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DHEA, or dehydroepiandrosterone, is a chemical naturally occurring in the body that is frequently suggested as a supplement for female fertility patients. DHEA is important for producing androgen hormones, specifically testosteroneDHEA, or dehydroepiandrosterone, is a chemical that naturally occurs in the body. It is important for producing androgen hormones, specifically testosterone, which is critical for female fertility. There is evidence supporting DHEA supplementation for female fertility patients because it may improve egg quality and/or production due to its roles in follicular development., which is critical for female fertility. There is evidence supporting DHEA supplementation may improve egg quality and/or production due to its role in follicular development.

Embryo freezing, also known as cryopreservation, is an assisted reproductive technology (ART) that involves storing preimplantation-stage embryos that were created through in vitro fertilization (IVF). The fast-freeze process, known as vitrification, is done at an extremely low temperature (-196°C or -321°F) to halt embryo development and preserve cellular vitality. Following vitrification, these embryos can be safely cryopreserved for extended periods until they are thawed for transfer back to the uterus (called a frozen embryo transfer).

Cryopreservation is necessary when preimplantation genetic testing (PGT) is chosen. Typically, fresh embryos undergo a biopsy before freezing to allow time for the genetic tests to be conducted and results to come back. However, there are cases where patients decide that they want to perform genetic testing of previously frozen embryos. In these circumstances, frozen embryos must be thawed for biopsy, then refrozen until a future date when they might be used. That means the embryos will undergo an additional freeze-thaw round compared to the typical protocol.

Diminished ovarian reserve (DOR) is a condition in which the quantity of oocytes left in a female’s ovaries is low, as determined by ovarian reserve testing. This low number might result in infertility for some individuals. In addition, females with DOR going through fertility treatments are at risk of having a poor response to fertility drugs.

In recent years, red light therapy, also known as phototherapy or light-emitting diode (LED) light therapy, has gained attention as a potential tool to enhance fertility in both males and females. This article will explore red light therapy and its impact on reproductive health, including who can benefit from it, the safety of red light therapy, and how it may potentially improve factors such as blood flow and cellular energy.

Sexually transmitted infections (STIs) can potentially damage reproductive organs and lead to infertility. It is crucial for sexually active individuals, regardless of age, gender, or sexual orientation, to undergo regular STI testing to take charge of their sexual health. Early diagnosis and management of STIs are essential for avoiding long-term harm to reproductive organs and for maintaining fertility. Read on to discover what STIs are, how they may impact fertility, and options for their prevention and treatment.

An embryo transfer is usually the final step in the process of in vitro fertilization (IVF), in which the embryo is transferred to the patient’s uterus. The embryos used in this procedure may either be fresh or thawed (after being frozen).

During IVF, mature eggs are fertilized, either by conventional IVF (insemination) or intracytoplasmic sperm injection (ICSI). Next, the resulting embryos are grown in an incubator in the embryology laboratory. Finally, an embryo transfer is the procedure whereby one or more of the embryos that have been grown in the lab are then transferred into the patient’s uterus in the hopes of initiating a pregnancy.

Fresh embryo transfers involve transfer to the uterus several days after egg retrieval within the same IVF cycle. The embryo is never frozen.ⁱ Alternatively, embryos can be frozen and preserved (known as cryopreservation), then stored to be transferred in a subsequent cycle. This process is known as a frozen embryo transfer (FET) and requires the cryopreserved embryo to be thawed before transfer into the uterus.ⁱⁱ

Acupuncture is a type of complementary medicine involving the insertion of small needles into specific acupuncture points in the body. It is believed to work by stimulating the nervous system, which can then affect muscles and glands. Fertility acupuncture gained popularity in North American around 2009. Since then, it has been estimated that over 30 percent of females undergoing fertility treatment will access an alternative medical approach such as acupuncture during their treatment.ⁱ

Research of varying quality has been conducted to assess the role of acupuncture in both male and female fertility. Its effectiveness in helping improve fertility, especially with respect to IVF success rates, remains unclear.

