It should be noted that this article makes use of biological terms.
In the modern world, expanding one’s family by having children is usually a planned process. This is especially true for people in the trans community, as the physical processes we undergo as part of gender transition may affect our fertility.
The process of bringing a child into the world, which consists of several junctions and decisions, can be divided into several main stages: fertility preservation (if necessary), pregnancy planning, the process of conception, the pregnancy itself, childbirth, and the postpartum period. There are several topics to consider and unique points for people on the trans spectrum that are important to address during pregnancy and birth planning.
Effects of Gender-Affirming Hormone Therapy on Achieving Pregnancy
Fertility Preservation
It is recommended to consult a fertility doctor for fertility preservation before starting hormonal treatment for gender reassignment because of the hormone therapy’s effect on the reproductive system. For those who have already started hormone therapy and still wish to preserve their fertility, it is still possible to undergo this process. Sperm, eggs or embryos
Gender-Affirming Hormone Therapy – HRT
Gender-affirming hormone therapy may affect the reproductive system and the health of sperm or eggs.
Despite this fact, it is important to note that hormone therapy is not a safe means of contraception.
The effects of hormone therapy on fertility are not fully known, but the limited research on the subject does show that HRT may reduce the chance of getting pregnant for trans men or the chance of fertilizing for trans women, although some have returned to adequate fertility after stopping hormone therapy. Due to the lack of sufficient data, fertility preservation is advised prior to commencing hormonal treatment.
There are no official guidelines regarding the cessation of testosterone before attempting to conceive, nor are there definitive research conclusions regarding the effects of stopping treatment. Generally speaking, trans men show similar rates of successful pregnancy as cisgender women once testosterone is stopped and menstruation returns.
While it was once thought that taking estrogen and androgen blockers caused irreversible damage to fertility in trans women, recent studies show success in restoring sperm fertility after a temporary pause in treatment.
It is customary to perform a semen evaluation before stopping feminizing hormone therapy. The sampled value serves as a baseline, and approximately three months after stopping hormones, a follow-up semen evaluation is performed to check for improvement in sperm quality.
Planning for Pregnancy and Birth
Choosing a Care Provider
There are many types of professionals authorized to provide pregnancy monitoring in the community: obstetricians in a public or private setting, midwives in a public or private setting, and pregnancy-monitoring nurses in some health insurance funds. It is very important to choose a caregiver who supports your desires, your identity, and that of all parents.
Choosing Where to Birth
A birthing person has the right to choose the hospital where they would like to give birth. The cost of hospitalization for childbirth is covered by the National Insurance Institute. It is recommended to register in advance at the hospital offices or attend birth tours at different hospitals.
A birthing person also has the right to give birth at home under the professional supervision of a licensed, authorized midwife or physician.
The place of birth must be the person’s home and a number of conditions must be met according to the Ministry of Health policy on home birth.
Currently, there is no coverage for home birth costs from the National Insurance Institute, but a birthing parent is still entitled to a birth grant. Some health insurance funds reimburse the cost of a private midwife partially.
Planning for Postpartum
Bodyfeeding (Nursing)
Human milk is the most enriched and healthiest food for babies, but not everyone can bodyfeed and there are a variety of formulas that can be fed to a baby with the recommendation of a doctor or lactation consultant. Those who have had a complete mastectomy cannot breastfeed and medication is often recommended to dry up any milk in order to prevent inflammation. Those who have had a breast reduction and breast tissue still remains may be able to bodyfeed, but even here it can lead to inflammation, Therefore it is important to rely on the guidance of a lactation consultant.
Those with sufficient breast tissue will be able to Bodyfeed. Trans women who wish to nurse will require appropriate preparation to increase their ability to produce milk supply through pumping and adjusting their hormonal treatment, similar to cisgender women who have not given birth and wish to nurse.. If the amount of milk produced is insufficient for the infant’s needs, or for any other reason, nursing can be combined with formula feeding.
Registering a Newborn at the Population Registry
The name of a newborn can be registered using an online form, or in person at one of the registry offices with a Birth Notification or a declaration from a midwife. Parents who have brought a child into the world through surrogacy must first obtain a Parentage Order before registering the baby.
Registering a Newborn at the Health Insurance Fund
The newborn will be automatically registered at the birthing parent’s (or the parent who Receives the birth grant’s) health insurance fund. A birth certificate or ID card must be submitted to the clinic in order to complete the registration process. In the case of a baby born through surrogacy, the newborn must first be registered with the Ministry of the Interior and then a Parentage Order must be obtained. After that, the newborn can be registered in the Health Insurance fund of one of the parents.
Physician Visits and Tipat Halav
A baby born outside of an approved delivery room must be brought to a hospital for examination by a pediatrician within 24 hours of birth.
A file must be opened for the newborn at a Tipat Halav branch within 10-14 days of birth.