Preserving Fertility for Patients Who are Gender Diverse and Transitioning

Abstract

Fertility preservation is the process of storing eggs, sperm, or embryos for future use. It can be an option for transgender people who want to have biological children in the future. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition showed the detrimental impact on the gonadal function and the future fertility, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. Early and regular counselling regarding future fertility, the treatment approach for fertility preservation and/or family-building in transgender and gender nonbinary individuals are very important. Fertility preservation should be offered to all transgender patients ideally prior to medical or surgical treatment. Fertility preservation options for transgender men are oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation with in vitro maturation (IVM). Semen cryopreservation or testicular tissue cryopreservation is one of the fertility preservation options for transwomen. However, there is relatively limited data and clinical information regarding fertility preservation for transgender individuals. Recently, there is a growing awareness of fertility preservation counselling prior to initiation of gender-affirming care. However, numerous studies have reported a limited standard of care with many transgender patients who are experiencing inadequate fertility counselling. Further prospective studies are needed for better quality fertility services and parenting options for transgender and nonbinary individuals. In conclusion, the denial of access to fertility services to transgender individuals and nonbinary persons is not justified.