Sperm retrieval procedures are used to remove sperm from the testicles for the purpose of fertilizing an oocyte (egg). They may be used for males who have zero sperm count in their ejaculate (azoospermia) but still produce sperm in the testes.

There are two main techniques for surgical sperm retrieval: aspiration and extraction. Sperm aspiration involves using a needle to aspirate (remove) sperm from the epididymis or the testes. Testicular sperm extraction takes a sample of the tissue, known as a biopsy, to collect the sperm. There are also different variations or subtypes of these procedures, as well as non-surgical approaches for individuals with ejaculation limitations.

To increase the chances of a successful pregnancy, embryo grading is completed by an embryologist during an in vitro fertilization (IVF) cycle. Assessing embryos for quality at specific stages of embryo development can be a valuable tool in reproductive medicine to help the doctor decide which embryo to transfer first (when there is more than one embryo available for transfer).

Reproductive immunology is an area of interest in reproductive medicine that aims to help individuals or couples achieve successful pregnancy outcomes when trying to conceive. Understanding reproductive immunology includes learning how the immune system affects human reproduction, what a reproductive immunologist does, and why someone may choose to consult with the reproductive immunologist in the first place.

Getting pregnant may seem like a straightforward matter, yet it is far from a simple process and has a number of steps that require just the right timing. Many factors contribute to whether or not an egg will get fertilized, develop into an embryo, and result in a live birth. Whether an individual is trying for pregnancy or thinks she may already be pregnant, understanding the fundamentals of conception can help when seeking medical advice to ensure optimal reproductive health.

Though a vasectomy used to be considered a permanent sterilization procedure, modern developments have made reversal possible. This article will explain various vasectomy reversal procedures and the likelihood of success in restoring fertility. It will also review alternative fertility options.

After an egg retrieval for a fresh cycle, or when contemplating a frozen embryo transfer, patients often wonder how many embryos should be placed into the uterus. Usually, single embryo transfer (SET) is promoted, especially if an embryo is genetically tested, meaning it undergoes preimplantation genetic testing (PGT). However, there are cases where a patient may want to transfer two or more embryos. Examining the pros and cons of multiple embryo transfers can help patients make an informed decision.

Menopause is a natural process all females will eventually go through as they reach middle age. During menopause, the ovaries stop releasing eggs, menstrual periods become less frequent and eventually cease, and hormones such as estrogen and progesterone decrease. While menopause marks the end of fertility, there is still a chance to get pregnant during menopause — either naturally or through fertility treatments.

Embryo implantation is a complex process and a significant step toward achieving a viable pregnancy. Implantation is aided by good-quality embryos (both genetically and structurally normal), a receptive endometrium, and complex communication between the embryo and the uterine lining.ⁱ

The term “implantation failure” describes the lack of a positive pregnancy test — and therefore lack of increased human chorionic gonadotropin (hCG) levels, or the lack of an intrauterine pregnancy seen on ultrasound following in vitro fertilization embryo transfer.ⁱⁱ When implantation failure happens multiple times, it is known as recurrent implantation failure (RIF) or repeated implantation failure. The terms can be used interchangeably.

For patients going through in vitro fertilization (IVF) or any type of fertility treatment, the clinic will build a comprehensive plan to examine all risk factors, health conditions, and reproductive issues that may interfere with the patients’ ability to conceive. Much of this plan will be related to the form and function of the female reproductive system, and the uterine lining (also called the endometrium or endometrial lining) is one part of the reproductive system that will be assessed.

The endometrial lining changes in thickness and appearance in response to the changing hormone levels throughout the menstrual cycle; therefore, it is part of the assessment for how a patient is responding to fertility treatment.

A dilation and curettage (D&C) is a surgical procedure that removes tissue from the uterus. While it is used for a variety of reasons including diagnostic purposes, it is typically performed following a miscarriage, or for elective termination of a pregnancy. An understanding of what to expect before, during, and after a D&C is beneficial for navigating this procedure, as well as to learn about potential risks and alternative treatments.

Sperm donation is a process in which a fertile male donates semen (ejaculatory fluid containing sperm) that can be used by an individual or couple wanting to have a baby. An understanding of how sperm donation works, what its success rates are, and why people might opt to use sperm donation, are helpful in determining how that fertility journey might look.

