They walked hand-in-hand, too, just over a year earlier, Heller bent over in pain, Jacobs’ face twisted with dismay, as they exited a Montreal fertility clinic after another failed attempt to impregnate Heller with Jacobs’ sperm.

Jacobs, a transgender woman, was born with a male body. She met Heller, who identifies as bisexual, at a yoga class in Montreal in 2010. They moved in together almost immediately and then became business partners, opening a co-operative vegetable farm in rural Quebec. Soon, they started trying for a baby using sperm Jacobs had stored before she started her transition.

It took nine rounds of intrauterine insemination for Heller to become pregnant. The first four experiences at a Montreal fertility clinic had been quick and impersonal. But their fifth try was worse than usual. The doctor rushed in, never said hello or gave his name, never looked at the women. He asked “insemination?” and they said “yes.” He was quick and rough, Heller recalled, and she bled afterward, something she’d never experienced. He left the lamp on between her legs as he rushed out of the room, they say.

“We left that day and I was just a wreck. I mean, I felt abused. And so frustrated, because it felt like I was so dependent on these people to have the life that I wanted to have,” Heller recalled.

“It felt like, ‘It’s not my fault that I need to come here. I don’t want to come here. Why are you treating me like this?’ ”

With the advent of reproductive technologies, transgender people have options if they want to have children after transitioning, but there are a number of challenges. Not the least of which is what some allege is discrimination or a lack of understanding in the fertility clinics they rely upon.

While the gay liberation movement took off more than 40 years ago, the trans-liberation movement is still relatively young, says Dr. Kevin Alderson, a Calgary psychologist who specializes in LGBTQ issues.

“The trans community has really just gained in momentum since about the 1990s and the explosion of Internet, which means people can get information on this like never before,” Alderson says.

“We’re moving along about 15 years behind lesbian and gay and bi folks,” says Andy Inkster, a health promoter with the LGBTQ Parenting Network in Toronto.

“Trans people are the final frontier of acceptance.”

***

Jenna Jacobs was born in 1977 in Edmonton. For as long as she can remember, she wore women’s clothing when she was alone. It felt great, she said, but knew it was wrong.

“I had all the parts of a boy. But it just never felt right, all through my childhood. The earliest memories I have are . . . of being unhappy with my gender. They never left,” Jacobs said. She sat carefully in a chair in the farmhouse, recovering from her recent vaginoplasty surgery, a process where a penis is surgically altered into a vagina.

Jacobs moved to Montreal when she was 31. She was mid-transition when she met Heller, presenting as a woman in many social situations but as a man at university, where she was completing her PhD.

Heller, who was born in 1984 in Chicago, has dated both men and women, but never a transgender person before she met Jacobs.

“She was still presenting back and forth at that time. And that was sometimes a little, that was kind of like a mind warp a little bit,” Heller said.

But Heller said she saw a richness, a beauty, in what it meant to be trans.

And Jacobs’ worries that Heller would expect her to be more male were unfounded.

“Every time I took a step further in my transition I was almost expecting her to try to put on the brakes or put influence on me at some point, and she never did. And there is something really unique and really special in that,” Jacobs said.

Heller’s eyes filled with tears.

She blamed the pregnancy hormones and Jacobs grinned, brushing a strand of her own long, brown hair behind one ear.

***

The majority of humans are cisgender — someone whose inate identity matches the gender they were born with. Transgender people fall outside of traditional masculine or feminine norms and not all feel a desire to be a member of the opposite sex.

For those who do, they describe it as being born in the wrong body, and many choose to go through sex reassignment treatments such as hormone therapies and surgeries.

B.C. NDP MP Randall Garrison submitted a private member’s bill to add gender identity to the Canadian Human Rights Code. It passed last spring, but still has to go through the Senate. But then, what Garrison calls a “major gap” in this country’s human rights agenda will finally be filled.

“Certainly, in my experience, the trans people I know have suffered tremendously. There’s no doubt there’s constant discrimination.”

Kate Schowalter of Edmonton says her experience highlights that.

She was 23 when she began transitioning into a woman. She was eager to begin her hormone treatment after being diagnosed with gender identity disorder (which is now called “gender dysphoria”). But first, her doctor suggested that she store her sperm in a local sperm bank.

“I’m not sure yet if I want kids or not. It’s more of an insurance thing,” Schowalter says, nervously flipping her bangs out of her eyes.

