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Chapter 17 - Transgender Assisted Reproductive Technology

from IV - Addressing the Needs of Diverse Populations

Published online by Cambridge University Press:  24 November 2022

By
Jamie Joseph ,
Trystan Reese  and
Molly Moravek
Edited by
Sharon N. Covington
Sharon N. Covington
Affiliation:
Shady Grove Fertility, Rockville, MD
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Summary

Assisted reproductive technology (ART) is essential for transgender people’s reproductive justice and autonomy in relation to fertility preservation and family building, whether using their own bodies (eggs, sperm, or uterus), donor gametes, or a gestational carrier. The ability to form a family using one’s own gametes and/or body is necessary for transgender people to consider before medical transition is initiated (hormones/surgeries) and is part of the Informed Consent process of gender medical transition. Progressive thinking, greater cultural awareness and modern medicine have contributed to an increase in transgender people utilizing ART to create their families. Helping transgender patients navigate medically assisted fertility preservation and reproduction requires diverse knowledge, sensitivity training and cultural inclusivity for fertility counselors. Providing gender-affirmative care in reproductive endocrinology and fertility settings when working with transgender patients involves understanding terminology used in the transgender population, use of a trauma-informed care lens, knowledge of a nonbinary gender system, avoiding heteronormativity, cisnormativity and knowledge of gender dysphoria. The American Society for Reproductive Medicine (ASRM), The Endocrine Society, World Professional Association for Transgender Health (WPATH) and American College of Obstetrics and Gynecology (ACOG) have published documents addressing fertility and preservation considerations for transgender people.

Keywords

transgenderhormonesmedical nonbinarytransitiongenderdysphoriaWPATHfertilitypreservation
Type
Chapter
Information
Fertility Counseling: Clinical Guide , pp. 172 - 182
Publisher: Cambridge University Press
Print publication year: 2022