Klinefelter syndrome (KS) is a genetic condition in which a male is born with an extra X chromosome. This condition often impacts fertility (potentially in addition to other aspects of health and development), though it does not necessarily mean a person cannot have biological children. By understanding the symptoms, causes, risks, and treatments, individuals with Klinefelter syndrome can better navigate treatment options.

With regard to in vitro fertilization (IVF), potential success is highly dependent on being able to retrieve enough high-quality eggs that may subsequently go on to produce healthy embryos. Part of that process involves ovarian stimulation. In some cases, fertility doctors will suggest priming protocols. As patients seeking pregnancy review the various IVF protocols suggested, it is important to understand what priming protocol may be best for them. This includes knowing how these protocols can impact reproductive health, what the protocols are used for, what drugs will be required, and what the success rates are.

Pregnancy loss can be devastating under any circumstances, but recurrent pregnancy loss (RPL) — defined as two or more miscarriages — can be particularly difficult. Overall, the risk of pregnancy loss is approximately 25 percent, meaning one in four clinically recognized pregnancies end in loss. The risk of two or three pregnancy losses in a row is about 2.25 percent and 1 percent, respectively. After three consecutive pregnancy losses, the risk of another pregnancy loss rises to around 40 percent.ⁱ

To understand recurrent pregnancy loss, it is important to know the potential causes of recurrent pregnancy loss and what tests and treatments are available to help individuals and couples experiencing the devastating impact of recurrent miscarriage.

In vitro fertilization (IVF) is an assisted reproductive technique where eggs are combined with sperm outside the body, then the resulting embryo or embryos are transferred into a uterus (called an embryo transfer). The process is performed at a fertility clinic and can help couples conceive if they are having trouble doing so, often after completing other, less invasive fertility interventions. IVF can also be an option for individuals without fertility issues, including single females, same-sex couples, and people with certain medical conditions such as cancer.

IVF can be performed using a female’s own eggs and her partner’s sperm, or with donor eggs or donor sperm. Embryos from IVF, whether donor embryos or embryos created from a female’s own eggs and partner’s sperm, may be transferred to either the intended parent’s uterus or into the uterus of a gestational carrier (colloquially referred to as a “surrogate”). Sometimes the term “IVF” is used to refer to the process of freezing eggs (oocyte cryopreservation) even if fertilization and creation of embryos does not take place.

Pelvic inflammatory disease (PID) refers to an infection of the female reproductive system. It can occur without symptoms but may also cause mild to severe pelvic pain. In rare cases, PID can lead to chronic complications.ⁱ It is also a risk factor for female infertility.

Understanding what causes PID and how it is treated can help individuals avoid the long-term complications related to the disease.

A miscarriage is defined as the loss of a clinically confirmed pregnancy. For individuals hoping to conceive, it is important to have accurate information regarding pregnancy loss including prevalence, common causes, warning signs, and management options. It can also be highly beneficial to understand what to expect after miscarriage and what physical and emotional factors should be considered before trying to conceive again.

Mitochondrial replacement therapy (MRT) is a highly controversial procedure used to either prevent genetic disease or support in vitro fertilization (IVF) success when advanced maternal age may be an issue. The therapy is not currently practiced or legal in many countries, including in the United States or Canada, as it is considered a very experimental form of genetic modification.

Mitochondrial replacement therapy often comes up when the term “three-person baby” is searched online, even though the two concepts are not synonymous. Several terms are frequently misused in attempting to define mitochondrial replacement, and the procedure itself is often misunderstood.

Asherman’s syndrome is a rare condition in which scar tissue is present in the uterine cavity. It is not a genetic condition; therefore, it can affect any female. In most cases, it develops in individuals who have undergone uterine surgeries. If someone has received an Asherman’s syndrome diagnosis and is concerned about its impact on their fertility, it is beneficial to understand the symptoms, causes, and range of potential reproductive outcomes.

Varicocele is a relatively common condition affecting the male reproductive system. Though not all varicoceles cause problems, they can sometimes lead to issues such as testicular pain, decreased sperm count, and decreased sperm quality that can affect fertility. For these individuals, varicocele treatment can help.

