Fertility Preservation for Adolescent and Young Adult Transmen: A Case Series and Insights on Oocyte Cryopreservation

Abstract

BackgroundThe opportunity for fertility preservation in adolescent and young adult (AYA) transmen is growing. Many AYA transmen desire future biologic children and are interested in ways to preserve fertility through oocyte cryopreservation prior to full gender affirmation, yet utilization of oocyte cryopreservation remains low. Additionally, standard practice guidelines currently do not exist for the provision of oocyte cryopreservation to AYA transmen. Our objective was to review our experience with oocyte cryopreservation in adolescent and young adult transmen in order to synthesize lessons regarding referral patterns, utilization, and oocyte cryopreservation outcomes as well as best practices to establish treatment guidance.MethodsThis is a case series of all AYA transmen (aged 10 to 25 years) who contacted, consulted or underwent oocyte cryopreservation at a single high volume New York City based academic fertility center between 2009 and 2021.ResultsForty-four adolescent and young adult transmen made contact to the fertility center over the study period. Eighty percent (35/44) had a consultation with a Reproductive and Endocrinology specialist, with a median age of 16 years (range 10 to 24 years) at consultation. The majority were testosterone-naive (71%, 25/35), and had not pursued gender affirming surgery (86%, 30/35). Expedited initiation of testosterone remained the most commonly cited goal (86%, 30/35). Fifty-seven percent (20/35) pursued oocyte cryopreservation. Ninety-five percent (19/20) underwent successful transvaginal oocyte aspiration, with a median of 22 oocytes retrieved and 15 mature oocytes cryopreserved. There were no significant adverse events. At time of review, no patient has returned to utilize their cryopreserved oocytes.ConclusionsOocyte cryopreservation is a safe fertility preservation option in AYA transmen and is an important aspect of providing comprehensive transgender care. Insights from referral patterns, utilization, and oocyte cryopreservation outcomes from a single center’s experience with adolescent and young adult transmen can be integrated to identify lessons learned with the goal of providing transparency surrounding the oocyte cryopreservation process, improving the education and comfort of patients and providers with fertility preservation, and easing the decision to pursue an oocyte cryopreservation cycle in parallel to gender-affirmatory care.

Ovarian stimulation and oocyte cryopreservation in females and transgender males aged 18 years or less: a systematic review

“…Another notably young patient ≤ 12 years-old (their exact age was not specified) was a transgender male who had 9 mature oocytes cryopreserved over 2 cycles ( 29 ). A further 31 patients aged 13-15 years old ( 10 , 19 , 26 – 29 , 31 , 32 , 35 , 36 , 38 – 40 ) cryopreserved a median of 9.5 oocytes (range 0-22) and 31 patients aged 16-18 years old ( 19 , 23 – 25 , 27 – 29 , 33 , 34 , 37 , 39 ) cryopreserved a median of 14 oocytes (range 0-35).…”

Update on bioethical, medical and fertility issues in gender incongruence during transition age

“…The GnRHas have an impact on gamete maturation but do not cause permanent damage to gonadal function, so an interruption of testosterone can result in the recovery of ovarian function. However, the long-term effects of therapy are not known, so it is recommended to do FP before therapy Light et al 2014 [ 63 ] Duncan et al 2017 [ 67 ] Maxwell et al 2017 [ 65 ] Rothenberg et al 2019 [ 66 ] Amir et al 2020a [ 68 ] Amir et al 2020b [ 70 ] Armuand et al 2020 [ 62 ] Marschalek et al 2020 [ 69 ] Barrett et al 2022 [ 64 ] Adeleye et al 2019 [ 61 ] Semen cryopreservation Semen cryopreservation is the method of FP for young transgender women. GAHT can cause alteration of seminal sperm parameters.…”

“…In a cross-sectional study on transgender men seeking pregnancy, 88% used their own cryopreserved oocytes before hormonal transition after the age of 17 [ 63 ]. A very recent case series from a single fertility centre of 44 adolescent transgender men reported that the majority were testosterone-naive (71%, 25/35), and had not pursued gender-affirming surgery (86%, 30/35), 57% underwent oocyte cryopreservation with a median of 22 oocytes retrieved and 15 mature oocytes cryopreserved [ 64 ]. In a case-report of three transgender men undergoing oocyte cryopreservation before transition, one of them cryopreserved during adolescence: a total of 21 oocytes were retrieved and 17 mature oocytes were successfully cryopreserved with vitrification [ 65 ].…”

Fertility treatment outcomes in transgender men with a history of testosterone therapy

“…Several of these focused on TG men who chose to complete oocyte cryopreservation before initiating testosterone therapy ( 20 , 21 , 22 ). Other studies evaluated outcomes for TG patients with prior use of exogenous testosterone therapy ( 23 , 24 , 25 , 26 , 27 ). In particular, a 2019 study by Leung et al.…”