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People assigned male at birth generally do not have the anatomy needed for natural embryonic and fetal development. Today, there are no successful cases regarding uterus transplant concerning a transgender woman. The theoretical issue of ectopic pregnancy (pregnancy outside the uterine cavity) by implantation in persons assigned male at birth has been addressed by experts in the field of fertility medicine, who stress that the concept of ectopic implantation, while theoretically plausible, has never been attempted and would be difficult to justify – even for cisgender women lacking a uterus – owing to the extreme health risks to both the parent and child.
Robert Winston, a pioneer of in-vitro fertilization, told London's Sunday Times that "male pregnancy would certainly be possible" by having an embryo implanted in a man's abdomen – with the placenta attached to an internal organ such as the bowel – and later delivered by Caesarean section. Ectopic implantation of the embryo along the abdominal wall, and resulting placenta growth would, however, be very dangerous and potentially fatal for the host, and is therefore unlikely to be studied in humans.
Pregnancy is possible for transgender men who retain a functioning vagina, ovaries and a uterus. Regardless of prior hormone replacement therapy treatments, the progression of pregnancy and birthing procedures are typically the same as those who are cisgender females. However, trans men who partake in gestation are often subjected to a variety of negative, social, emotional, and medical experiences, as pregnancy is regarded as an exclusively feminine or female activity. According to the study "Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning" by the American College of Obstetricians and Gynecologists, there is a lack of awareness, services, and medical assistance available to pregnant trans men. Inaccessibility to these services may lead to difficulty in finding comfortable and supportive services concerning prenatal care, as well as an increased risk for unsafe or unhealthy practices. Additionally, the study also exposed that some individuals reported having gender dysphoria and feelings of isolation due to the drastic changes in appearance which occur during pregnancy, such as enlarged breasts, and due to changes in public reception of their gender identity. Researchers also found that prior use of testosterone did not affect pregnancy.
Matt Rice, a transgender man, bore a son named Blake in October 1999 following random sperm donations from three cisgender male friends during a relationship with transgender writer Patrick Califia.
Thomas Beatie, another transgender man, has borne three children. He chose to become pregnant because his wife Nancy was infertile, doing so with cryogenic donated sperm and a syringe, at home. Thomas wrote an article about the experience in The Advocate. The Washington Post further broadened the story on March 25 when blogger Emil Steiner called Beatie the first "legally" pregnant man on record, in reference to certain states' and federal legal recognition of Beatie as male, though partially male. In 2010, Guinness World Records recognized Beatie as the world's "First Married Man to Give Birth." Beatie gave birth to a girl named Susan Juliette Beatie on June 29, 2008. Barbara Walters announced Beatie's second pregnancy on The View, and Beatie gave birth to a boy named Austin Alexander Beatie on June 9, 2009. Beatie gave birth to his third child, a boy named Jensen James Beatie, on July 25, 2010.
Yuval Topper, an Israeli transgender man, gave birth to a child on December 28, 2011. Fernando Machado, a South American transgender man, gave birth to a child. The baby is a biological child between Machado and his trans female wife Diane Marie Rodriguez Zambrano. More cases are documented in the United Kingdom and Australia. According to figures compiled by Medicare for Australia, one of the few national surveys as of 2019, 75 people who identified as male gave birth naturally or via C-section there in 2016, and 40 in 2017.
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