For some potential parents, the innate immune system — including immune cells called natural killer (NK) cells — may play a role in whether a pregnancy can be achieved. Knowing what natural killer cells are, what tests for these cells exist, and possible treatment options for high natural killer cell levels can help intended parents better understand their fertility options.

Hypothyroidism can play a role in fertility problems. That means females going through in vitro fertilization (IVF) should be aware of the symptoms of hypothyroidism and possible treatments.

At times, difficulty with conception can be traced to issues within the structure of the reproductive tract, such as the shape of the uterus or blockages in the fallopian tubes. If a physician suspects structural concerns, they may recommend a hysterosalpingogram. The hysterosalpingogram is a relatively common diagnostic procedure in reproductive medicine that gives doctors the ability to see how the uterus and fallopian tubes are shaped.

Endometriosis is a medical condition that affects millions of females worldwide, many of whom may develop endometriosis at an early age. Not only can endometriosis lead to severe pain (including very painful menstrual cramps) and pelvic inflammatory disease (PID), but it can also negatively affect fertility. Many reproductive-age females who have not been formally diagnosed with endometriosis may not realize that they have the condition until they experience challenges as they attempt to conceive children.

In order to recognize and subsequently treat endometriosis, it is critical to first understand the various types of endometriosis symptoms, surgical therapies, and fertility treatments available. Due to medical advances, there are treatments to effectively manage and treat endometriosis pain. In some cases, the most effective treatments are minor surgical procedures.

Turner Syndrome (TS), also known as monosomy X, is a chromosome abnormality that occurs randomly during fertilization and affects only females. It is a genetic condition that, if present in a fetus, causes significantly increased risk for miscarriage and prenatal complications such as heart defects.

After birth, individuals with Turner syndrome have an increased risk for growth issues, learning disabilities, and infertility as adults. Fortunately, with proper early intervention and counseling on reproductive options and risks, females with Turner syndrome may go on to have successful pregnancies.

Sperm, or spermatozoa, are the reproductive cells (gametes) of a biological male. The reproductive cell of a biological female is called an oocyte, ovum, or egg.

The primary function of sperm is to reach and fuse with an egg. This process allows the sperm to deliver male genetic information (DNA) into the egg. In doing so, a zygote (fertilized egg) is formed, which can then go through stages of development to form a fetus.

Human DNA is contained within structures called chromosomes, which are found inside the nucleus of every cell. Most human cells are diploid cells, meaning they contain two sets of 23 chromosomes — one set from the sperm and one set from the egg that made them. Sperm and egg cells, however, are haploid cells, and contain a single set of 23 chromosomes. When a sperm fuses with an egg, the newly formed zygote will have two sets of chromosomes, one from the sperm and one from the egg. This fusion is how most human cells end up with a total of 46 chromosomes.

Sperm production occurs inside male testes (also called testicles). Unlike biological females, who are born with all the eggs they will ever produce in their lifetime, biological males’ sperm production begins once they reach puberty, and they will continue making sperm throughout their lifespan.

As part of a reproductive treatment plan to assist in becoming pregnant, a physician may recommend medication to induce ovulation or to accompany timed intercourse, intrauterine insemination (IUI), therapeutic donor insemination (TDI), or in vitro fertilization (IVF). During treatment, a reproductive endocrinologist (RE) will most likely prescribe ovarian stimulation to maximize the number of eggs produced.

Polycystic ovary syndrome, or PCOS, is a condition that is often associated with having a negative impact on a female’s ability to conceive. It is characterized by a range of symptoms, from unwanted hair growth to irregular menstrual cycles, and can be difficult to diagnose and treat.

While both males and females can experience sexual dysfunction that affects fertility, erectile dysfunction (ED) in males is one of the more common and problematic concerns. The physical aspect of ED can mean an inability to perform during intercourse, as well as an impeded ability to deliver sperm. However, ED can also be a sign of other health problems and may lead to emotional distress, especially when trying to conceive.

Understanding what causes erectile dysfunction, who may be most at risk, and how it can be treated are all critical elements for reaching one’s fertility goals.

