A mom of 4, Mary Jackson* loved growing up surrounded by siblings in her large Irish-Catholic family. That's why she wanted to give her transgender daughter the chance to have a child of her own as an adult.
As her daughter approached her teens, Mary researched ways to preserve her fertility for possible later use.
“It was about having options and keeping pathways open," says Mary. “I wanted to ensure she could have children from her own genetic material later on if that becomes important to her."
Mary's research led her to the UPMC Fertility Preservation Program. It offers a new technique to freeze immature reproductive tissues and cells.
Originally for young people in cancer treatment, UPMC has expanded this option to preserve future fertility for trans kids.
Mary and her husband Dan* knew their youngest child identified as a girl as soon as the child could talk. It was not the gender assigned at birth.
“We listened and she was very clear. By age 4, she was adamant that she was a girl," says Mary. “We followed her lead."
Avery* socially transitioned and entered school as a girl.
She later began taking blockers to delay the onset of male puberty. Otherwise, it would lead to a deeper voice, Adam's apple, facial hair, and bone and muscle mass development.
“This was the healthiest way for her to be herself," says Mary.
Today at age 13, Avery is “healthy, thriving, smart, and funny," she adds.
The next step in Avery's transition will involve taking estrogen to form female traits. It's at this point that doctors often suggest that trans kids preserve sperm or eggs.
While adults can freeze eggs or sperm before treatment starts, it's more complex for kids because their reproductive system hasn't matured.
Delaying or stopping the transition process — and allowing puberty to progress — has the potential to cause psychological damage.
Kyle Orwig, PhD, is director of the UPMC Magee Center for Reproduction and Transplantation and the Fertility Preservation Program. He says freezing ovarian or testicular tissue provides a much-needed fertility option for trans children.
“Families came to us and said, 'We have a child who is ready to start hormone treatments,'" he said. “They asked, 'Can you save testicular or ovarian tissue for our child before starting treatment? '"
“After careful thought — and with approval of the institutional review board (IRB) — we came to a conclusion. The psychological risk of delaying or interrupting transgender treatments is greater than the risk of testicular and ovarian tissue freezing surgery."
Orwig cautions that techniques to use the immature tissues for reproduction are still experimental. That's why his team works hard to design next-generation technologies and bring them to the clinic.
For trans males, the procedure involves removing an ovary. Doctors then freeze and store the tissue until it matures in the future to produce eggs.
For trans females, the procedure involves a biopsy of the testicle. Doctors also freeze and store the tissue until it's mature enough to produce sperm.
Mary knows older transgender teens and young adults who regret not taking steps to preserve their fertility.
Not wanting Avery to have the same regret, she and Dan sat down with her to talk about the UPMC program.
“I was surprised by her smile. We could tell she was relieved," says Mary. “She was very clear that she absolutely wanted to do it."
Avery traveled to Pittsburgh to have testicular tissue removed and frozen.
“I was kind of nervous, but it ended up good. It went well," says Avery. “I'm glad I had it done. I don't know what I want to do in the future, but this gives me options."
For Mary, the procedure gave her a feeling of relief.
“It was the one thing I felt was a loss if she wanted children of her own someday and couldn't have them. It's part of the human experience and it's something she can experience if she chooses.
“We don't know what the future holds. But we can say that we did everything we could to make this possible for her in the future," Mary says.
The UPMC Fertility Preservation Program is part of the UPMC Magee Center for Reproduction and Transplantation. We can help you find the treatment that best meets your needs.
You or your doctor can request an appointment by:
* We've changed names of the patient and family to protect their privacy.