Fertility preservation rates vary across transgender youth

The number of transgender teenagers seeking fertility preservation prior to transitioning appears higher in those assigned male at birth.

The retrospective study based at the Royal Children's Hospital in Melbourne, Australia, assessed 102 transgender patients. They found that none of the 49 individuals who were assigned female at birth sought fertility preservation before commencing hormonal therapy, whereas of those assigned male at birth, this was 62 percent.

'Our findings suggest that there is a strong intrinsic desire to undertake fertility preservation among transgender adolescents assigned male at birth and highlight the importance of offering affordable fertility preservation to these young people.' said study leader  Dr Ken Pang, clinical scientist at Murdoch Children's Research Institute in Melbourne. 

The hormonal treatments transgender patients recieve include gonadotropin-releasing hormone agonists (GnRHa) to suppress puberty and either testosterone or oestrogen depending on gender identity. Such treatments can be detrimental to reproductive function, so guidelines recommend that individuals seek fertility counselling and access to fertility preservation prior to beginning any hormonal intervention. 

Previous studies have reported that 36 percent of transgender adolescents wanted to have children in the future, yet multiple North American studies identified only three percent to have undergone fertility preservation. 

According to the research letter published in JAMA Paediatrics, the significant difference in data is likely due to differences in access to fertility preservation between Australia and North America. This study was also conducted in a publicly funded gender clinic partnered with a paediatric oncofertility clinic which may explain the difference. 

'We were interested to know whether the low rates of fertility preservation that had been recently observed in North America reflected an intrinsic lack of desire for fertility preservation among transgender adolescents or instead arose due to health care barriers, such as high cost and limited availability,' Dr Pang told Healio. 

The greater percentage of male-at-birth transgender patients undergoing fertility preservation compared to female-at-birth patients could be due to the financial cost and time to preserve sperm samples or testicular tissue being far less than that of undergoing oocyte retrieval or ovarian tissue freezing. Other reasons cited by female-at-birth patients for not undergoing fertility preservation included not wanting children, preference for adoption, or opposing the invasiveness of the procedure.