Chapter 12: Ethical Considerations for Transgender and Non-Binary Reproduction

Assisted reproductive technologies (ART) have opened the door for many people to pursue genetic parenthood when it was previously not possible for them to do so, including cisgender heterosexual couples with infertility, single individuals, and those in the LGBTQ community. In this chapter, we focus specifically on transgender and non-binary (TGNB) reproduction, providing provide an overview of some of the ethical considerations at play. First, we describe how standard definitions of infertility exclude TGNB individuals, making it more difficult and expensive for them to access ART. Such narrow definitions of infertility uphold cisnormative beliefs about who is deserving of parenthood. Second, we discuss how the highly gendered binary framework upon which reproductive medicine is based marginalizes and erases TGNB individuals. We enumerate some actions fertility clients can take to make TGNB individuals feel welcome. Third, we turn to the high cost of ART, which is a barrier for many people and raises justice concerns. TGNB individuals are especially disadvantaged due to their gender identity and other intersecting marginalized identities Fourth, we examine the challenges for TGNB individuals and clinicians in making decisions about gender-affirming and reproductive care in the face of limited data. Finally, we explore some of the specific issues for TGNB youth, including the question of whether youth should be able to make their own decisions about fertility preservation prior to gender-affirming hormones and surgery.