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Barda S, Amir H, Mizrachi Y, Dviri M, Yaish I, Greenman Y, Sofer Y, Azem F, Hauser R, Lantsberg D. Sperm parameters in Israeli transgender women before and after cryopreservation. Andrology 2023; 11:1050-1056. [PMID: 36542410 DOI: 10.1111/andr.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-non-conforming individuals undergoing therapy for gender compatibility. OBJECTIVES To examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender-affirming hormonal medication. MATERIALS AND METHODS In this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000 and 2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed. RESULTS Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p < 0.001), lower sperm motility percentage (65.0% vs. 51.0%, respectively, p < 0.001), and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p < 0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0% vs. 45.0%, respectively, p < 0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p < 0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5% vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p < 0.01). DISCUSSION AND CONCLUSION Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women.
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Affiliation(s)
- Shimi Barda
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Israel Academic College, Ramat Gan, Israel
| | - Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michal Dviri
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Hauser
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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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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Stolk THR, Asseler JD, Huirne JAF, van den Boogaard E, van Mello NM. Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Pract Res Clin Obstet Gynaecol 2023; 87:102312. [PMID: 36806443 DOI: 10.1016/j.bpobgyn.2023.102312] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment.
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Affiliation(s)
- T H R Stolk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - J A F Huirne
- Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - E van den Boogaard
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - N M van Mello
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Center of Expertise on Gender Dysphoria, De Boelelaan 1117, Amsterdam University Medical Centers, the Netherlands; Amsterdam UMC, Department of Obstetrics & Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
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4
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Raja NS, Russell CB, Moravek MB. Assisted reproductive technology: considerations for the nonheterosexual population and single parents. Fertil Steril 2022; 118:47-53. [DOI: 10.1016/j.fertnstert.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
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de Nie I, Asseler J, Meißner A, Voorn-de Warem IAC, Kostelijk EH, den Heijer M, Huirne J, van Mello NM. A cohort study on factors impairing semen quality in transgender women. Am J Obstet Gynecol 2022; 226:390.e1-390.e10. [PMID: 34688596 DOI: 10.1016/j.ajog.2021.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transgender women (people assigned male genders at birth with female gender identities) can choose to cryopreserve semen before their medical transition, to retain the possibility to parent genetically related offspring later in life. Our previous retrospective study showed that semen quality in transgender women was decreased compared with the general population. The etiology of this impaired semen quality remains largely unknown. However, impaired semen quality might be related to habitual behavior more typically observed in transgender women, for example, the desire to hide their testicles because of genital dysphoria. Therefore, we decided to conduct a consecutive study with prospectively obtained data on behavior and lifestyle in transgender women. OBJECTIVE This study aimed to study the influence of a low ejaculation frequency, wearing tight undergarments, and bringing the testes in the inguinal position (tucking) on semen quality in transgender women at the time of fertility preservation. STUDY DESIGN In this cohort study, transgender women were included between May 2018 and September 2020, at the time of fertility counseling, before the start of hormonal treatment. Data were collected on demographics, lifestyle factors, medical history, endocrine laboratory results, and semen parameters. Semen parameters were categorized using reference values for human semen of the World Health Organization and compared with semen quality in the general population. The odds ratios with 95% confidence intervals were calculated using multivariable logistic regression analysis to assess the impact of tucking, wearing tight undergarments, and a low ejaculation frequency on semen quality, correcting for potential confounders. RESULTS Overall, 113 transgender women were included. Median semen parameters were significantly decreased than the general population. Crude logistic regression analyses showed an association between always wearing tight undergarments (odds ratio, 3.06; 95% confidence interval, 1.11-8.49) and extensive tucking (odds ratio, 6.09; 95% confidence interval, 1.54-24.01) on having a total motile sperm count of <5 million. Multivariable analyses showed that the association with tucking was independent of demographic factors, lifestyle factors, and medical history (odds ratio, 7.95; 95% confidence interval, 1.66-37.99). However, this was not the case for the association with always wearing tight undergarments (odds ratio, 2.89; 95% confidence interval, 0.95-8.82). Ejaculation frequency did not influence total motile sperm count. CONCLUSION Behavioral factors, including wearing tight undergarments and extensive tucking, may contribute to the lower semen quality in transgender women. These results will enable optimization of fertility counseling on how to adjust lifestyle before pursuing semen cryopreservation.