For people who are thinking about in vitro fertilization (IVF), there is a great deal of information to absorb at once, and much of it can be confusing. In particular, the discussion of eggs (also called oocytes) versus follicles involves a significant dive into the mechanisms of egg development and maturation. While females may know they are born with all the eggs they will ever have, they may not necessarily understand how their eggs differ from follicles and how these terms are used during IVF. Understanding what each term means can make the process easier to navigate.

Preimplantation genetic testing (PGT) is the general term for genetic testing that is performed on embryos produced by in vitro fertilization (IVF) before the embryos are transferred to the uterus. The purpose of PGT is to improve the chances of having a successful embryo transfer. Genetic testing does not impact or change the genetics of an embryo, but it does give doctors and prospective parents more information and may help them select the most viable embryos for transfer.

There are three types of PGT: PGT for monogenic disorders (PGT-M), PGT for structural chromosomal rearrangements (PGT-SR), and PGT for aneuploidy (PGT-A). PGT-A is the most routine type performed. As such, it is an important area of education for prospective parents.

Preimplantation genetic testing (PGT) is the general term for genetic testing performed on human embryos used for in vitro fertilization (IVF) and before transfer to the uterus. PGT aims to improve the chances of a successful ongoing pregnancy after embryo transfer.

While genetic testing does not impact or change the genetics of an embryo, it gives doctors and prospective parents more information and may help them select the most viable embryo(s) for transfer. It is important to understand that PGT will not improve the cumulative live birth rate of a given IVF cycle and that there are both advantages and disadvantages to PGT.

Egg donation is a process by which a fertile female donates her eggs (oocytes) to another individual or couple who want to conceive a baby. There are several steps involved in the decision to use donor eggs, and many more things to consider once the choice has been made. For anyone thinking about using donor eggs, it is important to understand the details around how egg donation works and how to find an egg donor. Being aware of egg donation success rates is also key.

Despite a commonly held perception, it is not always easy to get pregnant. Individuals can increase their chances of getting pregnant if they know when, how, and how often to have sex. There are also lifestyle tips and tricks that can be helpful in optimizing natural fertility, potentially leading to a positive pregnancy test and a viable birth. Most women who have been trying for only a few months to get pregnant should not be concerned if they have not yet conceived. However, after trying to get pregnant for a lengthier time (more than 6-12 months), it can be helpful to know what some of the indicators are that point towards consulting a health care professional who can provide medical advice regarding fertility issues.

Egg freezing is a fertility preservation technique that was first made available in the late 1990s to females undergoing cancer treatments that could potentially affect their fertility. The egg freezing process is now also used by individuals to preserve their fertility for a wide range of reasons. Previously considered experimental, egg freezing is currently considered to have minimal risk and is even covered by some employers in the U.S. through health insurance.

Chromosomes carry DNA, which forms genes that determine multiple aspects of a human’s makeup. A chromosome analysis is often performed to give a healthcare provider more insight into a range of issues, from potential genetic conditions to factors that may be causing recurrent miscarriage.

Embryonic and fetal genetic testing may be recommended for a variety of reasons. Sometimes, individuals or couples have genetic conditions that run in their families. In that case, in vitro fertilization (IVF) with preimplantation genetic testing (PGT) can help select embryos that do not carry the condition. In other cases, patients who have had multiple pregnancy losses may pursue genetic testing of an embryo to help discover a cause. Genetic testing can also give an early glimpse into the sex of the fetus as well as whether the fetus has extra/missing chromosomes that could cause conditions such as Down syndrome or Turner syndrome.

Embryo development is a delicate, multi-stage process. From the moment of fertilization, growth follows a pattern that can be influenced by many factors. With in vitro fertilization (IVF), that pattern closely mimics what happens in the human body during a natural pregnancy, when an embryo grows from a single cell to the blastocyst stage. However, rather than occurring in a fallopian tube and the uterus, the initial phases take place in a petri dish in a lab while being monitored by trained embryologists.

