Azoospermia; Testicular sperm extraction (TESE) may be performed when there is a non-obstructive azoospermia during sperm banking via masturbation or an inability for masturbation due to severe genital dysphoria. First, optimize (trans specific) life-style factors for 3 months, if present, similar to semen cryopreservation before performing a TESE.
Adolescents; TESE is an option for adolescents in early puberty who are not able to physically or mentally perform a semen sample via masturbation. This is probably successful from Tanner 3–4, with testicular volume > 10 ml (Peri et al., Citation2021) and therefore may require a delay in the start of PS. A TESE may be combined with placement of the subcutaneous GnRH agonist implant. Children born after TESE-ICSI procedure from cisgender males show no long-term effects on development and health outcomes (Meijerink et al., Citation2016).
Testicular tissue cryopreservation; Spermatogonial stem cells or testicular tissue cryopreservation are still experimental for both autologous transplantation and IVM (Wyns et al., Citation2021). Since autologous transplantation is not possible after orchiectomy TGD people will be depended on IVM.
Costs; In countries were fertility preservation is coffered by health care insurance there is a higher fertility preservation rate (Amir, Yaish, Oren, et al., Citation2020; Brik et al., Citation2019; Mattelin et al., Citation2022). In the countries with self-pay the main barrier for pursuing fertility preservation are costs (Rogers et al., Citation2021).
Future gamete use; The use of stored gametes is largely depended on the gametes of the future partner, the carrier (e.g. partner with uterus or gestational carrier) and the use of donor gametes. Before the start of fertility preservation we advise to discuss the options related to the patient.
TGD people may have different desires, values, challenges and considerations concerning parenthood compared to cisgender people. During their transition TGD people may experience changes in their fertility desires as they explore their gender identity and undergo medical transition. Therefore, it is of utmost importance that all TGD people have access to gender sensitive and culturally competent fertility counseling and preservation before and during their medical transition. Fertility preservation is a crucial aspect of transgender healthcare that enables TGD people to have the option of geneticparenthood. Fertility preservation still holds lots of barriers for TGD people. For example, lack of access to healthcare services, discriminatory laws that prohibit assisted reproductive technology, adoption, or surrogacy for TGD people and financial constraints by insufficient healthcare insurance. To promote equitable access to reproductive healthcare for all TGD people, it is crucial to challenge unjust laws and policies and replace them with evidence-based, inclusive practices.
Adeleye, A. J., Stark, B. A., Jalalian, L., Mok-Lin, E., & Smith, J. F. (2023). Evidence of spermatogenesis in the presence of hypothalamic suppression and low testosterone in an adolescent transgender female: A case report. Transgender Health, 8(1), 104–107. https://doi.org/10.1089/trgh.2021.0034
Anderson, R. A., Amant, F., Braat, D., D'Angelo, A., Lopes, S. M. C. D., Demeestere, I., Dwek, S., Frith, L., Lambertini, M., Maslin, C., Moura-Ramos, M., Nogueira, D., Rodriguez-Wallberg, K. (2020). ESHRE guideline: Female fertility preservation. Human Reproduction Open, 2020(4), hoaa052. https://doi.org/10.1093/hropen/hoaa052
Bahadur, G., Homburg, R., Jayaprakasan, K., Raperport, C. J., Huirne, J. A. F., Acharya, S., Racich, P., Ahmed, A., Gudi, A., Govind, A., & Jauniaux, E. (2023). Correlation of IVF outcomes and number of oocytes retrieved: A UK retrospective longitudinal observational study of 172 341 non-donor cycles. BMJ Open, 13(1), e064711. https://doi.org/10.1136/bmjopen-2022-064711
