Options for Fertility Treatments for Trans Women in Germany

Abstract

Fertility preservation in trans women is a crucial but thus far neglected component in the gender confirming treatment in Germany. It is difficult for trans women to access reproductive health care because centers offering treatment, psychological guidance, gender confirming surgery, as well as reproductive health services are scarce in Germany. Legal, social, or financial issues as well as individual patient comorbidities prevent trans women from receiving appropriate counselling. This review provides an overview on options of fertility preservation in trans women. We consider recent publications on testicular regression at the time of gender confirming surgery demonstrating presence of sperm or at least spermatogonia in the majority of tissues. This may open options for cryopreservation of sperm or testicular stem cells in trans women even at the final stage of transition. Hence, standardized urological procedures (i.e., sperm cryopreservation after masturbation or sperm extraction from the testicular tissue) and experimental approaches (cryopreservation of testicular tissue with undifferentiated spermatogonia) can be offered best at the initiation but also during the gender confirming process. However, counselling early in the gender confirming process increases the chances of fertility preservation because gender confirming hormone therapy has an impact on spermatogenesis.

Maternal Health in the Transgender Population

“…19 In addition, although estradiol therapy may inhibit spermatogenesis, a TGF could plausibly inseminate a female partner if viable sperm still are produced. 18 As such, professional organizations recommend that all transgender people who retain their gonads and engage in sexual activity that could result in pregnancy be counseled on the need for contraception. 15 Contraceptive therapies are particularly important in TGMs because testosterone and antiandrogen medications are teratogenic.…”

Gender-Affirming Surgeries in Transgender and Gender Diverse Adolescent and Young Adults: A Pediatric and Adolescent Gynecology Primer

“…13 Another emerging option involves sperm banking at the time of orchiectomy. 14 A urologist skilled in this technique should be involved for counseling and performance. For those with ovaries who desire the option of genetically linked offspring, egg retrieval prior to or following temporary discontinuance of testosterone is the most common approach.…”

“…49 The typical PIV procedure begins by excising the perineal and scrotal skin, which is removed and shaped as a dome. The orchiectomy is then performed (if fertility preservation is chosen, the testes are sent for sperm harvesting and preservation, although these procedures remain experimental 14 ). A roughly 15-cm-long cavity is then created anterior to the rectum and posterior to the bulbar urethra and the prostate.…”

Feminizing Gender-Affirming Surgery

“…If future fertility is desired, sperm retrieval may be attempted from the excised testicles and cryopreserved. 13 The penis is then degloved after creating a circumferential incision proximal to the glans penis (Fig. 2B).…”