Fertility
Why is it important to start thinking about your fertility early on, if you are thinking about genital surgery?
The desire to have children is separate from your gender identity. Everyone has the right to make their own choice about having children; this is what we call reproductive freedom. If you have your womb removed, you will no longer be able to carry children. If you have your ovaries removed, you will no longer be able to conceive children using your own eggs. These are operations that cannot be reversed. This means that you need to think about whether you might want to have children before undergoing genital surgery.
Thinking about parenthood can be difficult, especially when you are young. However, regardless of age, it is a good idea to discuss this with your healthcare provider and/or your loved ones. If you wish to have children or may wish to have them in the future, there are several ways to fulfil this wish. The options available also depend on the fertility of your partner, if you have one. Below, we discuss a few options.
Options for retaining your fertility
If you wish (or may wish) to have children in the future, there are several ways to fulfil this wish. If you wish to maintain the option of conceiving a child using your own eggs in the future, there are several options:
- The (temporary) preservation of the reproductive organs;
- Freezing eggs or embryos;
- Freezing ovarian tissue.
The figure below shows the anatomy of the reproductive organs.
Option 1: (Temporarily) retaining the reproductive organs
If you wish to have children or are unsure, retaining your womb, ovaries and vagina until you have had children gives you the best chance of maintaining your fertility. However, this choice is not suitable for everyone; gender dysphoria often relates specifically to these organs. Naturally, this is different for everyone, and it is a personal decision you must make yourself.
Carrying a child yourself
Do you want to have a child and carry it yourself? You can carry a baby if you retain your womb and vagina. Not much is currently known about the long-term effects of testosterone use on the womb, but short-term studies (covering a few years) have found no adverse effects. You can always decide later whether to have these organs removed.
Conceiving a child using your own eggs
Do you wish to have a child using your own eggs? This is possible as long as you keep your ovaries, as this is where the eggs are stored. However, you will need to temporarily stop taking testosterone once you decide to freeze your eggs. As far as we know at present, testosterone does not have a harmful effect on eggs, but there is still insufficient information about the effects of long-term testosterone use. We recommend that you schedule another fertility consultation in a few years’ time, as more may be known by then about the effects of testosterone on eggs. After a hysterectomy, it may be more difficult to retrieve all the eggs from the ovaries. To maximise the number of eggs retrieved, it is probably better to freeze the eggs before the hysterectomy.
If you choose to have the vagina (and womb) removed but leave the ovaries in place, this reduces your chances of fertility. This is because the ovaries can then only be accessed via the abdomen, which makes monitoring and retrieving eggs more difficult. There are also greater risks involved, and fewer eggs are usually found. This also applies to genital surgery in which access to the vagina is closed off (colpectomy).
Option 2: Freezing eggs or freezing embryos
There are various points at which you may decide to freeze your eggs:
- Before starting testosterone treatment;
- At a later stage, for example if you intend to use the eggs soon or if you have doubts about the outcomes of long-term exposure to testosterone;
- Before surgery to remove the ovaries.
As far as we know at present, the use of testosterone does not appear to affect the quantity or quality of the eggs in the body. For options two and three, you must stop taking testosterone three months in advance. The retrieval of eggs is preceded by hormone stimulation. These hormones stimulate the growth of eggs. You do not inject any female hormones, but their levels do rise during the stimulation period due to the growth of the follicles. If you have a regular partner with sperm or a chosen sperm donor with whom you wish to have children, it is also possible to fertilise the eggs in the laboratory (IVF treatment) and then freeze the fertilised eggs (embryos).
Please note: if you wish to freeze your eggs, there is a strict policy regarding smoking, alcohol and other drugs. You will need to stop using them completely to start the process and during the process.
Hormone stimulation
Only mature eggs can be frozen. To produce mature eggs, you will need to administer a daily hormone injection yourself. This takes 2 to 3 weeks. During this time, the doctor will use an ultrasound scan to check that the eggs are developing properly. Where possible, the ultrasound scan is carried out via the abdomen. Only if the eggs cannot be seen clearly this way will the option of performing a transvaginal (via the vagina) ultrasound be discussed with you. Once there are enough mature eggs, they are retrieved via the vagina using a needle (see image below). This is carried out under pain relief or general anaesthesia, depending on the healthcare facility where the procedure takes place. The eggs are then frozen immediately.
Possible physical disadvantages/side effects
- The treatment may cause feelings of dysphoria, for example because you have to undress and have ultrasound scans.