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Affiliation(s)
- Iris de Nie
- Department of Endocrinology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Joyce Asseler
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Andreas Meißner
- Department of Endocrinology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Ilona A C Voorn-de Warem
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - E Hanna Kostelijk
- IVF Center, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith Huirne
- Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Norah M van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands; Reproduction & Development Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
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6
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Fisher AD, Senofonte G, Cocchetti C, Guercio G, Lingiardi V, Meriggiola MC, Mosconi M, Motta G, Ristori J, Speranza AM, Pierdominici M, Maggi M, Corona G, Lombardo F. SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people. J Endocrinol Invest 2022; 45:657-673. [PMID: 34677807 DOI: 10.1007/s40618-021-01694-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/10/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.
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Affiliation(s)
- A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Senofonte
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Guercio
- Studio Legale Avv. Giovanni Guercio, Via Antonio Mordini, 14, 00195, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M C Meriggiola
- Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - M Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - A M Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185, Roma, Italy
| | - M Pierdominici
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - M Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl, Bologna, Italy
| | - F Lombardo
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Sapienza University of Rome, 00185, Rome, Italy.
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7
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Wilde M, Huguelet P, Alaniz VI. Transgender Medicine and Hormone Therapy: What the Gynecologist Needs to Know. Clin Obstet Gynecol 2021; 64:739-756. [PMID: 34292172 DOI: 10.1097/grf.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The transgender community comprises individuals with diverse identities in both gender and sexual orientation. Unfortunately, many face discrimination and harassment within our society-including within the medical system. There is an overall lack of provider training in transgender specific health which has led to health disparities and inequities within this population. This chapter aims to elucidate the medical needs unique to transgender and gender nonconforming individuals and thus enable medical providers to meet those needs with competency and compassion.
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Affiliation(s)
- Melyssa Wilde
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Sineath RC, Blasdel G, Dy GW. Addressing urologic health disparities in sexual and gender minority communities through patient-centered outcomes research. Urology 2021; 166:66-75. [PMID: 34774931 DOI: 10.1016/j.urology.2021.08.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 10/19/2022]
Abstract
Sexual and gender minority (SGM) communities face stigma and discrimination that impact all aspects of health. To better understand and improve their urologic health outcomes, we must study SGM patients as a distinct population and pursue research on outcomes identified as priorities to SGM communities. Patient-centered outcomes research (PCOR) is a methodology which is increasingly familiar to urologists and is crucial to adequately addressing SGM health in future urological research. We review existing literature focused on urologic outcomes of SGM populations and highlight specific PCOR initiatives built on SGM community engagement.
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Affiliation(s)
- R Craig Sineath
- Department of Urology, Oregon Health & Science University, Portland, Oregon.
| | - Gaines Blasdel
- Department of Urology, New York University Grossman School of Medicine, New York, New York
| | - Geolani W Dy
- Department of Urology, Oregon Health & Science University, Portland, Oregon
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9
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Medical therapies causing iatrogenic male infertility. Fertil Steril 2021; 116:618-624. [PMID: 34462096 DOI: 10.1016/j.fertnstert.2021.07.1202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 01/13/2023]
Abstract
Primum non nocere. As physicians, our goal is to treat illnesses and alleviate suffering; however, in doing so, we can generate new problems in a game of medical whack-a-mole. For some patients, certain consequences or side effects are tolerable, while others may believe they have no alternative. For a male patient with infertility, a thorough history is imperative to elucidate whether the patient has been or is currently being exposed to medications that will harm libido, spermatogenesis, ejaculation, or the hypothalamic-pituitary-testosterone axis. This article will review the most common medications causing iatrogenic male infertility as well as options to minimize or even reverse their impact.
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Schwartz AR, Moravek MB. Reproductive potential and fertility preservation in transgender and nonbinary individuals. Curr Opin Obstet Gynecol 2021; 33:327-334. [PMID: 34173770 DOI: 10.1097/gco.0000000000000729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To synthesize recent literature to better understand parenting desires and challenges of transgender individuals as well as the impact of gender-affirming care on reproductive potential. RECENT FINDINGS Survey studies of transgender and nonbinary individuals demonstrate significant parenting interest, yet uptake in fertility preservation services remains low with potential for decisional regret. Masculinizing hormones have demonstrated variable effects on folliculogenesis and follicle distribution in the human ovary. In the mouse model, testosterone administration has demonstrated an increase in atretic late antral follicles without a reduction in primordial or total antral follicle counts and a preserved ability to respond to gonadotropin stimulation. Case series of transgender individuals undergoing oocyte or embryo cryopreservation are promising with outcomes similar to cisgender controls. Feminizing hormones have shown detrimental effects on sperm parameters at time of cryopreservation and spermatogenesis in orchiectomy samples with uncertainty regarding the reversibility of these changes. SUMMARY Current evidence demonstrates variable effects of gender-affirming hormones on ovarian and testicular function with potential for detrimental impact on an individual's reproductive potential. As many individuals initiate gender-affirming care prior to or during their reproductive years it is imperative that they receive thorough fertility preservation counseling and improved access to reproductive care services.
