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Transgender people have the same range of reproductive desires as do non-transgender people. Although data are limited, there is no evidence that children of transgender parents are harmed in any unique way. Exogenous hormones and gonadectomy removal of testes or ovaries have clear impacts on fertility. Reproduction in transgender persons who have initiated transition and retain their gon generally involves discontinuation of exogenous hormones, though ovulation and spermatogenesis may continue in the presence of hormone therapy.
If an individual has not undergone gonadectomy, and if an initial evaluation demonstrates an absence of ovulation or spermatogenesis, return of fertility may be possible after discontinuing hormone therapy for a period of time. Anecdotally the time to return of fertility can range from months, though some may experience permanent loss of fertility, or require assisted technologies as described below. Because infertility is not absolute or universal in transgender people undergoing hormone therapy, all transgender people who have gon and engage in sexual activity that could result in pregnancy should be counseled on the need for contraception.
Gender affirming hormone therapy alone is not a reliable form of contraception, and testosterone is a teratogen that is contraindicated in pregnancy. It is unknown how long of a testosterone washout period is appropriate in transgender men prior to pregnancy Grading: X C S. Fertility preservation options may include sperm, oocyte, embryo, ovarian tissue or testicular tissue cryopreservation. Assisted reproduction may include the full range of fertility services.
Whether long-term hormone exposure confers any unique medical risks to the patient undergoing assisted reproduction procedures or any long-term impact on gametes and to future offspring is currently unknown. Transgender patients who undergo fertility preservation or assisted reproduction should be informed of the lack of data on outcomes. In transgender women, research suggests that prolonged estrogen exposure of the testes has been associated with testicular damage. Clomiphene citrate or hCG injections are sometimes used to stimulate spermatogenesis.
Several recently reported cases of uterine transplantation into non-transgender women represent a potential future option; however this technology is still in infancy. The effect of prolonged treatment with exogenous testosterone on ovarian function is unclear. Testosterone therapy usually le to anovulatory state and amenorrhea.
This is usually reversible upon discontinuation of testosterone therapy, and pregnancies have been reported in transmen following prolonged testosterone treatment. Fertility preservation options for transgender men include oocyte cryopreservation, embryo cryopreservation, and ovarian tissue cryopreservation. The frozen-thawed oocytes or embryos can then be later used for establishing a pregnancy using the patient's uterus or by transfer into a female partner or gestational carrier.
While solid data are lacking, transgender men who have initiated transition have been able to discontinue testosterone treatment and undergo insemination of sperm or IVF with embryo transfer to the patient's uterus, a female partner or gestational carrier. A recently published report surveyed transgender men who experienced pregnancy after initiation of testosterone. Seven percent used fertility medications. Obstetrical outcomes were similar in the testosterone and non-testosterone users, however it is not clear if participants reporting testosterone use were receiving testosterone at the time of conception and during pregnancy.
The men in the study also expressed a desire for more supportive resources and reported a lack of provider awareness and knowledge regarding fertility in transgender patients. One third of the pregnancies were unplanned, though it is not clear how many of these unplanned pregnancies occurred in the setting of current testosterone use. Nevertheless, such findings highlight the need for contraception in some patients. Ovarian tissue cryopreservation is currently still considered experimental. There have been several live births reported worldwide resulting after autotransplantation of cryopreserved ovarian tissue.
Research to create gametes through stem cell techniques is also ongoing. All patients should also be informed that these assisted reproductive options are expensive and often not covered by insurance. Mental health counseling and support should be made available for those transgender people pursuing reproductive options who request or require such services.
It is recommended that transgender children and adolescents, and their guardians, also be informed and counseled regarding options for fertility preservation prior to the initiation of pubertal suppression and treatment with gender affirming hormones. In children who have initiated natal puberty, fertility preservation options include sperm, oocyte, and embryo cryopreservation.
Currently it is not possible for children who have not undergone natal puberty and who may have used gender affirming hormones to preserve gametes. Prolonged pubertal suppression using gonadotropin releasing hormone GnRH analogs is usually reversible and should not impair resumption of puberty upon cessation, though most children who undergo pubertal suppression go on to begin gender affirming hormone therapy without undergoing natal puberty.
Further discussion of pubertal suppression, and the decision to undergo gonadectomy prior to the legal age of majority, is included in the guidelines for transgender children and adolescents. The CoE is unable to respond to individual patient requests for medical guidance. If you need medical advice, please contact your local primary care provider. If you need clarification, seek a second opinion locally or have your provider for more information. Publication Date:. June 17, Introduction Transgender people have the same range of reproductive desires as do non-transgender people.
Reproductive options for transgender women In transgender women, research suggests that prolonged estrogen exposure of the testes has been associated with testicular damage. Reproductive options for transgender men The effect of prolonged treatment with exogenous testosterone on ovarian function is unclear. Fertility preservation for children and adolescents It is recommended that transgender children and adolescents, and their guardians, also be informed and counseled regarding options for fertility preservation prior to the initiation of pubertal suppression and treatment with gender affirming hormones.
Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. Transgenderism and reproduction.
Curr Opin Endocrinol Diabetes Obes. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. Children born after autotransplantation of cryopreserved ovarian tissue. Ann Med. Pregnancies and live births after 20 transplantations of cryopreserved ovarian tissue in a single center.Ftm impregnation
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Fertility options for transgender persons