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Egg freezing during transition

Long-term testosterone therapy suppresses the menstrual cycle and ovulation.

Why before testosterone

Long-term testosterone therapy suppresses the menstrual cycle and ovulation. Recovery thereof after stopping is usually possible but varies per person. International guidelines (Endocrine Society 2017, WPATH SOC-8 2022, ESHRE 2020) recommend discussing fertility preservation before the start of masculinising hormone treatment, with attention to age, preference and any gender-related dysphoria around the procedure.

Procedure

The ovaries are hormonally stimulated for approximately two weeks with FSH injections. Under ultrasound monitoring, several mature eggs are punctured and removed via the vagina under light sedation. The eggs are vitrified (quickly frozen) and stored in liquid nitrogen.

Considerations

The stimulation phase can evoke gender-related discomfort due to temporary breast tenderness, bloated abdomen and elevated estradiol levels. Some patients choose to postpone the start of testosterone or to resume the cycle after a previous phase. Multidisciplinary consultation with endocrinologist and fertility specialist is common.

Reimbursement in the Netherlands

Fertility preservation with medical indication (including gender dysphoria) is reimbursed in the Netherlands under the basic insurance for freezing and in principle for storage; conditions differ per health insurer.