Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals

Insufficient fertility counseling and decisional regret: a call to raise our standards for fertility preservation counseling prior to gender-affirming care

“…Many TGNB individuals pursue gender-affirming care during their reproductive years, as supported by the investigation by Vyas et al (1) with a mean age of 29 years at the time of intake, and express interest in parenting biologically-related children in the future. In the setting of the definitive impact of gender-affirming surgery and the potential deleterious effects of gender-affirming hormone care on an individual's future reproductive potential, there is consensus among major medical societies, including the American Society for Reproductive Medicine, World Professional Association for Transgender Health, Endocrine Society, and European Society of Human Reproduction and Embryology, that fertility preservation counseling should be offered to TGNB individuals before initiation of genderaffirming treatments.…”

“…Health care providers, including fertility specialists, need to be able to counsel these patients accurately and sensitively about the possible reproductive consequences and the available options for fertility preservation. The study published in this issue by Vyas et al (1) describes the results of electronic surveys sent to a large cohort of patients of a gender health program at a large university hospital, examining reproductive intentions and decisional regret, as well as the barriers to pursuing fertility preservation.…”

“…In the setting of the definitive impact of gender-affirming surgery and the potential deleterious effects of gender-affirming hormone care on an individual's future reproductive potential, there is consensus among major medical societies, including the American Society for Reproductive Medicine, World Professional Association for Transgender Health, Endocrine Society, and European Society of Human Reproduction and Embryology, that fertility preservation counseling should be offered to TGNB individuals before initiation of genderaffirming treatments. Despite this consensus in recommendation, Vyas et al (1) demonstrated that fertility preservation counseling is provided inconsistently with 26% of respondents reporting that health care providers had not discussed family planning. When provided, such counseling was likely often incomplete with 49% of respondents receiving counseling from their primary care provider, 20% from a medical endocrinologist, and only 1% from a reproductive endocrinologist (1).…”

“…Despite this consensus in recommendation, Vyas et al (1) demonstrated that fertility preservation counseling is provided inconsistently with 26% of respondents reporting that health care providers had not discussed family planning. When provided, such counseling was likely often incomplete with 49% of respondents receiving counseling from their primary care provider, 20% from a medical endocrinologist, and only 1% from a reproductive endocrinologist (1). A previously published survey of over 200 transgender healthcare providers in 12 countries found variability in knowledge relating to fertility preservation, including the impact of gender-affirming therapies on fertility and whether certain fertility preservation options were established or experimental.…”

“…TGNB people represent an underserved population in medicine in the United States, with high rates of poverty, suicide, and violence on the basis of gender identity. Financial restrictions are a primary limiting factor as demonstrated by Vyas et al (1), with 36% of respondents identifying the cost of treatment or lack of insurance coverage as a barrier to fertility preservation. TGNB individuals often are excluded from non-profit and charitable institutions that may help to offset this financial burden for individuals with cancer seeking fertility preservation.…”