Ovarian stimulation outcomes among transgender men compared with fertile cisgender women

Abstract

Purpose To compare assisted reproductive technology (ART) outcomes among transgender men with those of fertile cisgender women. Methods This retrospective cohort study included 12 transgender men, six with no testosterone exposure and six after testosterone treatment, and 12 cisgender women (oocyte donors) who underwent ART in our institution between June 2017 and December 2019. Statistical analyses compared ART data and outcomes between three groups: cisgender women, transgender men without testosterone exposure, and transgender men after testosterone exposure. Comparisons were also made between transgender men with and without testosterone exposure. ResultsThe transgender men with no testosterone exposure (23.3 ± 4 years) were significantly younger than the transgender men who had undergone testosterone treatment (30.3 ± 3.8 years; P = 0.012) and the cisgender women (29.1 ± 3.1 years; P = 0.004). The amount of FSH used for ovulation induction (1999 ± 683 mIU/mL) was significantly lower among transgender men without prior testosterone exposure compared with that among cisgender women (3150 ± 487 mIU/mL; P = 0.007). There were no differences in the peak estradiol levels, the number of oocytes retrieved, the number of MII oocytes, and the oocyte maturity rates between the three groups. Five out of six testosterone-treated transgender men underwent embryo cryopreservation, and they all achieved good-quality embryos. Conclusions Transgender men have an excellent response to ovulation stimulation even after long-term exposure to testosterone. Oocyte/embryo cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.

Similar fertilization rates and preimplantation embryo development among testosterone-treated transgender men and cisgender women

“…As expected, the number of retrieved oocytes was comparable between the two groups of individuals who preserved fertility and significantly higher in the transgender men compared with the cisgender women with fertility problems. Similar to the findings of the current study, there is a fair amount of evidence that transgender men exposed to testosterone can provide mature oocytes comparable to what is seen in cisgender women (Adeleye et al, 2019;Amir et al, 2020;Leung et al, 2019,). In addition, human oocytes collected from the ovarian cortex of testosterone-exposed transgender men have demonstrated a normal meiotic spindle structure after invitro maturation (Lierman et al, 2017).…”

“…There are several lines of evidence relating to the oocyte fertilization of transgender men who have previously been treated with testosterone (Adeleye et al, 2019;Amir et al, 2020;Leung et al, 2019). In the current study, fertilization rates were comparable in all three study groups.…”

“…Ovarian stimulation outcomes between transgender men who had already initiated hormonal transition with the use of testosterone and matched cisgender women were reported as being comparable. Overall, there were no significant differences in the peak oestradiol concentrations, the number of retrieved oocytes, the number of mature oocytes and the maturity rate of the oocytes between the two groups (Adeleye et al, 2019;Amir et al, 2020;Leung et al, 2019).…”

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

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

Adolescent Fertility Preservation: Where Do We Stand Now

“…83 Oocyte banking after testosterone therapy has been reported in transgender men with no difference observed in the number of mature oocytes banked compared to cisgender women, oocyte donors, and transgender men who banked prior to starting testosterone. 84,85 In addition, high-quality embryos and high live birth rates have been reported after testosterone exposure. Measures should be taken if desired to minimize the hormonal side effects of oocyte banking in transgender men.…”