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Semen cryopreservation viable option for transgender patients, study shows
Semen cryopreservation is a viable method of fertility preservation for feminizing transgender individuals, according to findings published in Pediatrics.
“It is important to talk to people before initiating medical treatment of gender transition about fertility preservation and to periodically re-visit this topic, even after medical treatments have begun,” study author Hanna Valli-Pulaski, PhD, assistant professor at the UPMC Magee-Womens Hospital, told Infectious Diseases in Children. “This study offers hope that even after starting medical treatment, fertility preservation may still be an option for adolescents and young adults.”
According to the study, fertility preservation techniques were initially used to allow patients undergoing gonadotoxic cancer therapies to retain the option to have biological children after treatment. The techniques have now expanded to offer the same option to gender-nonconforming individuals undergoing therapy for gender dysphoria, the researchers wrote. They also noted that the desire among transgender youth for having biological children in the future may vary widely, with some surveys reporting lower rates of interest, whereas others reported interest in many types of family building, including adoption and having biological children.
Valli-Pulaski and colleagues collected retrospective data on 11 transgender patients seeking fertility preservation at the same institution between 2015 and 2018. The data included previous history of gonadotropin-releasing hormone (GnRH) agonists, age at initial consultation and semen analysis parameters. The patients received consultation at a median age of 19 years. A total of 10 patients attempted and completed at least one semen collection. Of these, eight cryopreserved semen before initiating treatment, and they all exhibited low morphology with otherwise normal median semen analysis parameters, according to the study.
Before presentation for semen cryopreservation, two patients had previously initiated treatment of gender dysphoria. The first patient discontinued leuprolide acetate to attempt fertility preservation and demonstrated transient azoospermia of 5 months’ duration with subsequent recovery of spermatogenesis. The second patient had previously received spironolactone and estradiol, and semen analysis revealed persistent azoospermia for the 4 months leading up to orchiectomy after discontinuation of both medicines, the researchers reported.
“Fertility preservation for all youth and adults is a big decision, and for young people especially, desires and methods of parenting may change,” Valli-Pulaski said. “This may give hope for the patients who have already started their transition and then change their mind about parenthood and having genetic children.”
Valli-Pulaski and colleagues noted that further research is needed to determine the length of time needed for spermatogenesis to resume after discontinuation of GnRH agonist treatment.
In a related editorial, Jason Rafferty, MD, MPH, EdM, a pediatrician and child psychiatrist at the Adolescent Healthcare Center at Hasbro Children’s Hospital in Providence, Rhode Island, wrote that the study by Valli-Pulaski and colleagues, which is the first to look at semen cryopreservation outcomes among transgender and gender-diverse adolescents and young adults, is a solid first step. However, “more research is critical to characterize the potential for and limitations of fertility preservation, specifically after initiating [medical affirming interventions], and on alternative approaches that are more effective and/or better tolerated.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
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