Trends in fertility preservation and barriers encountered by transgender individuals: where we started and have we progressed? A comprehensive review

The transgender and nonbinary (TGNB) communities face unique challenges when deciding to forego or pursue fertility because of gender-affirming medical or surgical interventions. Options for these patients have historically been limited because of overt discrimination within the healthcare system. The purpose of this comprehensive review is to discuss trends in TGNB reproductive access and healthcare over the past 2 decades and survey past and current legislation regarding TGNB reproductive rights. To better identify barriers for TGNB population and trends regarding fertility preservation, our review examines the attitudes, knowledge, and beliefs of both TGNB persons and healthcare providers. Second, we conduct a review of past and present legislation regarding reproductive rights and access related to TGNB care. The findings of our review demonstrate a failure to meet the standard of care for TGNB individuals in regard to fertility care, which likely contributes to the low uptake of fertility preservation services among this population. Furthermore, we find that healthcare providers must play a crucial role in advocating for systemic changes that can help alleviate barriers and provide equitable, gender-affirming care for TGNB individuals across the reproductive health spectrum.