How an embryo develops in the first few days — specifically, its rate of growth and changes in structure — directly impacts whether the embryo will result in a healthy live birth. Learning how embryos grow during the IVF process can help patients understand what a desirable outcome looks like and whether their embryos have achieved certain milestones.

Hyperthyroidism and hypothyroidism are both disorders involving thyroid function. But where hypothyroidism involves an underproduction of thyroid hormone, hyperthyroidism (also called overactive thyroid) causes the body to produce too much thyroid hormone. Typically, changes in weight as well as an increased heartbeat are apparent. Some people also experience problems with fertility and issues during pregnancy.

It is estimated that male infertility is the sole cause of 20 to 30 percent of infertility cases, and a contributing factor in approximately half of infertility cases.ⁱ Sperm defects, including a type of sperm DNA damage known as sperm DNA fragmentation (SDF), are a leading cause of male factor infertility. Doctors and researchers are still learning about SDF, including how it impacts fertility, what causes it, and how it can be treated.

Following an IVF cycle, any resulting embryos that are not transferred to the uterus (fresh transfer) are frozen, or cryopreserved. These frozen embryo(s) will remain frozen until the patient is ready to transfer them (called frozen embryo transfer). However, sometimes there are surplus embryos after the patient has completed their family, or plans change, and embryos remain unused for many reasons. Hundreds of thousands of surplus frozen embryos are currently stored at fertility clinics worldwide – that is, embryos created for fertility treatment and then are not needed by the person(s) that created them.

When a person has frozen embryos in storage that they do not plan to use, it can be difficult to decide what to do with those embryos. When people begin their IVF journey, they may not consider that this is something they may need to think about in the future. Alternatively, if they have considered this, their thoughts on what they plan to do with any unused embryos may have changed. This article outlines the logistical and emotional considerations for the four main options for additional or unused embryos: donation (to medical research, or to another family), destruction, compassionate transfer, and perpetual/indefinite storage.^i,ii,iii

This article will look at broad outlines, practices, and legislation, which do vary depending on where someone lives. Some countries have comprehensive regulations surrounding the handling of surplus embryos, including guidelines on informed consent and storage limits, while others have fewer rules in place, which leaves the decision largely down to clinics and individuals.^iv,v,vi

A Reproductive Endocrinology and Infertility (REI) specialist or fertility clinic can provide more information on local regulations surrounding the options for unused embryos.

Social media has transformed how many people access information about everything from current events to health conditions. This can be a positive thing, such as allowing users to share their experiences and connect with others, and it can remove barriers to accessing information.ⁱ However, social media platforms have also become a haven for the spread of misinformation, whether intentionally or unintentionally spread. This in turn can have profoundly negative consequences for people seeking advice or information.ⁱⁱ Misleading or inaccurate information may lead people to waste time and money when undergoing fertility treatment and consulting evidence-based sources that can be trusted is important.

Pregnancy loss is a relatively common, often heartbreaking outcome of pregnancy. Statistics on the prevalence of pregnancy loss are variable, though estimates suggest that between 10-30 percent of pregnancies will result in a miscarriage.^i,ii,iii,iv The chance of miscarriage increases based on age and other factors.^v Between 0.2-2.78 percent of pregnancies worldwide will end with stillbirth, which is the loss of a baby after 20 weeks' gestation (24 weeks is the cut-off definition for stillbirth in some regions).^vi,vii,viii Fewer than 0.3 percent of infants die before their first birthday in Western nations.^ix,x  

While losses may be common, each loss is unique, and each person will experience loss differently. The journey through grief can feel lonely, but there are things that can help people navigate towards healing.  

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Conceiving through in vitro fertilization (IVF), or other assisted reproductive technology, is a multifaceted process that involves several steps. Once eggs have been retrieved, successfully fertilized, and the embryos have developed, the embryo transfer procedure is planned by the reproductive endocrinologist (REI, also called RE).

IVF embryo transfer processes vary depending on multiple factors, including whether fresh or frozen embryos are used and how many embryos are planned for transfer. Successful embryo implantation into the uterine cavity requires careful planning before the transfer procedure itself. It may also involve lifestyle adjustments for the female during the weeks immediately following the procedure.

