From the Journals

New frontier: Transgender men yield eggs, babies, even after testosterone


 

Transgender men who were assigned female sex at birth show a similar response to ovarian stimulation as cisgender women, even after using testosterone, shows the first formal study of its kind in this patient group.

The transgender patients each had an average of 20 eggs retrieved, and all who transferred embryos eventually achieved a successful pregnancy and delivery, “representing the largest cohort of transgender male patients to be described in the literature thus far,” wrote Nina Resetkova, MD, and colleagues in their article, published in Fertility and Sterility.

The research has been hailed as groundbreaking.

Dr. Resetkova, a reproductive endocrinologist at Boston IVF, Beth Israel Deaconess Medical Center, said in an interview that “these new data show it is reasonable for transmen [female-to-male transition], even those who have used testosterone for some time, to undergo assisted reproductive technology [ART].

“We’ve found that there isn’t a decrease in oocyte retrieval and may actually be a slight increase. We found this to be remarkable,” she said, emphasizing that these findings should be very reassuring for transgender male patients concerned about fertility.

“Transmales worry that they’ve thrown in the towel, and by committing to testosterone have started on a pathway with no return, but these data suggest they still have options,” Dr. Resetkova explained.

“Our study shows that these patients can have ovarian stimulation outcomes that are similar to those of cisgender counterparts, and this seems to be true even in cases of patients who have already initiated hormonal transition with the use of testosterone,” she said.

The researcher hopes the results will encourage more referrals for transgender men wishing to explore their fertility options. “Previously, many doctors were reluctant to refer to a fertility practice if their transmale patient had already started testosterone therapy or they had been on it for several years,” she said.

In a comment, Joshua Safer, MD, a spokesperson on transgender issues for the Endocrine Society, said that “fertility compromise may represent the single largest risk of medical treatment for some transgender persons. At meetings and in personal communications, several clinical groups have reported successful egg harvest from transgender men.

“However, this is the first careful study of a defined cohort published formally. As such, it serves as an important reference in advancing transgender medical care,” noted Dr. Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery, New York.

Need for guidance

Previously, there has been an assumption that transgender individuals were not interested in maintaining their reproductive potential, but this has proven untrue. “Several recent studies have demonstrated that transgender people do desire parenthood, or at the least wish to preserve that possibility,” noted Dr. Resetkova and colleagues.

Both the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology have issued opinions that transgender patients should have the same access to fertility options as cisgender patients and that fertility preservation options should be discussed before gender transition, they noted.

The first and key intervention needed is the ability to preserve fertility through the cryopreservation of gametes before medical or surgical transition. In transgender men, this can be done via oocyte, embryo, or ovarian tissue cryopreservation.

Dr. Resetkova and the team at Boston IVF realized there was no published evidence, bar a couple of case reports, to guide clinicians caring for transgender men who wanted to preserve their fertility.

To help fill the research gap, they drew data from a retrospective cohort using electronic medical records from a single large in vitro fertilization (IVF) clinic. The search was conducted from January 2010 to July 2018, because the first transgender man was treated at the clinic in 2010.

To be included in the study, the patient had to identify as a transgender man and have completed an ovarian stimulation cycle for oocyte cryopreservation, embryo cryopreservation, or intended uterine transfer.

“This is the first study to describe transgender cycle parameters and outcomes in such detail and scope,” the authors noted in their article.

The study aimed to investigate ART outcomes in a female-to-male transgender cohort (n = 26) who wished to preserve fertility through egg freezing and/or undergo IVF with the intention of pregnancy.

Each transgender man was matched with five cisgender women for age, body mass index, and anti-Müllerian hormone level, and egg yield was compared. The 130 cisgender women were in straight relationships where there was difficulty conceiving, mostly because of male-factor, or tubal-factor, infertility; cisgender women with ovulatory dysfunction were excluded.

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