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Affiliation(s)
- Amanda R Schwartz
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Sermondade N, Benaloun E, Berthaut I, Moreau E, Prades M, Béranger A, Chabbert-Buffet N, Johnson N, Lévy R, Dupont C. Reproductive functions and fertility preservation in transgender women: a French case series. Reprod Biomed Online 2021; 43:339-345. [PMID: 34144898 DOI: 10.1016/j.rbmo.2021.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION The reproductive potential of transgender people may be impaired by gender-affirming hormone treatment (GAHT) and is obviously suppressed by gender-affirming surgery involving bilateral orchiectomy. The evolution of medical support for transgender people has made fertility preservation strategies possible. Fertility preservation in transgender women mainly relies on sperm cryopreservation. There are few studies on this subject, and the sample sizes are small, and so it difficult to know whether fertility preservation procedures are feasible and effective in trans women. DESIGN This retrospective study reports the management of fertility preservation in transgender women referred to the study centre for sperm cryopreservation, and the semen parameters of trans women were compared with those of sperm donors. RESULTS Ninety-six per cent of transgender women who had not started treatment benefitted from sperm cryopreservation, compared with 80% of those who attempted a therapeutic window and 50% of those receiving hormonal treatment at the time of sperm collection. No major impairment of semen parameters was observed in transgender women who had not started GAHT compared with sperm donors. However, even though the frequency of oligozoospermia was no different, two transgender women presented azoospermia. Some transgender women who had started GAHT could benefit from sperm freezing. None of them were treated with gonadotrophin-releasing hormone (GnRH) analogues. CONCLUSIONS Parenthood strategies for transgender people have long been ignored, but this is an important issue to consider, especially because medical treatments and surgeries may be undertaken in adolescents or very young adults. Fertility preservation should ideally be offered prior to initiation of GAHT.
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Affiliation(s)
- Nathalie Sermondade
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France
| | - Emmanuelle Benaloun
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Isabelle Berthaut
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Emilie Moreau
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Marie Prades
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Alix Béranger
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne Université, 75020 Paris, France
| | - Nicolaï Johnson
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon (AP-HP), Sorbonne Université, 75020 Paris, France
| | - Rachel Lévy
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France
| | - Charlotte Dupont
- Service de Biologie de la Reproduction CECOS, Hôpital Tenon (AP-HP), Sorbonne Université, Paris 75020, France; Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm US938, Paris 75012, France.
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de Nie I, Meißner A, Kostelijk EH, Soufan AT, Voorn-de Warem IAC, den Heijer M, Huirne J, van Mello NM. Impaired semen quality in trans women: prevalence and determinants. Hum Reprod 2021; 35:1529-1536. [PMID: 32613241 PMCID: PMC7368399 DOI: 10.1093/humrep/deaa133] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
STUDY QUESTION What is the semen quality in trans women at time of fertility preservation, prior to the start of gender-affirming hormone treatment? SUMMARY ANSWER Before the start of gender-affirming hormone treatment, semen quality in trans women was already strongly decreased compared to the general population. WHAT IS KNOWN ALREADY Hormone treatment for -trans women (birth-assigned males, female gender identity) consists of anti-androgens combined with estrogens in order to achieve feminization and it is accompanied by a loss of reproductive capability. Trans women can opt for semen cryopreservation prior to their medical transition to retain the possibility to parent genetically related offspring. Post-thaw semen parameters determine which ART can be used. Knowledge of semen quality and the factors negatively influencing semen parameters in trans women are important to improve semen quality before fertility preservation. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was performed between 1972 and 2017. In total, 260 trans women were included for this study. Due to the study design, there was no loss to follow-up or attrition. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied the quality of the preserved semen in trans women, prior to their medical transition, who visited our gender clinic. Semen parameters were collected, as well as data on age, alcohol consumption, smoking, cannabis use, BMI, previous use of estrogens or anti-androgens and endocrine laboratory results. Semen parameters were categorized using reference values for human semen of the World Health Organization (WHO) and compared with data from the general population. Logistic regression analyses were performed to analyze the extent to which factors known to have a negative impact on semen quality in the general population explained the impaired semen quality in the cohort. MAIN RESULTS AND THE ROLE OF CHANCE The cohort consisted of 260 trans women between the age of 16 and 52 years. Semen quality in trans women was significantly decreased compared to WHO data from the general population. In total, 21 trans women had an azoospermia and median semen parameters for the remaining trans women and the general population, respectively, were as follows: volume 2.7 and 3.2 ml (P < 0.05), sperm concentration 40 and 64 million/ml (P < 0.05), total sperm number 103 and 196 million (P < 0.05) and progressive motility 41% and 57% (P < 0.05). Smoking (odds ratio (OR) 2.35 (95% CI 1.06–5.21)) and a higher age at time of fertility preservation (OR 1.04 (95% CI 1.00–1.08)) were found to correlate with an impaired progressive motility. Twelve trans women reported to have used anti-androgens and estrogens, and all had discontinued for at least 3 months prior to the first attempt for semen cryopreservation. No correlation was found between previous gender-affirming hormone use and decreased semen parameters. The median post-thaw total motile sperm count was 1.0 million per vial (interquartile range 