Endometrial receptivity analysis (ERA, previously known as endometrial receptivity array) is a diagnostic tool intended to determine how “receptive” the maternal uterine lining (also called the endometrium) is to implantation of a transferred embryo.^i,ii ERA specifically evaluates the expression of genes involved in endometrial receptivity during a period of time called the window of implantation (WOI). The results are then used to determine whether a patient should have a frozen embryo transfer with standard timing, or if the timing needs to be adjusted to account for an atypical, or “displaced,” window of implantation — a process known as personalized embryo transfer (pET).

Donor eggs (oocytes) are derived from an individual other than the intended parent(s). This involves in vitro fertilization (IVF), where the recipient uses healthy and fertile donor eggs to conceive. Recipients of donor eggs are often uncertain as to whether they should choose to use fresh or frozen donor eggs, and the differences between the options.  This article explores the pros and cons of using fresh vs. frozen donor eggs.

Exploring epigenetics, the study of how environmental factors affect gene expression, reveals complex dynamics in the context of donor eggs used for fertility treatments. For mothers seeking a genetic connection to their donor egg–conceived child, epigenetics can provide some insight.

Epigenetic changes are reversible alterations to deoxyribonucleic acid (DNA, the genetic code) that do not alter the code itself but can influence how an embryo develops.ⁱ The dynamic interaction between inherited genetic information and environmental influences shapes the overall epigenetic profile of gametes (oocytes and sperm), the developing embryo, and fetus.ⁱⁱ Epigenetic changes are especially important during critical periods like prenatal development, where the epigenetic landscape is particularly sensitive to external cues.ⁱⁱⁱ

Individuals who are transgender or transitioning face unique issues regarding fertility, family building, and fertility preservation. Still, transgender parenthood is fairly common. Of the respondents to the U.S. Transgender Population Health Survey, 19 percent of trans individuals were parents.ⁱ Below, learn about options for creating a family as a transgender person, fertility considerations for individuals undergoing gender transition, as well as pregnancy, the delivery process, and aspects of postpartum life for trans individuals.

Note: Some transgender individuals prefer to be identified only as men/male or women/female, dropping the term transgender. Others prefer the terms trans man or trans woman. This article will use trans or transgender terminology for clarity, while recognizing the differences in preferred language.

When someone discloses that they are struggling with fertility, well-meaning friends, family members, and even health care providers, may offer the advice to “just relax and it’ll happen.”  While this may be well-intentioned, it can add to the stress already felt by a person experiencing fertility challenges. It is well-documented that experiencing difficulties when trying to conceive can increase feelings of stress, as well as symptoms of depression and anxiety.ⁱ

Grief is a natural and common reaction to all kinds of loss; this includes the loss of or the threat of losing the chance to have children when diagnosed with infertility. Grief involves several emotional reactions to loss such as negative thoughts, a change in behaviors (e.g., difficulty sleeping), conflicting feelings, and challenging interpersonal experiences such as difficulty attending baby showers or other child-focused activities.

Grief related to infertility affects many areas of a person’s life. Infertility-related grief can include sadness, anger, anxiety, shock, feeling invisible, feeling like no one understands your experience, emotional numbness, loneliness, and/or difficulty engaging in daily life.ⁱ Fertility issues can also impact self-esteem.^ii,iii Although infertility-related grief can sometimes be long-lasting, feelings of grief generally decrease over time.

Infertility is recognized as a medical condition by the World Health Organization (WHO), as well as many other professional societies including the American Medical Association (AMA), the American Society for Reproductive Medicine (ASRM), and the European Society of Human Reproduction and Embryology (ESHRE).^i,ii,iii,iv

Estimates of infertility frequency vary worldwide and even differ depending on the way data is collected. Prevalence is the term used to describe how common a medical condition is in a particular population. According to the U.S. National Survey of Family Growth, the prevalence of infertility in married heterosexual women aged 15 to 49 is approximately 19.4 percent.^v Estimates in the U.K. for a similar population were 12.5 percent.^vi Some studies indicate that the prevalence of male infertility is 10 to 15 percent, but these estimates may not be accurate due to the lack of quality evidence.^vii