Bailie, E., Maidarti, M., Hawthorn, R., Jack, S., Watson, N., Telfer, E., & Anderson, R. (2023). The ovaries of transgender men indicate effects of high dose testosterone on the primordial and early growing follicle pool. Reproduction and Fertility, 4(2), 335. https://doi.org/10.1530/RAF-22-0102
Brik, T., Vrouenraets, L., Schagen, S. E. E., Meissner, A., de Vries, M. C., & Hannema, S. E. (2019). Use of fertility preservation among a cohort of transgirls in the Netherlands. The Journal of Adolescent Health, 64(5), 589–593. https://doi.org/10.1016/j.jadohealth.2018.11.008
Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse People, Version 8 (vol 23, pg S1, 2022). International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2125695
de Nie, I., Mulder, C. L., Meißner, A., Schut, Y., Holleman, E. M., van der Sluis, W. B., Hannema, S. E., den Heijer, M., Huirne, J., van Pelt, A. M. M., & van Mello, N. M. (2022). Histological study on the influence of puberty suppression and hormonal treatment on developing germ cells in transgender women. Human Reproduction, 37(2), 297–308. https://doi.org/10.1093/humrep/deab240
de Nie, I., van Mello, N. M., Vlahakis, E., Cooper, C., Peri, A., den Heijer, M., Meißner, A., Huirne, J., & Pang, K. C. (2023). Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women. Cell Reports. Medicine, 4(1), 100858. https://doi.org/10.1016/j.xcrm.2022.100858
Dolmans, M. M., von Wolff, M., Poirot, C., Diaz-Garcia, C., Cacciottola, L., Boissel, N., Liebenthron, J., Pellicer, A., Donnez, J., & Andersen, C. Y. (2021). Transplantation of cryopreserved ovarian tissue in a series of 285 women: A review of five leading European centers. Fertility and Sterility, 115(5), 1102–1115. https://doi.org/10.1016/j.fertnstert.2021.03.008
Ellis, S. A., Wojnar, D. M., & Pettinato, M. (2015). Conception, pregnancy, and birth experiences of male and gender variant gestational parents: It’s how we could have a family. Journal of Midwifery & Women’s Health, 60(1), 62–69. https://doi.org/10.1111/jmwh.12213
Greenwald, P., Dubois, B., Lekovich, J., Pang, J. H., & Safer, J. (2022). Successful in vitro fertilization in a cisgender female carrier using oocytes retrieved from a transgender man maintained on testosterone. AACE Clinical Case Reports, 8(1), 19–21. https://doi.org/10.1016/j.aace.2021.06.007
Israeli, T., Preisler, L., Kalma, Y., Samara, N., Levi, S., Groutz, A., Azem, F., & Amir, H. (2022). Similar fertilization rates and preimplantation embryo development among testosterone-treated transgender men and cisgender women. Reproductive Biomedicine Online, 45(3), 448–456. https://doi.org/10.1016/j.rbmo.2022.04.016
Kerman, H. M., Pham, A., Crouch, J. M., Albertson, K., Salehi, P., Inwards-Breland, D. J., & Ahrens, K. R. (2021). Gender diverse youth on fertility and future family: A qualitative analysis. The Journal of Adolescent Health, 68(6), 1112–1120. https://doi.org/10.1016/j.jadohealth.2021.01.002
Dr MorKolbuck, V. D., Sajwani, A., Kyweluk, M. A., Finlayson, C., Gordon, E. J., & Chen, D. (2020). Formative development of a fertility decision aid for transgender adolescents and young adults: A multidisciplinary Delphi consensus study. Journal of Assisted Reproduction and Genetics, 37(11), 2805–2816. https://doi.org/10.1007/s10815-020-01947-8
Kumar, S., Mukherjee, S., O'Dwyer, C., Wassersug, R., Bertin, E., Mehra, N., Dahl, M., Genoway, K., & Kavanagh, A. G. (2022). Health outcomes associated with having an oophorectomy versus retaining one’s ovaries for transmasculine and gender diverse individuals treated with testosterone therapy: A systematic review. Sexual Medicine Reviews, 10(4), 636–647. https://doi.org/10.1016/j.sxmr.2022.03.003
Lai, T. C., Davies, C., Robinson, K., Feldman, D., Elder, C. V., Cooper, C., Pang, K. C., & McDougall, R. (2021). Effective fertility counselling for transgender adolescents: A qualitative study of clinician attitudes and practices. BMJ Open, 11(5), e043237. https://doi.org/10.1136/bmjopen-2020-043237
Leavy, M., Trottmann, M., Liedl, B., Reese, S., Stief, C., Freitag, B., Baugh, J., Spagnoli, G., & Kolle, S. (2017). Effects of elevated beta-estradiol levels on the functional morphology of the testis – New Insights. Scientific Reports, 7(1), 39931. https://doi.org/10.1038/srep39931
