Trans Reproductive Imaginaries: Access and Barriers to Fertility Preservation and Family Creation

Abstract

Transgender and non-binary (trans) people face unique challenges when considering decision-making about their reproductive futures. These may include navigating gendered parenthood roles and the potential impacts of medical gender affirmation on their fertility. While fertility preservation offers a way of having biologically related children, barriers to accessing these services among trans people have been identified in literature. This qualitative study sought to understand how trans young adults view and experience fertility preservation, in relation to their desire for family and parenthood. Through a thematic analysis of in-depth interviews with 13 trans and non-binary people in Aotearoa New Zealand, we identified four themes: variability in seeking accurate fertility preservation information; the compounding costs of trans reproduction; experiencing and anticipating cisnormativity in reproductive health services; and (re)imagining family. Overall, participants expressed diverse views on fertility preservation, informed by interpersonal and structural factors. Notably, we found discrepancies between uptake of sperm and egg cryopreservation due to public funding disparities, despite participants agreeing services should be offered equitably to all trans people. These structural barriers require further attention in healthcare, policy and community settings when working with trans young adults considering fertility preservation.