Study identifies major barriers to fertility preservation in transgender youth

Few transgender adolescents opted to pursue fertility preservation, according to a report from Ann & Robert H. Lurie Children's Hospital of Chicago, published in the Journal of Adolescent Health. While all patients were counseled about available options for fertility preservation prior to initiating hormones for medical transition, only 12 percent chose to see a fertility specialist and less than 5 percent completed fertility preservation procedures.

"In our study, transgender youth decided to pursue fertility preservation at much lower rates than we would have expected from research on reproductive desires of transgender adults, which suggests that about half want biological children and over a third would have considered preserving their fertility if techniques had been available and offered to them," said lead author Diane Chen, PhD, a pediatric psychologist with the Gender & Sex Development Program at Lurie Children's and in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine.
Chen and colleagues identified the major barriers to fertility preservation in transgender youth between the ages of 14 and 20 as cost, invasiveness of procedures and reluctance to delay initiating hormone therapy for medical transition.

"Not surprisingly, procedure invasiveness was a frequent concern for transgender men, who are assigned female at birth and identify as male. They often experience significant body dysphoria that can be exacerbated by fertility preservation procedures," said Chen. Fertility preservation for transgender men requires 10-14 days of daily hormone injections, monitoring via transvaginal ultrasounds, and oocyte (egg) retrieval using ultrasound-guided transvaginal aspiration of follicular fluid.
The study involved a retrospective chart review of all patients initiating hormones with the Gender & Sex Development Program at Lurie Children's between July 2013 and July 2016. Out of 105 transgender adolescents, 13 saw a fertility specialist for formal consultation and five underwent fertility preservation (four completed sperm cryopreservation and one completed oocyte cryopreservation).

"Anecdotally, we have heard from a few transgender youth after starting hormones, when they are more comfortable in their bodies, that they felt more ready to consider becoming parents in the future," said Chen. "Better understanding how these youth approach fertility-related decision-making and what information they may need from providers is important, which is why we are currently recruiting for a study looking at fertility-related knowledge, attitudes, and beliefs among transgender youth and their parents.

Lurie Children's Gender & Sex Development Program currently provides gender development services to 600 patients, including gender non-confirming children, gender questioning youth and transgender adolescents. The program is the first of its kind in the Midwest, aimed at supporting the physical, mental and social health of patients and their families.

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