Lierman, S., Tolpe, A., De Croo, I., De Gheselle, S., Defreyne, J., Baetens, M., Dheedene, A., Colman, R., Menten, B., T'Sjoen, G., De Sutter, P., & Tilleman, K. (2021). Low feasibility of in vitro matured oocytes originating from cumulus complexes found during ovarian tissue preparation at the moment of gender confirmation surgery and during testosterone treatment for fertility preservation in transgender men. Fertility and Sterility, 116(4), 1068–1076. https://doi.org/10.1016/j.fertnstert.2021.03.009
Meijerink, A. M., Ramos, L., Janssen, A. J. W. M., Maas-van Schaaijk, N. M., Meissner, A., Repping, S., Mochtar, M. H., Braat, D. D. M., & Fleischer, K. (2016). Behavioral, cognitive, and motor performance and physical development of five-year-old children who were born after intracytoplasmic sperm injection with the use of testicular sperm. Fertility and Sterility, 106(7), 1673–1682.e5. https://doi.org/10.1016/j.fertnstert.2016.09.011
Moseson, H., Fix, L., Hastings, J., Stoeffler, A., Lunn, M. R., Flentje, A., Lubensky, M. E., Capriotti, M. R., Ragosta, S., Forsberg, H., & Obedin-Maliver, J. (2021). Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. International Journal of Transgender Health, 22(1–2), 30–41. https://doi.org/10.1080/26895269.2020.1841058
Muthusamy, K., Smushkin, G., Lampropulos, J. F., Elamin, M. B., Abu Elnour, N. O., Elamin, K. B., Agrwal, N., Gallegos-Orozco, J. F., Lane, M. A., Erwin, P. J., Montori, V. M., & Murad, M. H. (2010). Prevention of virilization in pregnancies at risk of congenital adrenal hyperplasia with dexamethasone: A systematic review and metaanalysis. Clinical Endocrinology, 31(3), https://doi.org/10.1111/j.1365-2265.2010.03826.x
Peri, A., Ahler, A., Gook, D., O'Connell, M. A., Bourne, H., Nightingale, M., Telfer, M., Jayasinghe, Y., & Pang, K. C. (2021). Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy. Journal of Assisted Reproduction and Genetics, 38(10), 2735–2743. https://doi.org/10.1007/s10815-021-02293-z
Rogers, C., Webberley, M., Mateescu, R., El Rakhawy, Y., Daly-Gourdialsing, A., & Webberley, H. (2021). A retrospective study of positive and negative determinants of gamete storage in transgender and gender-diverse patients. International Journal of Transgender Health, 22(1–2), 167–178. https://doi.org/10.1080/26895269.2020.1848693
Sermondade, N., Benaloun, E., Berthaut, I., Moreau, E., Prades, M., Béranger, A., Chabbert-Buffet, N., Johnson, N., Lévy, R., & Dupont, C. (2021). Reproductive functions and fertility preservation in transgender women: A French case series. Reproductive Biomedicine Online, 43(2), 339–345. https://doi.org/10.1016/j.rbmo.2021.04.016
Stolk, T. H. R., Asseler, J. D., Huirne, J. A. F., van den Boogaard, E., & van Mello, N. M. (2023). Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review. Best Practice & Research. Clinical Obstetrics & Gynaecology, 87, 102312. https://doi.org/10.1016/j.bpobgyn.2023.102312
Stoop, D., Ermini, B., Polyzos, N. P., Haentjens, P., De Vos, M., Verheyen, G., & Devroey, P. (2012). Reproductive potential of a metaphase II oocyte retrieved after ovarian stimulation: An analysis of 23 354 ICSI cycles. Human Reproduction, 27(7), 2030–2035. https://doi.org/10.1093/humrep/des131
van Amesfoort, J. E., van Rooij, F. B., Painter, R. C., Valkenburg-van den Berg, A. W., Kreukels, B. P. C., Steensma, T. D., Huirne, J. A. F., de Groot, C. J. M., & Van Mello, N. M. (2023). The barriers and needs of transgender men in pregnancy and childbirth: A qualitative interview study. Midwifery, 120, 103620. https://doi.org/10.1016/j.midw.2023.103620
van der Loos, M. A. T. C., Hannema, S. E., Klink, D. T., den Heijer, M., & Wiepjes, C. M. (2022). Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: A cohort study in the Netherlands. The Lancet. Child & Adolescent Health, 6(12), 869–875. https://doi.org/10.1016/S2352-4642(22)00254-1
ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers.
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