Fertility Preservation

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

A hysterectomy ends the possibility of carrying a pregnancy. An oophorectomy ends the possibility of using your own eggs. Neither can be undone, and freezing eggs or embryos has to happen before the ovaries come out. Plenty of people look at this and decide it is not for them, which is a fine answer. What I have seen go wrong, more than once, is the question getting its first airing in the last five minutes of a pre-op appointment, with a date already booked. I am not a doctor or a fertility specialist, and none of this is medical advice; the numbers for your case come from a fertility clinic with your test results in front of it.

The options

• Egg freezing (oocyte cryopreservation). About ten to fourteen days of daily hormone injections to stimulate the ovaries, with several monitoring scans and blood tests along the way, then collection under sedation. The eggs are frozen unfertilised, so you decide later whose sperm and whose uterus.
• Embryo freezing. The same cycle, but the eggs are fertilised with a partner's or donor's sperm before freezing. Embryos tend to come through thawing more reliably than eggs. The catch is legal as much as medical: in many places, including the UK, both people who created an embryo have to consent to its use, and either can withdraw that consent later. If the relationship might not last, eggs keep the decision yours.
• Ovarian tissue freezing. A strip of ovary is removed and frozen, to be transplanted back later. Its appeal for trans men is that it can be taken during the oophorectomy itself, with no stimulation and no pause in testosterone. It is offered in far fewer places, most of the births so far have been in cancer patients rather than trans men, and using the tissue means having ovarian tissue put back in your body. If you want it, the surgeon and the fertility clinic have to arrange it before the day; it cannot be added in theatre.
• Keeping your ovaries. A hysterectomy that leaves the ovaries in place keeps egg collection possible later, through a full stimulation cycle. After a vaginectomy the usual route, a needle guided through the vaginal wall, is gone, and collection would need a different approach that not every clinic offers. If genital surgery is in your plans, treat vaginectomy as the practical cut-off too.

What freezing buys you

A chance, not a baby. Not every egg survives thawing, not every one fertilises, and not every embryo implants. The two things that matter most are your age at collection and how many eggs come out, and a single cycle can produce anything from a handful to twenty or more. Some people do a second cycle. A success figure given before anyone has seen your blood tests and scan is an average, not you.

Using the eggs later also needs a uterus, a partner's or a surrogate's, and surrogacy law varies a great deal by country and, in the US, by state.

Testosterone and the cycle

• Time on T. Years on testosterone is not generally treated as a bar to collection. Studies so far suggest trans men who have been on T can produce usable eggs, but they are small, and fertility specialists do not agree on how much prior T affects the numbers.
• The pause. Many clinics ask you to stop testosterone before stimulation, commonly until periods return or for around one to three months. Some now stimulate with a shorter pause, or none, and at least some of the published work suggests results can be comparable. This is contested, so ask the clinic what they do, why, and what their own results have been. Do not stop or change your dose yourself; that is arranged with whoever prescribes your T, who should know the plan before you start.
• What the pause is like. Coming off T can bring back periods and oestrogen effects, and for some people a real drop in mood, all right before and during a cycle of daily injections. Tell your prescriber and anyone supporting you in advance. Some clinics add a drug called letrozole to keep oestrogen levels lower during stimulation; ask whether that is an option.
• The scans. Monitoring and collection are normally done with an internal (transvaginal) ultrasound, several times across the cycle. Ask how many scans to expect, whether any can be done abdominally, and whether deeper sedation is available for collection.
• Afterwards. Most people restart T soon after collection, when the clinic and prescriber say so. Once frozen, the eggs are unaffected by it.

If you are not yet on testosterone, preserving before you start avoids the pause question entirely. It is not a requirement for starting T or for surgery. See testosterone requirements for how T fits into surgical eligibility.

Timing

Preservation has to happen before oophorectomy, and before vaginectomy if you are keeping your ovaries. A realistic sequence:

1. First fertility clinic appointment and baseline tests (blood tests and a scan): weeks privately, often months through a public system
2. A testosterone pause, if the clinic wants one: typically one to three months
3. Stimulation: ten to fourteen days
4. Collection, then back on T when you are told
5. Surgery, with a few weeks' gap after collection

Allow three to six months end to end, longer if waiting on funding. If you already have a surgery date, tell your surgeon and the fertility clinic now. In my experience most surgeons will move a date for this without argument; very few will move it the week before. See surgery order for where it sits among other procedures.

Cost

Figures here are rough, from mid-2026, and move with clinic, city and drug prices.

• US: roughly $10,000 to $20,000 per cycle all in, with stimulation drugs often billed separately and making up several thousand of that.
• UK private: often £3,000 to £5,000 for the cycle, with drugs adding £1,000 or more.
• Australia and Canada: several thousand to over ten thousand in local currency per cycle, with partial public support in some states and provinces.
• Storage: billed yearly, typically a few hundred in any currency, for as long as the eggs are kept. In the UK the law changed in 2022 to allow storage for up to 55 years, with consent renewed every ten.

On funding: the NHS can fund preservation before gender-affirming treatment, but it depends on where you live and waits are long. Some Canadian provinces and Australian states offer partial funding. In the US a number of states require some plans to cover preservation before treatment that is likely to cause infertility, but whether gender-affirming surgery counts depends on the state and the plan, and many plans still exclude it. Read the policy wording, not the summary. See insurance.

I have seen more than one person budget for the hysterectomy and find the fertility quote was larger. Get an itemised quote that shows drugs, anaesthesia, the freezing itself and the first year's storage as separate lines.

Questions for a fertility clinic

• How many trans men have you treated, and do you require a testosterone pause? For how long, and why?
• For someone my age, on T this long, what number of eggs would you expect from one cycle, and how many would you suggest banking?
• How many internal scans are involved, and what sedation is used for collection?
• What does the quote include, and what is billed separately?
• What happens to the eggs if I stop paying storage?
• If I use these later with a partner or surrogate, what does that involve where I live?

Raise it at your surgical consultation too, so the surgery date is planned around it.