“I feel like everyone should have the right to decide whether or not to have their own children.”

She banked her sperm at an Edmonton fertility clinic in October 2012 and was treated respectfully, she says. But she was shocked to find out it would cost $500 per year, and that she had to pay two years upfront.

According to the clinic’s policy, if she’d had a medical condition (i.e. “pre chemotherapy, pre-transplant”) it would only cost $200 per year with no upfront payment.

Citing her medical diagnosis, Schowalter asked the clinic why she had to pay the higher fee.

“The clerk straight up said, ‘You have a choice,’ ” Schowalter says.

“But it’s not a choice, obviously. I think that’s been pretty well established. I have a medical condition, and they’re refusing to recognize this.”

While she was able to pay the $1,000, plus a $50 non-refundable deposit in storage fees for each specimen, she knows others who can’t afford it.

Schowalter’s two friends are transitioning as well. Neither of them could afford to bank their sperm before they started hormone therapy. They forged ahead, desperate to begin their medical transition, with no sperm saved.

“They missed the boat,” Schowalter says.

***

A study conducted by the Ontario-based Trans Pulse found that 27 per cent of trans people in Ontario have children. For trans women, the number shoots to 40 per cent. However, the study did not differentiate between those who had children before transitioning and those who had them afterward.

A 2011 study from Europe, “Reproductive wish in transsexual men,” showed more than half of trans men in Belgium said they wished to have children, and 37.5 per cent said they would have considered freezing their eggs before transitioning if the procedure had been available. A 2022 Western European study called “The desire to have children and the preservation of fertility in transsexual women” found that 40 per cent of trans women wanted to have children. More than half of the trans women who also identified as lesbian or bisexual expressed interest in using their own sperm.

There are significant barriers to trans reproduction, says LGBTQ expert Inkster.

The first is believing that you’re entitled to have children. There aren’t a lot of good trans parent role models, Inkster says.

They need to become educated on how to pursue it, despite a lack of resources, and find a clinic willing to help.

Many fertility clinics just don’t seem to “get” transgender couples, says Rachel Epstein, co-ordinator for the LGBTQ Parenting Network in Toronto. Gender and sexuality and how they interrelate is very complex, Epstein says, and clinics are based on a heterosexual, cisgender, man-woman model.

“So, all these other permutations and family configuration and kinship structures are just really hard for them to get their heads around,” she says.

Few fertility clinics in Canada have reached out to LGBTQ communities, Inkster says. If more had an awareness of trans issues, or even a brochure for patients, it would help immensely, he says.

Inkster isn’t just a professional expert. He was born with a female body, and started identifying as trans when he was a teenager in Kingston, Ont.

He was 24 when he realized he wanted children “imminently,” and started looking at his options.

“Going into a pregnancy, whether someone’s queer, gay, lesbian, trans or straight, they know it may take some time and there’s some prep work involved. But for straight people that path is a little clearer,” Inkster says.

He eventually used assisted reproductive technologies at a clinic in the United States, he says, but for legal reasons he doesn’t want to go into further details about the process or location.

His daughter was born in the U.S., the first child in that particular state to be recognized on a birth certificate as having a “parent” instead of a mother or father, Inkster says.

“Legally, she has me. And she calls me Papa,” he says.

***

Jacobs stored her sperm at a fertility clinic before taking hormones to begin her physical transition.

When she and Heller decided to start trying for a baby they went back to the same clinic. After four tries in four months, they still weren’t pregnant.

They took a month off to go on a vacation, and then tried again. But the fifth round was the one that left Heller bleeding, shaking and in shock from how they were treated.

“I can really recognize that our situation is maybe unique and many clinics or many care providers haven’t ever encountered clients that fit kind of our, um, fit our model so to speak,” Jacobs said, reaching out to touch Heller’s hand.

Heller later complained to the medical director and the vice-president of the clinic. The medical director just wanted to smooth things over. The vice-president also listened to Heller’s complaints, and explained that the clinic doesn’t have a lot of experience with patients like them, Heller said.

After three more failed IUI sessions they switched clinics and then got pregnant on the first try. Baby Simone was born April 2.

“For sure there’s some reproductive issues of not having all the same parts as the rest of the women in this world. . . . But we’ve been able to overcome them,” Jacobs said.

“I’m just really happy that there is a way that I can bring a child into this world, and I can be a mom.”

The Calgary Herald