- The hormone injections can cause side effects; the most common are headaches and tiredness. Hormonal fluctuations can also cause psychological symptoms.
- The hormones and the growth of the ovaries can cause bloating or abdominal pain.
- Injecting the hormones (yourself) can be painful and nerve-wracking..
- The egg retrieval procedure can be uncomfortable, despite pain relief or anaesthesia.
If you’ve experienced physical changes due to testosterone use, such as beard growth and a deeper voice, these will remain the same. If you (still) have breasts, they may become temporarily more sensitive. You’ll also experience bleeding due to the hormonal fluctuations following the ovarian stimulation. If you have your eggs frozen, this often results in many additional hospital appointments and delays to your medical transition.
Costs
The cost of freezing eggs is approximately €900 to €1,000; this is usually covered in full by your health insurer. We recommend that you check this with your health insurer before you start treatment.
Storing the eggs costs a maximum of €190 per year (2026). The prices for freezing and storing eggs are set annually by the NZa – you can find the latest prices on their website. In addition, costs may vary from one healthcare provider to another. You will need to pay the costs of storing the eggs yourself.
Option 3: Freezing ovarian tissue
If retaining your ovaries or freezing eggs is not an option for you, you may want to consider freezing ovarian tissue. This is an experimental treatment which might, in the distant future, make it possible to mature immature eggs in the laboratory. Ovarian tissue is frozen during the operation to remove the ovaries.
Procedure for removing ovaries and freezing tissue
The removal of the ovaries takes place during keyhole surgery (laparoscopy) under general anaesthesia. This is usually a combined keyhole procedure, meaning that the uterus and/or vagina are also removed. During and after the keyhole surgery, there is a small risk of complications such as damage to the urinary tract, intestines or blood vessels, the development of infections, or thrombosis. After removal, the outer layer of the ovarian tissue is cut into small pieces. This is frozen and can be stored for many years. However, the process of freezing and later thawing does result in some of the eggs being damaged.
Experimental treatment
Freezing ovarian tissue is currently an experimental treatment. Extensive research is being carried out into the possibilities of in vitro maturation (the maturation of immature eggs into viable eggs in the laboratory). This may be a possibility in the distant future, but not at present. If you wish to freeze ovarian tissue just in case, please discuss this with your treating doctor before having your ovaries removed.
Costs
If you choose to freeze ovarian tissue, there will be no change to the operation that has already been scheduled, so there are no additional costs. However, you will need to pay the transport costs (approximately €400, a one-off payment) and storage costs (approximately €60 per year). These costs are not currently (2026) covered by your health insurer.
Decision aid for fertility preservation
On this page you will find more information about fertility preservation for each type of genital surgery. The pros and cons are set out for each possible operation.
Access to frozen eggs
You cannot automatically access your frozen eggs. If you wish to use your frozen eggs for a pregnancy in the future, you will need to attend a new consultation at the fertility clinic. During this consultation, the clinic will assess, for example, whether you are at that moment sufficiently capable of bringing up a child. The welfare of the unborn child is the primary consideration during this consultation.
Sperm donation
Do you wish to use sperm donation, for example because you do not have a partner who can provide the sperm for fertilisation? In that case, you can choose to find someone yourself, for example within your own network, or opt for a sperm bank. In the latter case, the treatment (artificial insemination) takes place in hospital. Anonymous sperm donation is not permitted by law in the Netherlands; this means that a child conceived with the help of a sperm donation may request information about the sperm donor from the age of 12. You can read more about requesting information following sperm and egg donation on the Government of the Netherlands website.
Other options for fulfilling the desire to have a child
If the options listed above are not suitable for you (and your partner, if you have one), there are other ways to fulfil your desire to have a child. One option to consider is surrogacy outside your relationship. Some people choose to fulfil their desire to have a child through adoption. For up-to-date information on adoption in the Netherlands, visit Stichting FIOM. In May 2024, the Dutch government decided that adopting a child from abroad would no longer be permitted. However, adoption procedures already underway will continue for the time being. For more information on same-sex parenting and domestic adoption, please visit the website of the Meer dan gewenst foundation. Foster care is also an option; for more information, visit www.pleegzorg.nl.
This text was edited on 3-11-2026
Next Step
We recommend that you go through all the information chapters step by step to get a complete picture of the various treatment options and the process involved!We strive to keep this information up to date. Do you have any additions or comments regarding the information above? Please email us at [email protected]
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Preparing for the genital operation
To be eligible for genital surgery, you must be well-informed and meet the requirements.
