Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine

Leung, Angela Q.; Sakkas, Denny; Pang, Samuel C.; Thornton, Kim L.; Resetkova, Nina

doi:10.1016/j.fertnstert.2019.07.014

Cited by 104 publications

(94 citation statements)

References 25 publications

(25 reference statements)

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“…When accounting for causes, some participants normalized pregnancy loss, suggesting that it was for many people a routine and expected aspect of reproduction. An example of this was Pete, who noted that his fertility specialist suggested it was likely just due to his age, or Cole, who suggested that in the immediate months after a person ceases taking testosterone, "our bodies can get pregnant, but they are not [yet] ready to actually carry a baby to term" (though as noted earlier in this paper, even this claim may not reflect the latest research evidence [11]). Other participants provided specific examples of what they believed to be the causes of a pregnancy loss, and these typically related to stressful life events.…”

Section: Accounting For the Causes Of Pregnancy Lossmentioning

confidence: 90%

“…Importantly, not all trans/masculine and non-binary people will choose or have access to hormonal treatments, and those who undertake a planned pregnancy are likely to have ceased hormone treatment in order to become pregnant [ 10 ]. Nonetheless, the most recent research suggests reproductive outcomes for men, trans/masculine, and non-binary people in receipt of testosterone on par with those of cisgender women [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Riggs

Pearce

Pfeffer

et al. 2020

BMC Pregnancy Childbirth

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Background: Growing numbers of men, trans/masculine, and non-binary people are becoming gestational parents, yet very little is known about experiences of pregnancy loss among this diverse population. Methods: The study employed a cross sectional design. Interviews were undertaken with a convenience sample of 51 trans/masculine and non-binary people who had undertaken at least one pregnancy, living in either Australia, the United States, Canada, or the European Union (including the United Kingdom). Participants were recruited by posts on Facebook and Twitter, via researcher networks, and by community members. 16 (31.2%) of the participants had experienced a pregnancy loss and are the focus of this paper. Thematic analysis was used to analyse interview responses given by these 16 participants to a specific question asking about becoming pregnant and a follow up probe question about pregnancy loss. Results: Thematic analysis of interview responses given by the 16 participants led to the development of 10 themes: (1) pregnancy losses count as children, (2) minimizing pregnancy loss, (3) accounting for causes of pregnancy loss, (4) pregnancy loss as devastating, (5) pregnancy loss as having positive meaning, (6) fears arising from a pregnancy loss, (7) experiences of hospitals enacting inclusion, (8) lack of formal support offered, (9) lack of understanding from family, and (10) importance of friends. Conclusions: The paper concludes by outlining specific recommendations for clinical practice. These include the importance of focusing on the emotions attached to pregnancy loss, the need for targeted support services for men, trans/ masculine, and non-binary people who undertake a pregnancy (including for their partners), and the need for ongoing training for hospital staff so as to ensure the provision of trans-affirming medical care.

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Section: Accounting For the Causes Of Pregnancy Lossmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Riggs

Pearce

Pfeffer

et al. 2020

BMC Pregnancy Childbirth

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“…These considerations lead back to the above raised question whether oocyte quality would be unaffected by testosterone treatment. Notably, a recent retrospective case-control study suggested that in vitro fertilization (IVF) outcomes were unaltered in transmen after testosterone therapy, despite that they were in need of higher total dose of gonadotropins for ovarian hyperstimulation (Leung et al 2019 ). As already mentioned, an important study on ovarian histology and cumulus-oocyte complexes in transmen revealed a surprisingly normal cortical follicle distribution (De Roo et al 2017 ) which was quite similar to that of normal fertile women in an older report (Gougeon and Chainy 1987 ).…”

Section: Introductionmentioning

confidence: 99%

Markers of vitality in ovaries of transmen after long-term androgen treatment: a prospective cohort study

Marschalek

Pietrowski

Dekan

et al. 2020

Mol Med

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Background Gender-affirming hormone therapy has been hypothesized to reduce the patient’s reproductive potential in transmen, although the exact long-term effects on future fertility are unknown. Methods In this prospective cohort study we aimed to evaluate ovaries of 20 transmen by using hormone serum levels, histomorphological analysis and fluorescence activated cells sorting (FACS) analysis – in order to assess the amount of vital cells. Results The median total number of follicles per field of view was 39 (IQR 12–122). Of all follicles ( n = 1661), the vast majority was primordial ( n = 1505, 90.6%), followed by primary ( n = 76, 4.6%), abnormal ( n = 63, 3.8%) and secondary follicles ( n = 17, 1.0%). FACS analysis was available for 13 samples (65.0%) and the median frequency of vital cells was 87.5% (IQR, 77.7–95.4%). Both a higher age ( p = 0.032) and a lower BMI ( p = 0.003) were significantly associated with a higher frequency of vital cells. Conclusion The majority of ovarian cells after long-term androgen treatment were vital in FACS analysis and histomorphological evaluation revealed a normal cortical follicle distribution. These results are currently exploratory, but might be promising for issues on fertility preservation. Trial registration The study was approved by the ethics committee of the Medical University of Vienna (EK 2240/2016) and was retrospectively registered in the Current Controlled Trials Register (registration number NCT03649087 , date of registration: 28.08.2018).

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“…The mean number of fertilized oocytes of the 11 transgender men who proceeded to oocyte fertilization was not significantly different from the number seen in the control group. Recently, Leung et al . (2019) published more results regarding this cohort.…”

Section: Discussionmentioning

confidence: 99%

A transgender man, a cisgender woman, and assisted reproductive technologies: a Brazilian case report

Resende

Kussumoto

Arima

et al. 2020

JBRA Assisted Reproduction

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Transgender men are individuals who identify as men but were assigned female at birth. Gender-afﬁrming medications include testosterone hormone therapy, known for its diverse eﬀects throughout the body, which include endometrial atrophy and the induction of amenorrhea by suppressing ovulation, without however affecting the ovarian follicle pool. This paper reports the first case in Brazil involving a transgender man and a cisgender woman attempting to form a family. A 34-year-old transgender man and a 28-year-old woman came to our assisted reproduction service. He had been on testosterone for two years. At their initial consultation, testosterone therapy was discontinued. Controlled ovarian stimulation for the transgender man was achieved using a combination of recombinant gonadotropins FSH and LH. Pituitary blockage was performed using a GnRH antagonist protocol. Twenty follicles were aspirated and 16 oocytes were retrieved, 12 of which mature. They were inseminated with donor semen. On the fifth day of development, one high quality blastocyst was transferred to the cisgender woman, resulting in an ongoing pregnancy. Five supernumerary embryos were cryopreserved. Controlled ovarian stimulation with high quality oocytes, high quality embryos, and clinical pregnancy are possible for transgender men, even with a history of testosterone use.

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Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine

Cited by 104 publications

References 25 publications

Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Markers of vitality in ovaries of transmen after long-term androgen treatment: a prospective cohort study

A transgender man, a cisgender woman, and assisted reproductive technologies: a Brazilian case report

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