Fertility Preservation for the Transgender Individual

Abstract

This review aims to update readers on recent evidence in order to counsel and guide clinical management of individuals with gender dysphoria seeking fertility preservation (FP). Relevant topics include a discussion of the consistent desire for children in transgender people despite a low utilization rate of FP services, animal models, and human histology depicting the effect of gender-affirming treatment (GAT) on the gonads, varied time for resumption of menses, and start of ovarian stimulation upon discontinuing testosterone (T) in transmen, feasible clinical and experimental options for FP in transgender males and females, worsening dysphoria, and recommended methods to mitigate symptoms, and lastly a short discussion of changes in legislation providing increased insurance coverage of medically indicated FP for transpatients. FP is an important option for transgender patients who desire to retain the ability to become genetic parents. While controlled ovarian stimulation for oocyte or embryo cryopreservation is the standard-of-care for transmen, unique considerations must be made in this population. Recent literature has highlighted the ability of transmen to have viable oocytes and pregnancies despite a history of T use, suggesting that the window of genetic parentage does not close with the start of GAT. FP for transwomen requires ejaculation or extraction with sperm cryopreservation; options for prepubertal transwomen are only in nascent phases. Research is rapidly evolving though many questions remain unanswered. The harmonization of advances in assisted reproduction with legislation advocating for transgender rights will continue to reach new peaks in the coming years.