Fertility Preservation for Adolescent Transgender Male Patients: A Case Series

Insogna, Iris G.; Ginsburg, Elizabeth S.; Srouji, Serene S.

doi:10.1016/j.jadohealth.2019.12.004

Cited by 29 publications

(19 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Case reports and series describe oocyte cryopreservation among transgender men before initiation or after discontinuation of androgen therapy (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report

et al. 2021

View full text Add to dashboard Cite

Objective: To report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy. Design: Report of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy. Setting: Private fertility clinic with university affiliation. Patient(s): A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy. Intervention(s): Fertility preservation through oocyte cryopreservation. Main Outcome Measure(s): This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk. Result(s): Cryopreservation of 22 mature oocytes. Conclusion(s): Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area. (Fertil Steril Rep Ò 2021;2:249-51. Ó2021 by American Society for Reproductive Medicine.

show abstract

“…Case reports and series describe oocyte cryopreservation among transgender men before initiation or after discontinuation of androgen therapy (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Due to a variety of physiological and psychological barriers, ovarian stimulation and oocyte harvest is best avoided in children, if it can be safely postponed to adulthood. A recent study showed that only 2 of 72 (2.8%) young transgender individuals chose to utilize fertility preservation after counseling (Nahata et al, 2019), which reflects a priority for HT initiation to attain features of their affirmed gender while avoiding the delay, invasiveness, or costs of fertility preservation (Armuand et al, 2017;Insogna et al, 2020). The desire for biological children may arise later in life, after months or years of HT exposure.…”

Section: Introductionmentioning

confidence: 99%

Short-term testosterone use in female mice does not impair fertilizability of eggs: implications for the fertility care of transgender males

et al. 2020

View full text Add to dashboard Cite

STUDY QUESTION Does testosterone use in females affect reproductive potential, particularly with regard to the production of fertilizable gametes? SUMMARY ANSWER Testosterone (T) injections given to post-pubertal female mice caused virilization and although the ovaries were smaller than controls they were still responsive and produced fertilizable eggs when superovulated. WHAT IS KNOWN ALREADY Studies to examine the effects of testosterone on reproductive potential in transgender males are lacking. Recently, a model was developed that simulates many aspects of testosterone use in transgender males in order to look at reproductive effects of testosterone in female mice. This study found masculinizing effects on the mice but did not find significant deficits on the number of ovarian follicles; however, effects of testosterone use on ovarian stimulation and fertilizability of oocytes were not investigated. STUDY DESIGN, SIZE, DURATION A total of 66, 6-week-old Hsd:NSA (CF-1) female mice and six Hsd:ICR (CD-1) male mice were used for this study. Mice were injected s.c. with 400 µg T or sesame oil once a week for 6 weeks and were either killed 1 week after the sixth injection (active exposure group), or 6–7 weeks after the final T injection (washout group). PARTICIPANTS/MATERIALS, SETTING, METHODS Both active exposure and washout groups were further subdivided into three groups: unstimulated, equine CG (eCG)-stimulated or eCG/hCG-stimulated. eCG-stimulated mice were killed 44–48 h after eCG injection. eCG/hCG-stimulated mice were injected with eCG, followed 48 h later with hCG. Mice were killed ∼13–18 h after the hCG injection. Data collected included daily vaginal cytology, terminal testosterone levels, ovary weights and histology, number of oocytes/eggs collected in each group, and cleavage to the two-cell stage following IVF. MAIN RESULTS AND THE ROLE OF CHANCE Testosterone-treated mice had testosterone levels elevated to the level of male mice and ceased cycling. Ovaries were significantly smaller in testosterone-treated mice, but they contained normal cohorts of follicles and responded to gonadotrophin stimulation by ovulating similar numbers of eggs as controls, that fertilized and cleaved in vitro. LIMITATIONS, REASONS FOR CAUTION Mice were treated for only 6 weeks, whereas many transgender men use testosterone for many years before considering biological children, and developmental competence was not assessed. Importantly, a mouse system may not perfectly simulate human reproductive physiology. WIDER IMPLICATIONS OF THE FINDINGS The current standard of care for transgender men who desire biological children is to cease testosterone therapy prior to ovarian stimulation, but the necessity for stopping testosterone is not known. Our model demonstrates that it is possible for testosterone-suppressed ovaries to respond to gonadotrophic stimulation by producing and ovulating fertilizable eggs, thereby obviating the need for testosterone cessation prior to ovarian stimulation. In time, these results may provide insights for future clinical trials of fertility treatment options for transgender men. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Reproductive Endocrinology and Infertility fellowship program through UConn Health Graduate Medical Education (to C.B.B.). The authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.

show abstract

“…It is of great importance that little is known about transgender men's experience of FP procedures such as cryopreservation of oocytes due to a lack of previous empirical research on this topic [51]. Importantly, Insogna, Ginsburg and Srouji (2020) reported that 'adolescent transgender males who choose to undergo oocyte cryopreservation tolerate the process well' [60]. In our opinion, the aforementioned ndings of our study give us the opportunity to formulate starting points for further research.…”

Section: Barriers Related To Discrimination and Bullyingmentioning

confidence: 73%

A qualitative study examining transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece

Voultsos

Zymvragou

Karakasi

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Advances in biomedical technologies permit transgender individuals not only to achieve gender transition but also to experience parenthood. Little is known about this topic in Greece, a traditionally conservative country; however, Greece is changing at the legal level towards a greater recognition of transgender people’s rights. This study aimed to investigate transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece.Methods: This is a prospective qualitative study conducted with adult individuals who identified as transgender men or transgender women between April 2019 and March 2020. Individual in-depth qualitative interviews were conducted with twelve participants. The interviews were carried out in person and were digitally recorded and transcribed verbatim. We performed an inductive analysis of the data.Results: The inductive data analysis resulted in the identification of themes that represent key barriers to pursuing fertility preservation (FP) or the use of assisted reproductive technology (ART). Six major themes were clearly present in the findings (lack of adequate information and counseling, worsening gender dysphoria, increased discrimination against transgender people due to the rise of extreme far-right populism, low parental self-efficacy, high costs, and a less than perfect legal framework). Moreover, diverse cases were examined, and minor themes, such as the symbolic value of the uterus and pregnancy, the relationship between the type of gender transition and willingness to pursue fertility treatments, and transgender people’s adherence to heteronormative patterns in the context of reproduction, were identified. Various reasons for transgender people’s differing degrees of desire for parenthood were identified.Conclusion: Our findings demonstrated contextual factors as well as factors related to transgender people themselves as barriers to pursuing transgender parenthood. Most aspects of our findings are consistent with those of previous research. However, some aspects of our findings (regarding aggressive behaviors and economic instability) are specific to the context of Greece, which is characterized by the rise of extreme far-right populism due to the decade-long Greek economic crisis and the deeply conservative traditionalist background. In that regard, the participants highlighted the (perceived as) less than perfect Greek legislation on transgender people’s right as barrier to transgender (biological) parenthood.

show abstract

Fertility Preservation for Adolescent Transgender Male Patients: A Case Series

Cited by 29 publications

References 5 publications

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report

Short-term testosterone use in female mice does not impair fertilizability of eggs: implications for the fertility care of transgender males

A qualitative study examining transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece

Contact Info

Product

Resources

About