0.1–3.1) and in only 26.4% of thawed semen samples was the quality adequate for a minimally invasive IUI. LIMITATIONS, REASONS FOR CAUTION Limitations include the retrospective design and insufficient data on transgender-specific factors, such as bringing the testes into the inguinal position (tucking), wearing tight underwear and low masturbation frequency. WIDER IMPLICATIONS OF THE FINDINGS Semen quality in trans women was decreased compared to the general population, which could not be explained by known risk factors, such as BMI, alcohol consumption, cannabis use, gender-affirming hormone use or abnormal endocrine laboratory results. Although a negative impact of smoking was observed, it was insufficient to explain the overall decreased semen quality in this cohort. Since low pre-freeze semen quality results in an even lower post-thaw semen quality, the majority of trans women and their female partner or surrogate may need an invasive and burdensome treatment to establish a pregnancy. STUDY FUNDING/COMPETING INTEREST(S) For this study, no external funding was obtained and there were no competing interests. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- I de Nie
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands.,Amsterdam Reproduction & Development research institute, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands
| | - A Meißner
- Center for Reproductive Medicine, Amsterdam UMC, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands.,Department of Urology, Amsterdam UMC, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - E H Kostelijk
- IVF Center, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands
| | - A T Soufan
- Center for Reproductive Medicine, Amsterdam UMC, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - I A C Voorn-de Warem
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands
| | - M den Heijer
- Department of Endocrinology, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands
| | - J Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, VU University Medical Centre, 1081 HV Amsterdam, the Netherlands
| | - N M van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, 1081 HV Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam UMC, VU University Medical Centre, 1081 HV Amsterdam, the Netherlands
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Yan M, Bustos SS, Kuruoglu D, Ciudad P, Forte AJ, Kim EA, Del Corral G, Manrique OJ. Systematic review of fertility preservation options in transgender patients: a guide for plastic surgeons. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:613. [PMID: 33987311 DOI: 10.21037/atm-20-4523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transgender patients often desire to have biological children. However, their reproductive potential is often negatively impacted by gender affirming surgery (GAS) such as gender confirmation surgery (bottom surgery) and medical hormone therapy. Therefore, counselling patients on fertility preservation options before initiating gender-affirming treatments is prudent to avoid reducing their reproductive potential. A systematic review of English, Spanish, Chinese, French and Turkish languages from 2000 to December 23rd, 2019, using the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines, was conducted. The search strategy was designed and conducted by an experienced librarian with input from the study's principle investigator. Fifteen articles that report outcomes of fertility preservation options in transgenders were included. Eight articles described options for transgender women, six reported options for transgender men and one included both transgender women and transgender men. Semen cryopreservation and oocyte cryopreservation are the most common and available methods for fertility preservation in transgenders. Physician awareness of fertility preservation options in transgender patients is crucial to ensure informed discussions regarding reproductive options in the early phase of transition.
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Affiliation(s)
- Maria Yan
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Doga Kuruoglu
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Antonio J Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Esther A Kim
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, California, USA
| | - Gabriel Del Corral
- Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [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: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Building a Multidisciplinary Academic Surgical Gender-affirmation Program: Lessons Learned. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3478. [PMID: 33968551 PMCID: PMC8099415 DOI: 10.1097/gox.0000000000003478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
Background: Every day, we see more patients present to hospitals and clinics seeking gender-affirmation care to ameliorate the symptoms of gender dysphoria. However, to provide a multidisciplinary approach, it is important to offer an integrated clinical program that provides mental health assessment, endocrine therapy, physical therapy, research, and the full spectrum of surgical services devoted to transgender patients. This article describes our experience on building a specialized, multidisciplinary, academic state-of-the-art gender-affirmation program. Methods: Herein, we describe the main and critical components on how to build a multidisciplinary academic gender-affirmation program. We share our lessons learned from this experience and describe how to overcome some of the obstacles during the process. Results: Building a multidisciplinary academic gender-affirmation program requires an invested team, as each and every member is essential for feedback, referrals, and to improve patient’s experience. Institutional support is essential and by far the most important component to overcome some of the obstacles during the process. Having all team members working under the same institution provides all the critical components needed to improve outcomes and patient satisfaction. In addition, the collection of prospective data with a well-structured research team will provide information needed to improve clinical services and standardize clinical protocols, while leaving space for innovation. Conclusions: This article describes the steps and experience needed to build a multidisciplinary holistic academic gender-affirmation program. We provide our lessons learned during the process that will help guide those who intend to start an academic gender-affirmation program.
