First UK medical guidelines issued for trans fertility preservation

The Royal College of Obstetricians and Gynaecologists (RCOG) has published a first draft guideline on improving care for trans and gender diverse people accessing health services.

Key recommendations highlight the need to inform patients considering gender affirmative hormone therapy or surgical procedures of the impact that treatment may have on their fertility, and of fertility preservation options that are available.

'There is a lot of work to be done to ensure healthcare is fully inclusive and the development of this draft guidance is a welcome step towards this,' said Clare Ettinghausen from the Human Fertilisation and Embryology Authority. 'It's important that a diverse group of voices further inform this work so once finalised, the guidance can be put into practice and begin making a difference. We'd advise anyone considering fertility preservation to think carefully about their options and discuss them with medically qualified staff.'

A consultation on the draft Care of Trans and Gender Diverse Adults in Obstetrics and Gynaecology  guideline runs until 6 September 2022. The guidelines suggest clinicians discuss and offer fertility preservation options to people before they access gender-affirming interventions. This is because procedures like genital reconstruction surgery or puberty blockers may result in a loss of fertility.

Common fertility preservation technologies include the cryopreservation of oocytes, sperm, embryos and ovarian or testicular tissue. Guidelines suggest that patients should be informed about the lack of evidence for long-term outcomes for patients and their offspring after using fertility preservation techniques but also state there is no 'ethical justification' for denying fertility preservation or treatment to trans people. The potential impact of fertility preservation on gender dysphoria should also be considered by clinicians, the guidelines state.

Besides advising the need for fertility preservation services, this draft also highlights the importance of offering equitable antenatal care and information. It also makes the recommendation that trans men should be advised to stop hormone treatment three months before trying to conceive.

When finalised the RCOG's guidelines should influence the two new regional centres planned in London and the North West of England to replace the Tavistock Centre which is due to be closed in spring 2023. This closure of the UK's only gender identity clinic for children and young people follows the publication of an independent review commissioned after the clinic received an 'inadequate' rating by the Care Quality Commission. This rating was due in part to safety concerns raised regarding a lack of adequate recording of patients' consent to gender affirmative treatment. Investigations took place after concerns were raised by whistleblowing staff who had worked there.