Fertility Preservation in Transgender Patients

Transgender (TGD) individuals are at risk of premature infertility, caused by gender-affirming hormone therapy and surgery. International scientific societies recommend that every TGD person should be offered fertility preservation counselling, as part of their gender-affirming journey. Whilst standard assisted reproductive technology (ART) can be readily used for semen and oocyte trans-cryopreservation, there are challenges specific to this patient group. These include addressing patient fears and expectations around intimate examinations, as well as minimising gender dysphoria during the preservation process. The effect of concurrent or recently discontinued gender-affirming hormone therapy on the fertility preservation process is uncertain, and there is paucity of long-term data on reproductive outcomes from trans-gametes. Since a growing minority of TGDs presenting for preservation are minors (under 18s), additional challenges relevant to making informed decisions within the local regulatory and legal framework are also present. Testicular or ovarian tissue cryopreservation, which is otherwise available for pre-pubertal cancer individuals, may not currently be a realistic option for pre-pubertal TGDs.