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Bayar E, Williams NJ, Alghrani A, Murugesu S, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Sangster P, Yasmin E, Smith JR, Wilkinson S, Pacey A, Jones BP. Fertility preservation and realignment in transgender women. HUM FERTIL 2023; 26:463-482. [PMID: 36799335 DOI: 10.1080/14647273.2022.2163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2023]
Abstract
Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored.
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Affiliation(s)
- Erna Bayar
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicola J Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - Sughashini Murugesu
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - Philippa Sangster
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - J Richard Smith
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Benjamin P Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Rodriguez-Wallberg K, Obedin-Maliver J, Taylor B, Van Mello N, Tilleman K, Nahata L. Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:7-25. [PMID: 36713139 PMCID: PMC9879176 DOI: 10.1080/26895269.2022.2035883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background Hormonal treatments and surgical interventions practiced with the aim to affirm gender identity in transgender and gender diverse patients may impact their future reproductive ability, family building, and family planning options. Whereas it is recommended by international guidelines to discuss the potential risks of infertility and to present fertility preservation (FP) options to transgender individuals and their families prior to initiating any of these treatments, many barriers still remain. Further, transgender and gender diverse individuals often experience barriers to accessing contraception, abortion, pre-conception care, and comprehensive perinatal care. Aims In this review we summarize the current literature on reproductive healthcare issues reported in transgender people including fertility issues, fertility preservation (FP), contraception, pregnancy and lactation and perinatal health. Methods A narrative literature search of major databases (Pubmed, Medline, PsycInfo, Google Scholar, Web of Science) was conducted. Given the paucity and heterogeneity of studies, summative review tactics were not available. The literature was critically reviewed by international experts in the field with focus on the impact of gender-affirming medical interventions on future fertility, current FP options and reproductive health issues in transgender people. Results The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain. Discussion Specialized FP reproductive healthcare for transgender and gender diverse individuals is in early evolution. Research should be conducted to examine effects of medical interventions on fertility, timing of FP, gamete preservation and outcome of the fertility treatments. Strategies to inform and educate transgender and gender diverse patients can lead to optimization of reproductive care and counseling and decision making of FP for this population.
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Affiliation(s)
- Kenny Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pahology, Karolinska Institutet, Stockholm, Sweden
- Laboratory of Translational Fertility Preservation, NKS, Stockholm, Sweden
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Taylor
- Department of Obstetrics and Gynecology, Atrium Health, Charlotte, NC, USA
| | - Norah Van Mello
- Department of Obstetrics and Gynecology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, OH, USA
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Jones BP, Rajamanoharan A, Vali S, Williams NJ, Saso S, Thum MY, Ghaem-Maghami S, Quiroga I, Diaz-Garcia C, Thomas P, Wilkinson S, Yazbek J, Smith JR. Perceptions and Motivations for Uterus Transplant in Transgender Women. JAMA Netw Open 2021; 4:e2034561. [PMID: 33471119 PMCID: PMC7818101 DOI: 10.1001/jamanetworkopen.2020.34561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Uterus transplant has been demonstrated to be a viable fertility-restoring treatment for women categorized as female at birth with absolute uterine factor infertility. Recent advancements, as well as considerations of fairness and equality in reproductive care, have now led to the possibility of uterus transplant being undertaken in transgender women. OBJECTIVE To investigate the reproductive aspirations of transgender women and their perceptions of uterus transplant. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used a 27-item electronic questionnaire to investigate the reproductive aspirations of 182 transgender women older than 16 years, including their perceptions of and motivations for uterus transplant, between May 1 and November 1, 2019. MAIN OUTCOMES AND MEASURES Perceptions of and motivations for uterus transplant, including perceived significance of the ability to gestate, menstruate, and have a physiologically functioning vagina. RESULTS A total of 182 transgender women completed the questionnaire; most women (109 [60%]) were aged 20 to 29 years. Most did not have children prior to transitioning (167 [92%]) and expressed a desire to have children in the future (171 [94%]). In addition, most respondents agreed or strongly agreed that the ability to gestate and give birth to children (171 [94%]) and menstruate (161 [88%]) would enhance perceptions of their femininity. Similarly, high proportions strongly agreed or agreed that having a transplanted, functioning vagina would improve their sexual experience (163 [90%]), improve their quality of life (163 [90%]), and help them to feel like more of a woman (168 [92%]). Nearly all respondents (180 [99%]) believed that uterus transplant would lead to greater happiness in transgender women. More than three-quarters of the respondents (140 [77%]) strongly agreed or agreed that they would be more inclined to cryopreserve sperm if uterus transplant became a realistic option. CONCLUSIONS AND RELEVANCE This study provides insights into the reproductive aspirations of transgender women and reports on their multifaceted motivation to undergo uterus transplant. The survey responses suggest that transgender women would choose to have female physiologic experiences, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. If proven feasible and safe in this setting, uterus transplant may facilitate the achievement of reproductive aspirations, improve quality of life, and further alleviate dysphoric symptoms in transgender women.
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Affiliation(s)
- Benjamin P. Jones
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abirami Rajamanoharan
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | - Saaliha Vali
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Nicola J. Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, United Kingdom
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Meen-Yau Thum
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Lister Fertility Clinic, The Lister Hospital, London, United Kingdom
| | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Isabel Quiroga
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | | | - Philip Thomas
- Department of Gender Surgery, Charing Cross Hospital, London, United Kingdom
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, United Kingdom
| | - Joseph Yazbek
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - J. Richard Smith
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Jones BP, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Diaz-Garcia C, Friend P, Ghaem-Maghami S, Testa G, Johannesson L, Quiroga I, Yazbek J, Smith JR. Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG 2019; 126:1310-1319. [PMID: 31410987 DOI: 10.1111/1471-0528.15863] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.
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Affiliation(s)
- B P Jones
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - S Saso
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - T Bracewell-Milnes
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - M-Y Thum
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - J Nicopoullos
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - C Diaz-Garcia
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,IVI London, IVIRMA Global, London, UK
| | - P Friend
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - S Ghaem-Maghami
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - G Testa
- Baylor University Medical Center, Dallas, TX, USA
| | | | - I Quiroga
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Yazbek
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - J R Smith
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
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Hammond‐Browning N. Author's reply re: Uterine transplantation in transgender women: medical, legal and ethical considerations. BJOG 2019; 126:546. [DOI: 10.1111/1471-0528.15555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
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