved 2023-12-04.
- ↑ "Sperm Banking". www.hopkinsmedicine.org. 2021-11-02. Retrieved 2023-12-04.
- ↑ Asafu-Adjei*, Denise; Caputo, Joseph M.; Bockting, Walter O.; Diah, Jonathan; Alukal, Joseph; Stahl, Peter J. (April 2020). "MP26-16 Mismatch Between Attitudes Towards Fertility and Clinical Care for Fertility Preservation in Transgender Women: Data From Project Affirm". Journal of Urology. 203 (Supplement 4). doi:10.1097/ju.0000000000000865.016. ISSN 0022-5347.
- ↑ 52.0 52.1 Segers, Seppe; Mertes, Heidi; Pennings, Guido; de Wert, Guido; Dondorp, Wybo (2017-01-25). "Using stem cell-derived gametes for same-sex reproduction: an alternative scenario". Journal of Medical Ethics. 43 (10): 688–691. doi:10.1136/medethics-2016-103863. ISSN 0306-6800. PMID 28122990. Unknown parameter
|s2cid=ignored (help) - ↑ Adashi, Eli Y.; Cohen, I. Glenn (2020-11-15). "Assisted Same-Sex Reproduction: The Promise of Haploid Stem Cells?". Stem Cells and Development. 29 (22): 1417–1419. doi:10.1089/scd.2020.0146. ISSN 1547-3287. PMID 32967574 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ Devlin, Hannah; correspondent, Hannah Devlin Science (2023-03-08). "Scientists create mice with two fathers after making eggs from male cells". The Guardian. ISSN 0261-3077. Retrieved 2023-11-30.
- ↑ Hunt, Katie (2023-03-24). "Scientists create mice from two dads after making eggs from skin cells". CNN. Retrieved 2023-11-30.
- ↑ 56.0 56.1 56.2 56.3 Jones, BP; Williams, NJ; Saso, S; Thum, M-Y; Quiroga, I; Yazbek, J; Wilkinson, S; Ghaem-Maghami, S; Thomas, P; Smith, JR (January 2019). "Uterine transplantation in transgender women". BJOG. 126 (2): 152–156. doi:10.1111/1471-0528.15438. ISSN 1470-0328. PMC 6492192. PMID 30125449.
- ↑ 57.0 57.1 57.2 Richards, Elliott G.; Ferrando, Cecile A.; Farrell, Ruth M.; Flyckt, Rebecca L. (March 2023). "A "first" on the horizon: the expansion of uterus transplantation to transgender women". Fertility and Sterility. 119 (3): 390–391. doi:10.1016/j.fertnstert.2023.01.017. ISSN 0015-0282. PMID 36669554 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help) - ↑ 58.0 58.1 58.2 Mookerjee, Vikram G.; Kwan, Daniel (2019-04-25). "Uterus transplantation as a fertility option in transgender healthcare". International Journal of Transgender Health. 21 (2): 122–124. doi:10.1080/15532739.2019.1599764. ISSN 2689-5269. PMC 7430417 Check
|pmc=value (help). PMID 33005906 Check|pmid=value (help). - ↑ Balayla, Jacques; Pounds, Pauline; Lasry, Ariane; Volodarsky-Perel, Alexander; Gil, Yaron (May 2021). "The Montreal Criteria and uterine transplants in transgender women". Bioethics. 35 (4): 326–330. doi:10.1111/bioe.12832. ISSN 0269-9702. PMID 33550647 Check
|pmid=value (help). Unknown parameter|s2cid=ignored (help)
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