Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey

Abstract

Purpose To examine provider perceptions of practice behaviors and barriers related to fertility counseling, fertility preservation, and family building among transgender patients. Methods Participants were medical and mental health professionals who treat adult and youth transgender patients. Recruitment occurred online and in person, via professional listservs for transgender professionals, conferences, and gender clinics. From August-November 2017, 110 participants representing nine countries responded to four open-ended questions included on a survey related to provider practice behaviors and perceived barriers to fertility counseling, fertility preservation, and family building with transgender patients. Thematic coding analysis was used to identify themes. Results Multiple themes were identified including the following: access and cost issues; urgency for gender-affirming treatment; patient maturity and inability to make future-oriented decisions; and provider-related challenges pertaining to knowledge, role, and general lack of information in the nascent field of transgender reproductive health. Conclusion(s) This study yielded insights into practice behaviors, challenges, and perceived barriers to fertility counseling with transgender individuals and can serve as a basis for intervention development to optimize clinical practices with this population.

Where has the quest for conception taken us? Lessons from anthropology and sociology

“…These men are not alone. A recent international survey of fertility preservation providers in nine countries (Tishelman et al, 2019) showed that oocyte cryopreservation is increasing in the transgender community, as transgender men work to preserve their potential for future fatherhood.…”

Ethical Considerations of Fertility Preservation for Transmasculine and Nonbinary Youth

“…7 Unfortunately, physicians' selfreported limited knowledge of fertility preservation for transgender patients was recently identified as a barrier to care. 20 To better support medical providers, a ''decision tool web portal'' that houses up-to-date literature and helps providers tailor patient discussions can be developed similar to what has been done for 202 KATABI ET AL.…”

Health considerations for transgender women and remaining unknowns: a narrative review

“…150 Although there are many options for fertility preservation in trans people, 151 many trans people still consider fertility the price to pay for transition 152 and cost remains an incredible barrier to undergoing fertility preservation. 153 For TW who underwent pubertal suppression, fertility preservation was often not possible at pubertal developmental Tanner 2 stage. 147 Adolescents are offered the choice of postponing pubertal suppression in order to proceed with fertility preservation or to initiate pubertal suppression at Tanner 2 and to interrupt the therapy for fertility preservation prior to initiation of GAHT.…”