Fertility preservation for transgender, non-binary, and gender-expansive individuals in France: A comprehensive assessment of healthcare services and practices

Abstract

Introduction

Fertility preservation (FP) consultations are recommended before treatments that may affect fertility, including gender-affirming hormone therapy (GAHT). While some FP centers in France assist individuals undergoing gender transition, many transgender, non-binary, and gender-expansive individuals still choose not to pursue gamete cryopreservation. This study provides an overview of access to FP for transgender individuals in France in 2021.

Materials and methods

This descriptive observational study includes 47 French centers authorized to conduct FP activities. A total of 85.1 % (40/47) of these centers responded to an online questionnaire conducted between September 2022 and March 2023. The questionnaire addressed the activities of the centers in 2021, waiting times, methods of care for transgender, non-binary, and gender-expansive individuals, and training provided to healthcare professionals.

Results and discussion

In 2021, 29 centers reported performing FP cycles for transgender, non-binary, and gender-expansive individuals, with some showing specialized expertise. Significant differences were noted between oocyte and sperm cryopreservation. Waiting times for sperm freezing were acceptable, but oocyte freezing faced longer delays. Some centers provided professional training and communication activities to promote services. The findings highlight the need for improved regional coverage, shorter waiting times, and better communication to ensure equitable access to fertility care for all.

Conclusion

This study reveals disparities in access to and quality of FP services for transgender, non-binary, and gender-expansive individuals in France. Further evaluations are needed to understand the disparities between centers and, where possible, include all centers offering FP services in France.