The Next Frontier in Fertility Treatment
New York Times By SARAH ELIZABETH RICHARDS
ANDY INKSTER, a transgender man, had always wanted biological children. So when he embarked on the transition from female to male at age 18 — changing his name, taking testosterone and eventually undergoing surgery to remove his breasts — he left his female reproductive organs intact.
In his mid-20s, he decided it was time. He stopped taking testosterone and started trying to get pregnant. Eventually, in 2009, after beginning graduate school at the University of Massachusetts at Amherst, he sought fertility treatment at Baystate Reproductive Medicine. Baystate was one of the few clinics in the country with an anti-discrimination policy for gender identity. And yet, it refused to treat him, arguing that it didn’t have enough expertise to treat transgender patients. Mr. Inkster insisted there was no medical reason to deny him; his baby-making parts were the same as any woman’s.
The more than 700,000 transgender people living in the United States have long faced discrimination by health care providers. Over the past 15 years, activists have fought to compel insurers to cover transgender-related health care — from hormone therapy to gender reassignment surgery — or at least be prevented from excluding transgender clients from buying policies for basic services. Finally, starting this month, thanks to the Affordable Care Act, “transsexualism” can no longer be considered a pre-existing condition. What’s been left out of the spotlight: having babies. Many Americans have come to accept gay parents; the transgender community is next in line for recognition.
Mr. Inkster eventually found another clinic that helped him conceive via in vitro fertilization and donor sperm, and in October 2010, he gave birth to a daughter, Elise. A month later, he sued Baystate for sexual discrimination.
According to court documents, he was denied treatment after failing to comply with a clinic counselor’s request that he supply information from his current therapist that he was emotionally ready to handle pregnancy and parenting. Mr. Inkster argued that nontransgender patients weren’t asked to do the same. This fall, the Massachusetts Commission Against Discrimination — the state’s civil rights agency — found probable cause for Mr. Inkster. The case will next move on to a conciliation conference, and then to a possible settlement.
Admittedly, the idea of a “pregnant man” makes many people uncomfortable, and photos of Mr. Inkster caressing his bulging belly are startling. The issue is controversial even within the transgender community. “Some people believe if you’re a trans man you shouldn’t be wanting to bear kids,” Jamison Green, the author of “Becoming a Visible Man,” told me. “That’s not something men do. Others think, If you have a body part that does something, why can’t you use it? It’s your body.”
The issue brings up unprecedented questions: Do you use your genetic material to reproduce, and at what time during your transition? Before or after hormone therapy? Before undergoing reassignment surgery that will make you sterile? Should a transgender man like Mr. Inkster keep his breasts so he can nurse later? Is it generally psychologically healthier for someone like him to freeze his eggs and have them inseminated and the embryos transferred to a female partner or surrogate, rather than leave his female reproductive parts intact? How might years of estrogen or testosterone therapy affect eggs and sperm?
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