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Rodriguez-Wallberg KA, Häljestig J, Arver S, Johansson ALV, Lundberg FE. Sperm quality in transgender women before or after gender affirming hormone therapy-A prospective cohort study. Andrology 2021; 9:1773-1780. [PMID: 33683832 DOI: 10.1111/andr.12999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to recent changes in the legal framework, access to fertility preservation (FP) for transgender individuals has opened up in several countries. In Sweden and the Nordic countries, fertility preservation for medical reasons is fully reimbursed as part of the established tax-funded healthcare services. As this issue is relatively new, procedures for FP have seldom been reported in the transgender patient population. The very limited literature has indicated that transgender women may have poorer sperm quality than cisgender men when assessing samples aimed at semen banking. OBJECTIVES To assess sperm quality parameters of semen samples provided for FP by transgender women before or after gender affirming hormone therapy (GAHT), and to compare sperm quality with a reference population of unscreened men defined by the World Health Organization (WHO). Additionally, we aimed to describe referral patterns over calendar time and estimate time from referral to semen cryopreservation. MATERIAL AND METHODS Prospective cohort study of 212 transgender women referred for FP to the Reproductive Medicine Clinic of Karolinska University Hospital, Sweden, between 2013 and 2018. Among 177 individuals that provided semen samples for cryopreservation, 16 had previously received GAHT. RESULTS Individuals with previous GAHT presented with significantly lower total sperm count than individuals without GAHT (p = 0.002). However, higher proportions of sperm abnormalities were also noted among individuals who had not undergone previous GAHT, compared to the WHO reference population (p < 0.001). Referrals of transgender women for FP increased over time. The median time from referral to semen cryopreservation was 27 days. CONCLUSIONS A high occurrence of sperm abnormalities was found in transgender women, especially among individuals who had previously received GAHT. The results underline the importance of thoroughly discussing parenthood options and FP with patients early after diagnosis and referring the patients for semen banking preferably before starting GAHT.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden
| | - Jakob Häljestig
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden
| | - Stefan Arver
- Department of Medicine/Huddinge, Karolinska Institutet and ANOVA Andrology, Sexual Medicine, Trans Medicine Karolinska University Hospital, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Frida E Lundberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Benaloun E, Sermondade N, Moreau E, Chabbert-Buffet N, Cristofari S, Johnson N, Lévy R, Dupont C. [Fertility preservation for transwomen]. ACTA ACUST UNITED AC 2021; 49:547-552. [PMID: 33434749 DOI: 10.1016/j.gofs.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/19/2022]
Abstract
The evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The "reproductive" aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women ("male to female"). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process.
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Affiliation(s)
- E Benaloun
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Sermondade
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - E Moreau
- Service de biologie de la reproduction CECOS, AP-HP, hôpital Tenon, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - S Cristofari
- Service de chirurugie plastique reconstructrice et esthétique, AP-HP, hôpital Tenon, Sorbonne université, Paris, France
| | - N Johnson
- Service de gynécologie-obstétrique et médecine de la reproduction, AP-HP, hôpital Tenon, Paris, France
| | - R Lévy
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France
| | - C Dupont
- Service de biologie de la reproduction-CECOS, AP-HP, hôpital Tenon, Sorbonne université, Saint-Antoine Research centre, Inserm équipe lipodystrophies génétiques et acquises, Paris, France.
