Abstract

Requests for assisted reproduction by transgender persons appear to be increasing. This chapter outlines relevant ethical considerations (autonomy, reproductive rights, child welfare, and non-discrimination) and provides guidance to clinicians regarding requests for medically assisted reproduction and fertility preservation for transgender persons. Those who advocate for inclusive access to fertility services note that transgender persons often express the desire to have children and should be afforded the human right of an opportunity to procreate. Cryopreservation of gametes or embryos is a viable option for assisted reproduction in transgender patients, however, knowledge about both the impact of long-term hormone therapy on gametogenesis and the recovery of reproductive function after stopping pubertal blockers and cross-hormone therapy is limited. Professional autonomy in deciding whom to treat is also limited by an obligation to consider all patients equally regardless of gender identity (non-discrimination). Those who oppose access to ART by transgender people do so out of concern for well-being of future children (beneficence/non-maleficence), though this concern is not supported by research results (Freedman, Clin Child Psychol Psychiatry 7:42, 2002; White and Ettner, J Gay Lesbian Psychother 8:129–145, 2008; Green, Int J Transgenderism 2:4, 1998). There is no ethical basis to deny transgender people access to assisted reproduction. Resources should continue to be allocated towards creating culturally sensitive educational materials, training providers to provide competent care for transgender patients and continuing to research fertility preservation and long-term outcomes of hormone therapy.