Currently, family building is not limited to heterosexual couples but also includes LGBTQIA+ individuals who wish to have children. However, for those planning to undergo gender-affirming surgery or who are concerned about future fertility, preserving reproductive cells in advance has become an important option.

Key considerations for reproductive cell preservation before gender-affirming surgery

Gender-affirming surgery has permanent effects on the reproductive system.

• Female to Male (FTM): Undergoing gender transition involves taking testosterone, which causes the ovaries to stop producing eggs. If the uterus and ovaries are removed, natural conception will no longer be possible.

• Male to Female (MTF): Transitioning to female involves taking estrogen, which reduces or stops sperm production. If permanent genital surgery is performed, sperm production will cease, making natural conception impossible.

Therefore, egg freezing (for FTM) or sperm freezing (for MTF) is an option for preserving reproductive cells before starting gender-affirming procedures. It is important to consult a doctor beforehand to plan for future family building.

Although Thailand is recognized as one of the more progressive countries for LGBTQIA+ rights, access to Assisted Reproductive Technology (ART) remains limited by law, especially in the case of IVF (In Vitro Fertilization).

• Current law (2015): Only legally registered heterosexual married couples (male-female) are allowed to use assisted reproductive technology.

• LGBTQIA+ and Same-sex couples: Even if they are legally married, same-sex couples are still not permitted to undergo IVF under the current law.

• Egg and Sperm freezing: Currently, egg and sperm freezing is allowed. While these preserved cells cannot yet be used for IVF, they can be stored for potential future use when the law changes.

Egg Freezing (Oocyte cryopreservation)

Egg freezing is the process of stimulating the ovaries to retrieve and freeze eggs to preserve the reproductive cells' age. This option is particularly relevant for transgender men (Female to Male - FTM) who wish to have children in the future before undergoing gender-affirming surgery and starting hormone therapy. By freezing eggs beforehand, they can later use their own eggs for conception without relying on donor eggs.

Egg freezing process for FTM individuals

1. Consultation with a fertility specialist:
   Meet with a fertility specialist to discuss future family planning. It is important to inform the doctor if you are currently taking any hormones or vitamins.

2. Physical examination:
   A thorough examination is performed, including a pelvic exam to check for any abnormalities in the uterus and an ovarian assessment. Hormone tests are also conducted to evaluate ovarian function.

3. Stimulation of ovaries:
   Once menstruation begins, the process of egg retrieval starts with daily hormone injections for about 13 days, as prescribed by the doctor.

4. Monitoring response:
   During the hormone stimulation, the doctor will schedule regular visits to monitor the response of the ovaries to the stimulation.

5. Egg retrieval:
   Once the doctor determines that the eggs are mature and ready for retrieval, the patient will be scheduled for the procedure. Fasting for 6-8 hours before the procedure is required, and anesthesia will be administered by an anesthesiologist.

6. Freezing the eggs:
   After the eggs are retrieved, specialized scientists will select the eggs and proceed to freeze them.

7. Post-procedure recovery:
   After egg retrieval, normal life can resume, though intense physical activity should be avoided for the initial period.

Key points to know about egg freezing

• When you are ready to have children, IVF-ICSI (In Vitro Fertilization) is the only method to use the frozen eggs.
• Frozen eggs cannot be bought, sold, or traded.
• Frozen eggs cannot be transferred across countries.

Sperm freezing process for individuals planning gender-affirming surgery (Male to Female)

1. Consultation with a fertility specialist:
   Meet with a fertility specialist to discuss future family planning. It's important to inform the doctor if you are currently taking any hormones or vitamins.

2. Preparation:
   Prepare by refraining from ejaculation for 5-7 days, or as advised by the doctor.

3. Sperm collection:
   On the designated day, visit the clinic to provide a sperm sample.

4. Freezing the sperm:
   A specialized scientist will process and freeze the sperm for future use.

Key points to know about sperm freezing

• When you are ready to have children, IVF-ICSI (In Vitro Fertilization) is the only method to use the frozen sperm.
• Frozen sperm cannot be bought, sold, or traded.
• Frozen sperm cannot be transferred across countries.

Currently, many countries around the world, such as the United States, Canada, Australia, and some European countries, allow same-sex couples to access assisted reproductive technology. Meanwhile, Thailand has completed the process of establishing equal marriage rights, which will influence laws regarding parenthood in the future.