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18
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Paoli D, Dal Canto M, Baldi E, Cervi M, Ciotti PM, Ciriminna R, Dabizzi S, Farace D, Garello C, Garolla A, Giacchetta D, Gualtieri R, Menegazzo M, Minasi MG, Oneta M, Pisaturo V, Rienzi L, Scarica C, Taliani G, De Santis L. Cryopreserved Gamete and Embryo Transport: Proposed Protocol and Form Templates-SIERR (Italian Society of Embryology, Reproduction, and Research). Biopreserv Biobank 2020; 19:27-32. [PMID: 33026886 DOI: 10.1089/bio.2020.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: In Italy, the transport of cryopreserved biological material is controlled by several Decrees (Legislative Decree No. 191/2007 and No. 16/2010 and Health Ministry's Decree of October 10, 2012). Given the nature of their applications, the transport of reproductive cells has peculiar quality and safety requirements that must be applied universally, minimizing the chance of error. To standardize the cross-border shipping procedure to meet the quality, traceability, and safety criteria for cells and tissues, it is appropriate to establish a unified process using the same tools, forms, and communication channels. Methods: A working group has been created by SIERR. This "FOCUS Group" was constituted by representatives from Italian-assisted reproductive technology centers and sperm banks who worked together to define joint procedural steps and create specific forms to support the movement of cryopreserved samples. Results: The FOCUS Group identified the critical steps in the communication procedures between Italian centers and created the related forms: patient authorization, request from the recipient center, critical checks carried out by both sending and recipient centers, start of samples transfer, collection, transport and taking responsibility of the biological material, acknowledgment of samples arrival, and acknowledgement of any adverse event that occurred. Discussion: Indications on shipping between tissue institutions and legal responsibilities are important points and a working protocol with shared transport forms has been defined. Standard Operating Procedures are necessary in light of the increasingly widespread movement of biological samples between the various countries, and represent a valid means of support for the patients who could have a higher awareness of safety and traceability during each stage of gamete transport.
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Affiliation(s)
- Donatella Paoli
- Laboratory of Seminology-"Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Cervi
- IVF Unit, Azienda Sanitaria Friuli Occidentale ASFO, Sacile, Italy
| | - Patrizia Maria Ciotti
- Infertility and In Vitro Fertilization Unit, University Hospital S. Orsola, Bologna, Italy
| | | | - Sara Dabizzi
- Unit of Andrology-Female Endocrinology and Gender Incongruence, Careggi Hospital, Florence, Italy
| | - Dario Farace
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Andrea Garolla
- Andrology and Reproductive Medicine, University Hospital, Padova, Italy
| | - Daniela Giacchetta
- Laboratory of Seminology and Male Gametes Cryopreservation, San Paolo University Hospital, Milan, Italy
| | | | - Massimo Menegazzo
- Andrology and Reproductive Medicine, University Hospital, Padova, Italy
| | | | - Monica Oneta
- Reproductive Unit, Department of Obstetric and Gynaecology, Sacco Clinical Sciences Institute, Milan, Italy
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, Genera Centers for Reproductive Medicine, Roma, Italy
| | - Catello Scarica
- Casa di cura Villa Salaria in Partnership with Institut Marques, Rome, Italy
| | - Gloria Taliani
- Umberto I Hospital, Sapienza of Rome University, Rome, Italy
| | - Lucia De Santis
- IVF Unit, Department Ob/Gyn, Vita-Salute University, Milan, Italy
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19
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Mayhew AC, Gomez-Lobo V. Fertility Options for the Transgender and Gender Nonbinary Patient. J Clin Endocrinol Metab 2020; 105:5892794. [PMID: 32797184 PMCID: PMC7455280 DOI: 10.1210/clinem/dgaa529] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Comprehensive care for transgender and gender nonbinary patients has been a priority established by the World Professional Association for Transgender Health. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition can affect gonadal function, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. In this review, we outline the impacts of gender-affirming treatments on fertility potential and discuss the counseling and the treatment approach for fertility preservation and/or family building in transgender and gender nonbinary individuals.
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Affiliation(s)
- Allison C Mayhew
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
| | - Veronica Gomez-Lobo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Children’s National Medical Center, Washington, DC
- Correspondence and Reprint Requests: Veronica Gomez-Lobo, MD, National Institute of Child Health and Human Development, Children’s National Medical Center, Division of Pediatric and Adolescent Gynecology, 10 Central Dr, Bldg 10, Rm 8N248, Bethesda, MD 20892, USA. E-mail:
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20
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Fertility preservation options for transgender and gender-nonconforming individuals. Curr Opin Obstet Gynecol 2020; 31:170-176. [PMID: 30870185 DOI: 10.1097/gco.0000000000000537] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of the current state of knowledge of fertility risks of gender-affirming therapy, review fertility preservation options for transgender individuals and ways to minimize gender dysphoria during fertility treatment, and identify gaps in knowledge. RECENT FINDINGS Recent studies have corroborated older data that gender-affirming hormone therapy creates histopathological changes in the gonads; however, the newer data suggests that some function of the gametes may be preserved. One study in transgender men reported successful in-vitro maturation of testosterone-exposed oocytes with normal spindle structures, and recent studies in transgender women reveal early spermatogenesis in estradiol-exposed testes and some recovery of semen parameters following cessation of hormones. Particular attention has recently been given to fertility preservation in transgender adolescents, revealing unmet informational needs in this population and very few are actually pursuing fertility preservation, even with counseling. SUMMARY There is currently a paucity of data on the fertility effects of gender-affirming hormones, necessitating fertility preservation counseling prior to initiation of therapy. Several modifications can be made to fertility preservation protocols and procedures to decrease gender dysphoria or distress in transgender individuals, but outcome data is still lacking. Achieving high-quality data collection will likely require cooperation across multiple institutions.
