Luckily, our society is advancing by leaps and bounds. The transgender population today already represents a proportion of the population between 0.1 and 2.7%. But what about the gestational wishes of transgender people? From IVI we want to shed light on this issue.
Gestational desire in transgender people
We know that the desire to be mothers and fathers in transgender people is the same as that of cisgender people. This is around 50-60% for both population groups. Starting from this base, from assisted reproduction we have various techniques to fulfill the desire to have a child in transgender people. And it is that, according to ‘Desire to Have Children Among Transgender People in Germany: A Cross-Sectional Multi-Center Study’up to 76% of these patients consider the fertility preservation technique in order to have children in the future.
“Given this reality, and given the evolution of reproductive medicine to help create new family models, as has been done with single women and couples of women, we now open our support to all transgender people to fulfill their reproductive desires. And how do we make it possible? Offering them the possibility of preserving their gametes before undergoing a medical and even surgical process that will allow them to acquire the role with which they identify”comments Dr. Antonio Requena, IVI’s medical director.
Preservation of fertility in transgender people
As we have mentioned, the desire to be fathers and mothers in the future is just as high among the transgender population as in the cisgender population. But there are barriers to deciding on a gamete vitrification treatment.
“The most frequent concerns in the field of reproduction are the lack of adequate medical advice, the unwanted side effects of endogenous hormones, the sometimes invasive procedures and the need to delay or stop treatment with exogenous hormones, which which can lead to the reappearance of the symptoms associated with gender dysphoria –a state of anxiety secondary to the discrepancy between gender identity and the sex assigned at birth-“explains Dr. Requena.
IVI Barcelona: leading the way in treatments for transgender people
The professionals that make up IVI Barcelona have spent time developing projects focused on reproductive medicine care for transgender people. At IVI we are aware of the need to have personalized care protocols for transgender people. Therefore, the path started by IVI Barcelona is laying the foundation for the processes that we follow in all our clinics nationwide in Spain.
Fertility preservation in transgender men
Transgender men are those people who were born female and are in or have transitioned to a male gender role. Your fertility preservation options can be grouped into two large groups:
Before and after the start of testosterone hormone therapy: a trans man can opt for oocyte vitrification.
“Currently there are no clear studies about the recommendation to stop testosterone treatment before treatment and for how long, and there are even publications in which hormonal stimulation has been performed without testosterone treatment suspension, with no differences observed. in the quality of the oocytes obtained. In this regard, data have recently been published on the results of oocyte vitrification in trans men undergoing hormone therapy (suspended before starting stimulation) in comparison with trans men who had not started testosterone treatment and with cisgender women. And as a result, there appears to be no difference in the number and maturity of oocytes retrieved or in the response to stimulation, although one study did show the need for a lower dose of FSH and higher peak estradiol levels in transgender men in comparison with cisgender women”points out Dr. Requena.
In addition, there is an experimental option for fertility preservation in transgender men: ovarian cortex cryopreservation. This is removed surgically by laparoscopy.
Assisted reproductive treatments in transgender men
In addition, no effects on the health of live newborns have been observed after treatments with cryopreserved oocytes in transgender men with prior hormone therapy or in those who preserved fertility prior to testosterone therapy.
On the other hand, the vitrified oocytes in transgender men can have several reproductive destinations: generate in the future embryos that will be transferred to the patient’s own uterus, if he has not undergone gender reaffirmation surgery -through hysterectomy-, or to the uterus of the cisgender female couple, through a ROPA treatment (Reception of Oocytes from the Couple). It is worth mentioning that in this second case the embryos would be generated by using donor semen.
Fertility preservation in transgender women
Trans women, those who were born male and who are or have changed their gender role to female, also have options to preserve their fertility. These would be the freezing of both semen and testicular tissue.
“The treatments that involve ovarian stimulation in trans men will require the exogenous administration of hormones (with elevation of endogenous estrogen levels), the practice of vaginal examinations, ultrasound scans and, in the case of obtaining oocytes, puncture for transvaginal aspiration of follicles. In the case of trans women, the need to resort to masturbation to obtain seminal samples would arise, which could be emotionally and psychologically hard for these patients. It is for this reason that any reproductive treatment in trans people must be emotionally supported by a team of psychologists to alleviate the emotional disorders linked to these processes”adds Dr. Requena.
Is there a recommended time for fertility preservation in transgender people?
Reproductive treatments to preserve fertility in transgender patients may conflict with their gender identity and emotions when undergoing hormonal treatment of the sex they were born with. Therefore, it is advisable to opt for fertility preservation when starting gender reassignment hormone therapy.
“It is true that we still do not have very conclusive data, because there is not a large enough case mix, and that there is much to be done in this area. We are beginning to face these new challenges in reproductive medicine and doubts arise that today cannot be answered with complete certainty due to the lack of scientific evidence. For this reason, it would be most advisable that when these patients begin this process of changing their gender identity, they should consider preservation. Both in the case of spermatozoa in transgender women, and in the case of trying to save eggs early, before they have been on testosterone treatment for a long time, in transgender men”concludes Dr. Requena.
