Successful In Vitro Fertilization in a Cisgender Female Carrier Using Oocytes Retrieved From a Transgender Man Maintained on Testosterone

Background

Health care providers routinely discontinue testosterone in transgender men undergoing oocyte retrieval. To date, there is little literature to support such discontinuation. The sudden drop in testosterone levels can be distressing for transgender men. The objective of this report was to describe a case study of successful reciprocal in vitro fertilization (IVF) using oocytes retrieved from a transgender man who remained on testosterone during the entire course of gonadotropin controlled ovarian stimulation and retrieval.

Case Report

A 33-year-old gravida 0 transgender man and his partner, a 42-year-old gravida 0 cisgender woman, presented to an outpatient clinic in 2017 seeking reciprocal IVF. Both patients were healthy with no significant past medical history. The transgender patient reported a 10-year history of testosterone hormone therapy. Both patients reported no other medication use. The transgender man underwent a 14-day course of ovarian stimulation before oocytes were retrieved. An oocyte was then fertilized and implanted into the uterus of the patient’s cisgender female partner. The reciprocal IVF resulted in an uncomplicated, full-term pregnancy with vaginal delivery. The child is now 2 years old and developmentally normal.

Discussion

To our knowledge, this is the first report of a live birth from an oocyte retrieved from a transgender man who continued to use testosterone throughout assisted reproduction.

Conclusion

Fertility preservation options for transmasculine people may include stimulated egg retrieval if the ovaries are left in place even when the patients remain on testosterone therapy.

MON-198 Feminizing Regimen Requirements in Transgender Females Following Orchiectomy

Introduction: Transgender females (TF) may undergo orchiectomy as part of their treatment. However, there is no clear recommendation in hormonal transition between pre- and post-orchiectomy (1, 2). Methods: All TF with orchiectomy in the transgender registry at Boston Medical Center (BMC) were reviewed. Feminizing regimens prior to and after orchiectomy were evaluated. The type, form and dose of hormones along with serum estradiol, testosterone, FSH and LH were assessed. Results: 124 TF consented to be included in the transgender registry at BMC. 23 of 124 (18%) TF had orchiectomy. 10/23 TF had the hormonal regimen available pre-orchiectomy and 6 months or more post-orchiectomy. All 10 TF used oral 17-beta estradiol. 6 TF were prescribed less estradiol relative to their pre-orchiectomy regimen, 3 were prescribed the same estradiol dose and 1 was prescribed a higher estradiol dose. An average of adjusted post-orchiectomy estradiol doses was 78% (range 50%-150%) of pre-orchiectomy dose. Among 10 TF with an available hormone regimen pre-and post-orchiectomy, 5 (50%) had serum estradiol at goal (100-200 pg/mL) and FSH in a pre-menopausal cis-female range. Among these 5 TF, the average of the adjusted post-orchiectomy estradiol dose was 96% (range 50%-150%) of the pre-orchiectomy dose. Estradiol doses up to 6 months or more following orchiectomy were available in 17 TF. 15 used oral 17-beta estradiol (average dose of 3.1mg/day with the range of 1-8 mg), 1 used oral conjugated estradiol and 1 used 17-beta estradiol gel. 7/17 had estradiol level at goal (100-200 pg/mL) and FSH in the pre-menopausal female range. All 7 TF used oral 17-beta estradiol. An average of post-orchiectomy estradiol doses was 2.85 mg/day (range 1-5 mg). Conclusion: Most TF who underwent orchiectomy had a lower estradiol dose (approximately 75% of the pre-orchiectomy regimen). However, to achieve the estradiol level at goal and maintain FSH in the the pre-menopausal female range, trans women required estradiol doses closer to the pre-orchiectomy regimen. The dose range of oral 17-beta estradiol in post-orchiectomy TF is 1-5 mg, similar to recommendations for TF who have not undergone orchiectomy (2-6 mg) (1). References: (1) Hembree et al., J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869–903. (2) Coleman et al., International Journal of Transgenderism. 2012;13:4, 165-232.

Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study

BACKGROUND

Venous thromboembolism (VTE), ischemic stroke, and myocardial infarction in transgender persons may be related to hormone use.

OBJECTIVE

To examine the incidence of these events in a cohort of transgender persons.

DESIGN

Electronic medical record-based cohort study of transgender members of integrated health care systems who had an index date (first evidence of transgender status) from 2006 through 2014. Ten male and 10 female cisgender enrollees were matched to each transgender participant by year of birth, race/ethnicity, study site, and index date enrollment.

SETTING

Kaiser Permanente in Georgia and northern and southern California.

PATIENTS

2842 transfeminine and 2118 transmasculine members with a mean follow-up of 4.0 and 3.6 years, respectively, matched to 48 686 cisgender men and 48 775 cisgender women.

MEASUREMENTS

VTE, ischemic stroke, and myocardial infarction events ascertained from diagnostic codes through the end of 2016 in transgender and reference cohorts.

RESULTS

Transfeminine participants had a higher incidence of VTE, with 2- and 8-year risk differences of 4.1 (95% CI, 1.6 to 6.7) and 16.7 (CI, 6.4 to 27.5) per 1000 persons relative to cisgender men and 3.4 (CI, 1.1 to 5.6) and 13.7 (CI, 4.1 to 22.7) relative to cisgender women. The overall analyses for ischemic stroke and myocardial infarction demonstrated similar incidence across groups. More pronounced differences for VTE and ischemic stroke were observed among transfeminine participants who initiated hormone therapy during follow-up. The evidence was insufficient to allow conclusions regarding risk among transmasculine participants.

LIMITATION

Inability to determine which transgender members received hormones elsewhere.

CONCLUSION

The patterns of increases in VTE and ischemic stroke rates among transfeminine persons are not consistent with those observed in cisgender women. These results may indicate the need for long-term vigilance in identifying vascular side effects of cross-sex estrogen.

PRIMARY FUNDING SOURCE

Patient-Centered Outcomes Research Institute and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Radiology on the information superhighway

PURPOSE

To explore the potential for the information superhighway to provide radiologists with new opportunities.

MATERIALS AND METHODS

The Internet was used as the communication and distribution medium. MOSAIC, a graphical interface, provided access for clients, and a computer was used to serve text, images, sound, and cine onto the Internet.

RESULTS

The system can be used to send reports and images to referring physicians or consulting radiologists; to provide a large database that is constantly available; to provide an increasing collection of teaching files; and to distribute interactive, multimedia teaching tools that can be used on any computer system. The use of the MOSAIC interface facilitates interaction, which allows users with limited computer experience to access the system.

CONCLUSION

The Internet can dramatically expand the ways radiologists interact with their colleagues. These preliminary results indicate that there will be great challenges and opportunities for improving care and teaching in the future.