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Abstract
Gender affirming medical and surgical treatments affect the reproductive potential of transgender individuals. Prior to the development of assisted reproductive technologies (ART), genital gender-affirming surgery frequently eliminated a patient’s reproductive potential. Today, all patients should be counseled on their fertility preservation (FP) options before medical and surgical transition, yet this appears to seldom occur in practice. The following review is the result of a systematic literature search of PubMed, Medline and Google Scholar to identify current and future FP options, barriers to treatment patients face, practice patterns of transgender health care providers, and if there were any standardized counseling protocols. Options for transwomen at any point in their transition range from simply providing a semen sample to be used with assistive reproductive techniques to experimental techniques involving testicular cryopreservation followed by in vitro initiation of spermatogenesis. Transmen before and after starting hormone therapy can pursue any assistive reproductive techniques available for ciswomen. Future options currently under investigation include ovarian tissue cryopreservation (OTC) with in vitro oocyte maturation. In addition to counseling about their FP options, patients should be advised prospectively about the requirements, process details, the total costs associated with achieving pregnancy, and the inherent risks associated with using preserved genetic material including risk of failure, and maternal and fetal health risks. Transgender patients report using assistive reproductive services difficult, due to a lack of dialogue about fertility and the lack of information offered to them- presumably because their circumstances do not fit into a traditional narrative familiar to providers. Physicians and health care providers would benefit from better educational tools to help transgender patients make informed decisions and better training about transgender patients in general, and FP options available to them.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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22
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Baram S, Myers SA, Yee S, Librach CL. Fertility preservation for transgender adolescents and young adults: a systematic review. Hum Reprod Update 2019; 25:694-716. [DOI: 10.1093/humupd/dmz026] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/21/2019] [Accepted: 07/14/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
BACKGROUND
Many transgender individuals choose to undergo gender-affirming hormone treatment (GAHT) and/or sex reassignment surgery (SRS) to alleviate the distress that is associated with gender dysphoria. Although these treatment options often succeed in alleviating such symptoms, they can also negatively impact future reproductive potential.
OBJECTIVE AND RATIONALE
The purpose of this systematic review was to synthesize the available psychosocial and medical literature on fertility preservation (FP) for transgender adolescents and young adults (TAYAs), to identify gaps in the current research and provide suggestions for future research directions.
SEARCH METHODS
A systematic review of English peer-reviewed papers published from 2001 onwards, using the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines, was conducted. Four journal databases (Ovid MEDLINE, PubMed Medline, Ovid Embase and Ovid PsychINFO) were used to identify all relevant studies exploring psychosocial or medical aspects of FP in TAYAs. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Bibliographies of the selected articles were also hand searched and cross-checked to ensure comprehensive coverage. All selected papers were independently reviewed by the co-authors. Characteristics of the studies, objectives and key findings were extracted, and a systematic review was conducted.
OUTCOMES
Included in the study were 19 psychosocial-based research papers and 21 medical-based research papers that explore fertility-related aspects specific for this population. Key psychosocial themes included the desire to have children for TAYAs; FP discussions, counselling and referrals provided by healthcare providers (HCPs); FP utilization; the attitudes, knowledge and beliefs of TAYAs, HCPs and the parents/guardians of TAYAs; and barriers to accessing FP. Key medical themes included fertility-related effects of GAHT, FP options and outcomes. From a synthesis of the literature, we conclude that there are many barriers preventing TAYAs from pursuing FP, including a lack of awareness of FP options, high costs, invasiveness of the available procedures and the potential psychological impact of the FP process. The available medical data on the reproductive effects of GAHT are diverse, and while detrimental effects are anticipated, the extent to which these effects are reversible is unknown.
WIDER IMPLICATIONS
FP counselling should begin as early as possible as a standard of care before GAHT to allow time for informed decisions. The current lack of high-quality medical data specific to FP counselling practice for this population means there is a reliance on expert opinion and extrapolation from studies in the cisgender population. Future research should include large-scale cohort studies (preferably multi-centered), longitudinal studies of TAYAs across the FP process, qualitative studies of the parents/guardians of TAYAs and studies evaluating the effectiveness of different strategies to improve the attitudes, knowledge and beliefs of HCPs.
