Can we have children?

Parenting options for couples affected by male transsexualism*

An obvious consequence of male transsexualism (TS) is infertility due to absent sperm production. The following information is offered to couples pursuing parenthood despite this challenge.

Across the general population, infertility is quite common. About 15% of couples have difficulty conceiving – roughly a third of cases being related to the male partner, another third related to the female partner and the final third a combination of both.

There are various causes of male infertility, including testicular injury or disease, blockages, varicocele (swollen veins), sperm disorders, genetic disorders, hormonal problems, other medical disorders, problems with erection or ejaculation, use of certain drugs and environmental toxins or radiation. In many cases these causes can be overcome but a number of men, including men of transsexual history, will never be able to biologically father children.

Alternative parenting options can be considered in terms of either conceiving a childthrough assisted conception techniques using donated sperm or parenting a child already born (eg fostering or adoption).

I. Assisted Conception

‘Assisted conception’ is a general term that covers the range of medical treatments that are used with the aim of achieving a successful pregnancy. Conception can be assisted by donor insemination (either by private arrangement or through a fertility clinic, with or without hormones to stimulate ovarian function), In Vitro Fertilisation (IVF) and Embryo Transfer (ET), or Gamete Intra-Fallopian Transfer (GIFT). The treatment option chosen will depend on individual circumstances.

Conceiving children or assisting someone else have children with the help of donated gametes or embryos is a complex and lifelong decision. There are many factors that need to be considered, including potential long term psychosocial, legal and health issues.

“Our children are the result of fertility treatment (assisted insemination by donor), in other words I have a biological connection to them but Cameron doesn’t. In no way does this affect my perception (or the children’s or anyone else’s as far as I can tell) of Cameron as 100% their Dad, absolutely no less their parent than I am…Cameron passes SO MUCH of himself on to the boys just by being around them. He’s a great father, hands on, lots of cuddles and wrestles, lets them tag along with him, involves them in what he’s doing, very responsible and loving, rolls up the sleeves and gets in there be it bathtime, playtime, dinnertime, nappytime, anytime.

Cameron was there when they were conceived, sharing the pregnancies was special, labour and all that’s happened since. The circumstances of me meeting Cameron and wanting to raise a family with him and even the fact that we needed the help of a donor, means that if not for Cameron these two gorgeous little people would never have existed – WOW!!! Thinking of it that way we both thank goodness things happened the way they did. Lot’s of people can’t conceive without donated sperm or eggs or embryos, due to fertility issues or single parenthood or same sex partnerships – luckily the technology is there to assist if desired.”
— Liz speaking about her husband, NSW.

Donors, recipients and people born from donated sperm all have rights and responsibilities, though these may vary between different states/territories of Australia and may change over time. It is important to learn about these rights and responsibilities and take these into account, even if you know the donor. Thought needs to be given to guaranteeing parental rights and responsibilities of the non-biological parent, lest misfortune or relationship breakdown occur (particularly if the couple are not legally married).

Eligibility criteria may also vary from state to state, for example Victorian laws forbid assisted reproductive technologies to single women, or women in same-sex relationships, unless it can be shown that the woman has “medical infertility”. Similarly different fertility clinics will have different guidelines, which may pose challenges for couples seeking to conceive.

Couples affected by TS are on par with other infertile couples. Should you believe you are being unfairly discriminated against, there is usually a social worker attached to every clinic whom you may wish to consult with. You may even wish to seek legal advice, however it may be easier and less stressful to seek another clinic more willing to assist.

In Melbourne, a clinic at the Royal Women’s Hospital Reproductive Services conducts a self-insemination programme to assist women in screening their known sperm donors to ensure that the self-insemination procedures can be carried out with maximum safety and efficiency. Melbourne IVF is also willing to assist couples seeking artificial insemination treatment interstate.

For more information regarding the use of donated sperm see the website of Donor Conception Support Group of Australia

II. Adoption

Adoption is a process whereby legal rights and responsibilities are permanently transferred from birth parents to adoptive parents. There are several different avenues of adoption: local adoption and permanent care programs, special needs adoption and intercountry adoption programs.

The process moves in stages to determine that adoption matches your life circumstances to ensure the best interests of the child, both in childhood and later life. The first step when approaching an agency is learning more about their specific eligibility criteria. All adoptions must comply with relevant state-based legislation, which in some cases may challenge couples affected by TS. For example according to the NSW Adoption Act 2000adoption orders may be made solely by or on behalf of one person or jointly by or on behalf of a couple. A couple is defined by the NSW Adoption Act as “a man and a woman who are married or have a defacto relationship” and therefore does not recognise same sex partners as couples. This may prove an obstacle for a man who has transitioned and is in a relationship with another man or for someone who has not changed their birth record to “male” and is in a relationship with a woman.

Information about adoption is offered here somewhat hypothetically – FTM Australia is not aware of specific couples affected by TS who have adopted children. As  a man of transsexual history (fully transitioned with a male birth certificate) can be legally married to a woman in Australia then he is also recognised as the male partner in the adoption process.

III. Fostering

Foster care is provided to children and young people who, for a range of reasons, are unable to live with their own families. To foster, you take on the responsibilities of a parent for a period of time, to provide a safe, nurturing and secure family environment.

Foster care is only arranged after options within the child’s own family and community have been explored, the aim being to reunite children with their parents as soon as possible. Most children and young people are in foster care because they are at risk of harm or neglect or because their parent or carer needs periodic relief. Foster care could be short term or long term – for one or two nights, a few weeks or months, or even years. In cases where serious abuse or neglect has occurred or parents can’t guarantee the safety of their child, children may need to remain in foster care until the age of 18.

For more information contact child welfare agencies in your state or territory.

Managing Strategies

Coping with infertility, undergoing fertility procedures, applying to adopt or foster, experiencing pregnancy, and becoming a new parent can be all-consuming, stressful and expensive.

For these reasons many men complete their sex affirmation treatment or the majority of the process in advance so as to more confidently present to a clinic or agency fully and legally male (undoubtedly, couples will judge for themselves when this stage has arrived).

Similarly it may be wise to resolve any other major issues or recover from other major life events, before pursuing parenthood.

For many people the unfulfilled desire to have a child can be hard to bear. Efforts to conceive, adopt or foster – even if the outcome is successful – can impose a considerable emotional burden at various stages along the way. Plans for coping may help, such as:

  • Set limits in regard to time frames and expense
  • Consider all options and determining alternatives (which may include not having children)
  • Locate support groups or counselling services in advance, and making use of them
  • Express yourself (eg any feelings of grief, guilt, anger)
  • Stay in touch with loved ones
  • Explore therapies for stress management and relaxation.

In Summary

This information sheet outlines parenting possibilities for couples who experience infertility due to male transsexualism. There is an enormous amount of published material ‘out there’ about assisted-conception, adoption and fostering and many service providers available to inform interested couples. The good news in a nutshell is that couples affected by TS can and do become parents.

*where a male partner was identified ‘female’ at birth and has subsequently undergone masculinising sex affirmation procedures.

Written 6 July 2006
Updated 28 December 2010

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