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References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association, 2013.CrossRefGoogle Scholar
Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823. Obstet Gynecol 2021;137(3):e75–e88.Google Scholar
Chang, SC, Singh, AA, Dickey, LM. A Clinician’s Guide to Gender-affirming Care: Working with Transgender and Gender Nonconforming Clients. Oakland, CA: New Harbinger Publications Inc., 2018.Google Scholar
Dickey, LM, Ducheny, KM, Ehrbar, RD. Family creation options for transgender and gender nonconforming people. Psychol Sex Orientat Gend Divers 2016;3(2):173–179.CrossRefGoogle Scholar
Ethics Committee of the American Society of Reproductive Medicine. Access to fertility services by transgender and nonbinary persons: an Ethics Committee Opinion. Fertil Steril 2021;115(4):874–878.CrossRefGoogle Scholar
American Psychological Association. Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. Am Psychologist 2015;70(9):832–864.CrossRefGoogle Scholar
American Academy of Child and Adolescent Psychiatry. Gay, lesbian, bisexual or transgender parents. Published 2013. Available from: www.aacap.org/AACAP/Policy_Statements/2008/Gay_Lesbian_Bisexual_or_Transgender_Parents.aspx [last accessed June 16, 2022].Google Scholar
De Sutter, P, Verschoor, A, Hotimsky, A, Kira, K. The desire to have children and the preservation of fertility in transsexual women: a survey. Int J Transgend 2002;6(3).Google Scholar
Wierckx, K, Van Caenegem, E, Pennings, G, et al. Reproductive wish in transsexual men. Hum Reprod 2012;27(2):483–487.CrossRefGoogle ScholarPubMed
Besse, M, Lampe, NM, Mann, ES. Experiences with achieving pregnancy and giving birth among transgender men: a narrative literature review. Yale J Biol Med 2020;93:517–528.Google Scholar
MacDonald, TK, Walks, M, Biender, M, Kibbe, A. Disrupting the norms: reproduction, gender identity, gender dysphoria, and intersectionality. Int J Transgend 2021 ;22(1–2):18–29.Google Scholar
Green, R, Money, J. Transsexualism and Sex Reassignment. Baltimore, MA: John Hopkins Press, 1969.Google Scholar
Transgender Europe – Trans Rights Europe Index, 2018. Produced by: The International Lesbian, Gay, Bisexual, Trans & Intersex Association (ILGA) Europe. Brussels, Belgium.Google Scholar
World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender and gender variant people. Version 7. Available from: www.wpath.org. Published 2012.Google Scholar
Hembree, WC, Cohen-Kettenis, P, Gooren, IJ, et al. Endocrine treatment of gender-dysphoric/gender incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocr Metab 2017;102:3869–3903.CrossRefGoogle Scholar
Moravek, MB. Gender-affirming hormone therapy for transgender men. Clin Obstet Gynecol 2018;61(4):687–704.Google Scholar
Defreyne, J, Vanwonterghem, Y, Collet, S, et al. Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: a prospective cohort study (ENIGI). Int J Transgend Health 2020;21(2):163–175.Google Scholar
Taub, RL, Ellis, SA, Neal-Perry, G, Magaret, AS, Prager, SW, Micks, EA. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol 2020;223(2):229.e1–229.e8.CrossRefGoogle ScholarPubMed
Randolph, JF Jr. Gender-affirming hormone therapy for transgender females. Clin Obstet Gynecol 2018;61(4):705–721.CrossRefGoogle ScholarPubMed
Adeleye, AJ, Reid, G, Kao, CN, Mok-Lin, E, Smith, JF. Semen parameters among transgender women with a history of hormonal treatment. Urology 2019;124:136–141.CrossRefGoogle ScholarPubMed
Kent, MA, Winoker, JS, Grotas, AB. Effects of feminizing hormones on sperm production and malignant changes: microscopic examination of post orchiectomy specimens in transwomen. Urology 2018;121:93–96.Google Scholar
Matoso, A, Khandakar, B, Yuan, S, et al. Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery. Hum Pathol 2018;76:91–99.Google Scholar
Li, K, Rodriguez, D, Gabrielsen, JS, Centola, GM, Tanrikut, C. Sperm cryopreservation of transgender individuals: trends and findings in the past decade. Andrology 2018;6(6):860–864.CrossRefGoogle ScholarPubMed
Marsh, C, McCracken, M, Gray, M, Nangia, A, Gay, J, Roby, KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet 2019;36(8):1639–1648.Google Scholar
Light, AD, Obedin-Maliver, J, Sevelius, JM, Kerns, JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol 2014;124(6):1120–1127.Google Scholar
Moravek, MB, Kinnear, HM, George, J, et al. Impact of exogenous testosterone on reproduction in transgender men. Endocrinology 2020;161(3):bqaa014. https://doi.org/10.1210/endocr/bqaa014Google Scholar
Grimstad, FW, Fowler, KG, New, EP, et al. Ovarian histopathology in transmasculine persons on testosterone: a multicenter case series. J Sex Med 2020;17(9):1807–1818.CrossRefGoogle ScholarPubMed
De Roo, C, Lierman, S, Tilleman, K, et al. Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod Biomed Online 2017;34(6):557–566.Google Scholar
Leung, A, Sakkas, D, Pang, S, Thornton, K, Resetkova, N. Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Fertil Steril 2019;112(5):858–865.CrossRefGoogle ScholarPubMed
Adeleye, AJ, Cedars, MI, Smith, J, Mok-Lin, E. Ovarian stimulation for fertility preservation or family building in a cohort of transgender men. J Assist Reprod Genet 2019;36(10):2155–2161.Google Scholar
Rothenberg, SS, Witchel, SF, Menke, MN. Oocyte cryopreservation in a transgender male adolescent. N Engl J Med 2019;380(9):886–887.Google Scholar
Martin, CE, Lewis, C, Omurtag, K. Successful oocyte cryopreservation using letrozole as an adjunct to stimulation in a transgender adolescent after GnRH agonist suppression. Fertil Steril 2021 (online). https://doi.org/10.1016/j.fertnstert.2021.02.025.Google Scholar
“USTS Reports – 2015 U.S. Trans Survey.” Available from: www.ustranssurvey.org/reports [last accessed 16 June, 2022].Google Scholar
Mendoza, NS, Moreno, FA, Hishaw, GA, et al. Affirmative care across cultures: broadening application. Focus 2020;18:31–39.Google Scholar
Gates, TG, Brian, K. Affirming Strengths-Based Models of Practice. Social Work Practice with the LBGTQ Community, 2017, pp. 235–248. Retrieved from Loyola eCommons, Social Work: School of Social Work Faculty Publications and Other Works.Google Scholar
Hidalgo, M, Ehrensaft, D, Tishelman, A, et al. The gender affirmative model: what we know and what we aim to learn. Hum Develop 2013;56:285–290.CrossRefGoogle Scholar
SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.Google Scholar

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