Sperm cryopreservation of transgender individuals: trends and findings in the past decade

Li, K.; Rodríguez, Dayron; Gabrielsen, J. Scott; Centola, Grace M.; Tanrikut, Cigdem

doi:10.1111/andr.12527

Cited by 31 publications

(30 citation statements)

References 22 publications

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“…Our findings are in line with previous studies on semen quality in trans women, which also showed a high incidence of azoospermia, oligozoospermia and asthenozoospermia ( Hamada et al , 2015 ; Li et al , 2018 ; Marsh et al , 2019 ). Only one of these studies collected data on personal behavior, feelings of depression, anxiety and stress, as well as serum hormone concentrations.…”

Section: Discussionsupporting

confidence: 93%

“…Although data on semen characteristics in trans women show a high incidence of impaired semen quality, these studies report on a relatively low number of people ( Hamada et al , 2015 ; Li et al , 2018 ; Marsh et al , 2019 ). The etiology could not be identified in these studies due to the small sample size and a lack of endocrine laboratory results and complete clinical data on certain lifestyle factors known to influence semen quality, such as age, obesity and cigarette smoking ( Sermondade et al , 2013 ; Johnson et al , 2015 ; Sharma et al , 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Impaired semen quality in trans women: prevalence and determinants

et al. 2020

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Abstract STUDY QUESTION What is the semen quality in trans women at time of fertility preservation, prior to the start of gender-affirming hormone treatment? SUMMARY ANSWER Before the start of gender-affirming hormone treatment, semen quality in trans women was already strongly decreased compared to the general population. WHAT IS KNOWN ALREADY Hormone treatment for -trans women (birth-assigned males, female gender identity) consists of anti-androgens combined with estrogens in order to achieve feminization and it is accompanied by a loss of reproductive capability. Trans women can opt for semen cryopreservation prior to their medical transition to retain the possibility to parent genetically related offspring. Post-thaw semen parameters determine which ART can be used. Knowledge of semen quality and the factors negatively influencing semen parameters in trans women are important to improve semen quality before fertility preservation. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was performed between 1972 and 2017. In total, 260 trans women were included for this study. Due to the study design, there was no loss to follow-up or attrition. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied the quality of the preserved semen in trans women, prior to their medical transition, who visited our gender clinic. Semen parameters were collected, as well as data on age, alcohol consumption, smoking, cannabis use, BMI, previous use of estrogens or anti-androgens and endocrine laboratory results. Semen parameters were categorized using reference values for human semen of the World Health Organization (WHO) and compared with data from the general population. Logistic regression analyses were performed to analyze the extent to which factors known to have a negative impact on semen quality in the general population explained the impaired semen quality in the cohort. MAIN RESULTS AND THE ROLE OF CHANCE The cohort consisted of 260 trans women between the age of 16 and 52 years. Semen quality in trans women was significantly decreased compared to WHO data from the general population. In total, 21 trans women had an azoospermia and median semen parameters for the remaining trans women and the general population, respectively, were as follows: volume 2.7 and 3.2 ml (P < 0.05), sperm concentration 40 and 64 million/ml (P < 0.05), total sperm number 103 and 196 million (P < 0.05) and progressive motility 41% and 57% (P < 0.05). Smoking (odds ratio (OR) 2.35 (95% CI 1.06–5.21)) and a higher age at time of fertility preservation (OR 1.04 (95% CI 1.00–1.08)) were found to correlate with an impaired progressive motility. Twelve trans women reported to have used anti-androgens and estrogens, and all had discontinued for at least 3 months prior to the first attempt for semen cryopreservation. No correlation was found between previous gender-affirming hormone use and decreased semen parameters. The median post-thaw total motile sperm count was 1.0 million per vial (interquartile range 0.1–3.1) and in only 26.4% of thawed semen samples was the quality adequate for a minimally invasive IUI. LIMITATIONS, REASONS FOR CAUTION Limitations include the retrospective design and insufficient data on transgender-specific factors, such as bringing the testes into the inguinal position (tucking), wearing tight underwear and low masturbation frequency. WIDER IMPLICATIONS OF THE FINDINGS Semen quality in trans women was decreased compared to the general population, which could not be explained by known risk factors, such as BMI, alcohol consumption, cannabis use, gender-affirming hormone use or abnormal endocrine laboratory results. Although a negative impact of smoking was observed, it was insufficient to explain the overall decreased semen quality in this cohort. Since low pre-freeze semen quality results in an even lower post-thaw semen quality, the majority of trans women and their female partner or surrogate may need an invasive and burdensome treatment to establish a pregnancy. STUDY FUNDING/COMPETING INTEREST(S) For this study, no external funding was obtained and there were no competing interests. TRIAL REGISTRATION NUMBER NA.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Impaired semen quality in trans women: prevalence and determinants

et al. 2020

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“…Li et al (10) performed a retrospective review of 78 transgender sperm bankers and compared them with 141 cisgender sperm bankers from the same private cryobank. Transgender specimens showed lower sperm concentration, total motile sperm count and post-thaw sperm parameters, as well as higher incidence of oligozoospermia.…”

Section: Semen Cryopreservationmentioning

confidence: 99%

“…In the last decade, the incidence of transgender women seeking sperm cryopreservation has increased compared with cisgender men (10). In a survey of 121 transgender women performed by De Sutter et al (11), 77% reported that they would very interested in sperm banking if it was offered, and agreed that fertility preservation should be discussed with their healthcare provider.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of fertility preservation options in transgender patients: a guide for plastic surgeons

Yan

Bustos²,

Kuruoglu³

et al. 2021

Ann Transl Med

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Transgender patients often desire to have biological children. However, their reproductive potential is often negatively impacted by gender affirming surgery (GAS) such as gender confirmation surgery (bottom surgery) and medical hormone therapy. Therefore, counselling patients on fertility preservation options before initiating gender-affirming treatments is prudent to avoid reducing their reproductive potential. A systematic review of English, Spanish, Chinese, French and Turkish languages from 2000 to December 23rd, 2019, using the preferred reporting items for systematic review and metaanalysis protocols (PRISMA-P) guidelines, was conducted. The search strategy was designed and conducted by an experienced librarian with input from the study's principle investigator. Fifteen articles that report outcomes of fertility preservation options in transgenders were included. Eight articles described options for transgender women, six reported options for transgender men and one included both transgender women and transgender men. Semen cryopreservation and oocyte cryopreservation are the most common and available methods for fertility preservation in transgenders. Physician awareness of fertility preservation options in transgender patients is crucial to ensure informed discussions regarding reproductive options in the early phase of transition.

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“…The largest study evaluating the incidence of sperm banking and semen quality among transwomen revealed an increasing incidence of sperm cryopreservation in this population (48). Surprisingly, compared to cisgender sperm bankers, the 78 transwomen included in the study had worse semen parameters, including sperm concentration and total motile sperm count (48). Similarly, another study showed high rates of oligozoospermia, asthenozoospermia, and teratozoospermia, though there was no control group (49).…”

Section: Cryopreservation Of Sperm or Embryosmentioning

confidence: 93%

Fertility concerns of the transgender patient

Cheng

Pastuszak

Myers

et al. 2019

Transl. Androl. Urol

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Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential.Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.

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Sperm cryopreservation of transgender individuals: trends and findings in the past decade

Cited by 31 publications

References 22 publications

Impaired semen quality in trans women: prevalence and determinants

Impaired semen quality in trans women: prevalence and determinants

Systematic review of fertility preservation options in transgender patients: a guide for plastic surgeons

Fertility concerns of the transgender patient

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