UK Data Collection of Semen Quality in Transgender Adolescent Females Seeking Fertility Preservation

Abstract

ObjectiveIncreasing numbers of adolescents with gender dysphoria start gonadotropin-releasing hormone agonists to halt puberty, minimising psychological distress. The uncertainty of long-term effects of this medication, and the subsequent likelihood of accessing gender affirming hormone treatment, highlights the importance of fertility preservation prior to starting hormone treatment. We investigated the take up, hormonal profile and sperm quality in adolescents undergoing fertility preservation via cryopreservation by masturbation or surgical sperm retrieval, prior to starting hormonal therapy. DesignData was prospectively maintained from a tertiary UK-based hospital. 122 people under 19 years, mean age 15.2 +/- 1.7 years, referred by gender clinics and GPs, were included in this cohort study. SubjectsParticipants were counselled for fertility preservation, and serum testosterone, follicle stimulating hormone, and luteinizing hormone levels were recorded prior to providing semen samples. InterventionMasturbation semen samples were classified as normal (>15mil/ml), oligozoospermia (1mil-15mil/ml), cryptozoospermia (<1mil/ml) or azoospermia. If the sample was insufficient or the person was unwilling to masturbate, surgical sperm retrieval was offered in a stepwise manner using electroejaculation, TESE +/- mTESE. Main Outcome measurementsQuality of semen produced by participants, via masturbation or surgical sperm retrieval, was analysed to determine if it was good enough to cryopreserve for future fertility use. Results23/122 (19%) participants declined sample storage.In the masturbation group (average age 16.3), 78 people produced 106 samples. 86/106 were stored - 43.7% were normospermic, 35.9% oligozoospermic, 8.7% cryptozoospermic, 11.7% azoospermic. Overall, semen parameters varied but were generally abnormal, illustrated by only 43.7% of the masturbation samples produced being normospermic.For surgical sperm retrieval subjects (average age 15.2), electroejaculation was successful in 4/21 people, while the rest proceeded with TESE/mTESE. Encouragingly, 16/21 subjects had an average of 5 vials stored, and all participants had a testosterone level >8nmol/l. Semen parameters in this sub-cohort were poor but possibly adequate for intracytoplasmic sperm injection. ConclusionsIn this large database of transgender girls referred for fertility preservation in the UK, fertility preservation is possible, even with those unwilling to masturbate. Long-term data is required to check the health of these gametes, observing live birth rates using these preserved gametes.