Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity

Abstract

Children and adolescents with gender and sex diversity include (1) gender-nonconforming and transgender individuals for whom gender identity or expression are incongruent with birth-assigned sex (heretofore, transgender) and (2) individuals who have differences in sex development (DSD). Although these are largely disparate groups, there is overlap in the medical expertise necessary to care for individuals with both gender and sex diversity. In addition, both groups face potential infertility or sterility as a result of desired medical and surgical therapies. The Ann & Robert H. Lurie Children’s Hospital of Chicago (Lurie Children’s) gender and sex development program (GSDP) provides specialized multidisciplinary care for both transgender and DSD patients. In response to patient concerns that recommended medical treatments have the potential to affect fertility, the Lurie Children’s GSDP team partnered with experts from the Oncofertility Consortium at Northwestern University to expand fertility preservation options to gender and sex diverse youth. This article summarizes the results of a meeting of experts across this field at the annual Oncofertility Consortium conference with thoughts on next steps toward a unified protocol for this patient group.

Research Review: Gender identity in youth: treatment paradigms and controversies

“…These discussions are best held with the presence of both medical and mental health professionals who can provide medical and psychological counsel to the family (Ehrensaft & Hsaio, ). Clinicians should be aware that long‐term data regarding the effects of hormonal interventions on fertility are limited, and that cross‐sex hormones appear to impair fertility (Finlayson et al., ).…”

Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents

“…[17][18][19] It is hoped that this statement contributes to this overall goal by increasing accessibility of quality service provision. As noted above, the recommendations in this document draw on clinician consensus, standards of care, 8 treatment guidelines and position statements, [9][10][11][12][13][14][15] and limited data from non-randomised clinical and observational studies. [16][17][18][19][20][21][22][23][24][25][26][27] It is clear that further research is warranted across all domains of care for TGD children and adolescents, the findings of which are likely to influence future recommendations.…”

“…The Australian standards of care and treatment guidelines (the statement) are based primarily on clinician consensus, along with previously published standards of care, 8 treatment guidelines and position statements, [9][10][11][12][13][14][15] and data from a limited number of non-randomised clinical studies and observational studies. [16][17][18][19][20][21][22][23][24][25][26][27] In creating the Australian statement, we consulted all the known child and adolescent psychiatrists, paediatricians, paediatric endocrinologists and allied health specialists who work clinically in the area of transgender health across Australia.…”

“…9 Because of this, it is recommended that adolescents who present in the latter stages of pubertal development (Tanner stage 3e5) be counselled on the benefits of storing semen for cryopreservation either through masturbation or surgical extraction. 13 Should the adolescent not be able to produce mature sperm for cryopreservation, a testicular biopsy for tissue storage can be offered as a potential means for reproduction in the future. However, this technique is currently experimental and yet to be successful.…”

Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice

“…According to international guidelines, fertility preservation should thus be discussed with transgender youth before pubertal suppression, keeping in mind that techniques for the in vitro maturation of immature germ cells are still mostly experimental . For more information, the reader is redirected to one of the recent reviews on this topic …”