Fertility care in transgender and gender-diverse individuals: the possibility of oocyte and sperm cryopreservation after medical transition

Some transgender and gender-diverse individuals desire biological children; however, only a small percentage of these individuals preserve their fertility. There are many barriers preventing such patients from accessing assisted reproductive technologies. Many of them are not informed regarding fertility preservation options before initiation of gender-affirming hormonal therapy (GAHT). Transgender women and transfeminine individuals have worse semen parameters than cisgender men, even without exposure to GAHT. For those who seek GAHT, estradiol and/or antiandrogens may negatively impact semen parameters. Although a hiatus from GAHT before sperm cryopreservation may be considered, this may impose hardship. Transgender men and transmasculine individuals on GAHT have similar oocyte retrieval outcomes compared with transgender men not on GAHT and cisgender women. Multiple reports have indicated positive outcomes even in those who continue their testosterone through the oocyte stimulation cycle. Ideally, transgender and gender-diverse individuals should see a reproductive endocrinologist for a discussion of fertility preservation options and, if desired, should ideally complete fertility preservation before starting GAHT. Still, for several reasons, patients may decline or omit this step before initiating medical transition and then decide later that they wish to pursue fertility preservation or treatment. Thankfully for transgender males, data indicates that successful fertility preservation is possible even after medical transition. For transgender females, estradiol may reduce fertility potential, and outcomes after medical transition can be more limited.