Ethical considerations of providing fertility services to transgender patients are examined in an updated policy statement from the American Society for Reproductive Medicine.1 The statement authors concluded transgender status should not prevent a patient from accessing fertility preservation. Reproductive services should be offered to all interested transgender or nonbinary individuals, barring other disqualifying factors (based on empirical evidence as opposed to bias or stereotypes).

The authors of another recent paper support the right of transgender and nonbinary youth to reproductive technologies and providing gender-affirming care to transgender patients.2

“We realized that there was a growing population of prepubescent children seeking care for gender-affirming care,” says Kavita Shah Arora, MD, MBE, MS, an associate professor of reproductive biology and bioethics at Case Western Reserve University.

Gender-affirming therapy may impair future fertility. Arora and colleagues advocated for wider access to fertility preservation counseling and options before providing gender-affirming care in this population.

“This is aligned with a reproductive justice framework that centers each person’s family-building goals rather than making assumptions based on sex, gender identity, gender expression, and sexual orientation,” Arora says.

She adds: “Greater training in how to operationalize shared decision-making in this complex situation, bridging pediatrics and reproductive medicine, is needed.” 


  1. Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender and nonbinary persons: An ethics committee opinion. Fertil Steril 2021;115:874-878.
  2. Katabi LJ, Ng HH, Streed CG Jr, Arora KS. Ethical considerations of fertility preservation for transmasculine and nonbinary youth. Transgend Health 2020;5:201-204.