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Affiliation(s)
- Shira Baram
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
| | - Samantha A Myers
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Samantha Yee
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
| | - Clifford L Librach
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario M5G 1N8, Canada
- Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Physiology, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Institute of Medical Science, University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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23
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Liu W, Schulster ML, Alukal JP, Najari BB. Fertility Preservation in Male to Female Transgender Patients. Urol Clin North Am 2019; 46:487-493. [PMID: 31582023 DOI: 10.1016/j.ucl.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.
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Affiliation(s)
- Wen Liu
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Michael L Schulster
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA
| | - Joseph P Alukal
- Department of Urology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Bobby B Najari
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, 222 East 41st Street, New York, NY 10017, USA; Department of Population Health, NYU Langone Medical Center, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
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24
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Marsh C, McCracken M, Gray M, Nangia A, Gay J, Roby KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet 2019; 36:1639-1648. [PMID: 31250175 DOI: 10.1007/s10815-019-01504-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study was undertaken to compare semen quality, hormonal status, and social factors in transgender women seeking fertility preservation with those of fertile cisgender men. Long-range goals are to establish standard practice measures ensuring optimum semen quality for cryopreservation and fertility preservation in transgender women. METHODS This is a case-control study carried out at an academic medical center. Cases are transgender women seeking fertility preservation prior to initiation of hormone therapy. Controls are cisgender men recently fathering a child. All participants completed the Depression Anxiety Stress Scales 21 survey and additional survey questions related to personal behaviors. Complete semen analysis was carried out in a clinical andrology laboratory according to WHO guidelines, 5th edition. Serum follicle stimulating hormone, estradiol, and testosterone were measured at the time of semen analysis. RESULTS Sperm concentration, total sperm per ejaculate, total motile sperm, volume, and normal sperm morphology were significantly lower in transgender females compared with fertile cisgender men. Other measures of semen parameters and hormone concentrations were not different between groups. Survey results indicated transgender women were more likely to have symptoms of depression, anxiety, and stress and utilize tucking and tight undergarments, compared with controls; however, both groups reported similar numbers of ejaculations per week. CONCLUSIONS Although semen parameters were low, cryopreservation of sperm prior to hormone therapy is a viable fertility preservation option for most transgender women. The etiology of the differences in semen parameters is not known. Enhanced education related to personal behaviors or treatment to reduce effects of stressors prior to cryopreservation may improve future fertility potential.
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Affiliation(s)
- Courtney Marsh
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Megan McCracken
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Meredith Gray
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Ajay Nangia
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Judy Gay
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Katherine F Roby
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Department of Anatomy & Cell Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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25
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Cheng PJ, Pastuszak AW, Myers JB, Goodwin IA, Hotaling JM. Fertility concerns of the transgender patient. Transl Androl Urol 2019; 8:209-218. [PMID: 31380227 DOI: 10.21037/tau.2019.05.09] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.
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Affiliation(s)
- Philip J Cheng
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Isak A Goodwin
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
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26
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Brik T, Vrouenraets LJJJ, Schagen SEE, Meissner A, de Vries MC, Hannema SE. Use of Fertility Preservation Among a Cohort of Transgirls in the Netherlands. J Adolesc Health 2019; 64:589-593. [PMID: 30691936 DOI: 10.1016/j.jadohealth.2018.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The primary aims of the study are to examine the rate of attempted fertility preservation (FP) among a Dutch cohort of transgirls who started gonadotropin-releasing hormone analog treatment and the reasons why adolescents did or did not choose to attempt FP. METHODS The study was a single-center retrospective review of medical records of 35 transgirls who started gonadotropin-releasing hormone analog treatment between 2011 and 2017. RESULTS Ninety-one percent of adolescents were counseled on the option of FP. Thirty-eight percent of counseled adolescents attempted FP, and 75% of them were able to cryopreserve sperm suitable for intrauterine insemination or intracytoplasmic sperm injection. Younger and Caucasian transgirls were less likely to attempt FP. No specific reason for declining FP was known in 33% adolescents, 32% of adolescents were not able to produce a semen sample because of early puberty, 17% felt uncomfortable with masturbation, 17% did not want to have children, and 13% wanted to adopt. CONCLUSIONS One third of adolescents attempted FP, which is much more than the percentage reported in previous studies from the United States. One third of the transgirls could not make use of FP because they were unable to produce a semen sample because of early pubertal stage. For these adolescents, alternatives need to be explored.
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Affiliation(s)
- Tessa Brik
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieke J J J Vrouenraets
- Department of Pediatric Psychology, Curium-Leiden University Medical Center, Leiden, The Netherlands
| | | | - Andreas Meissner
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabine E Hannema
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
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