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06/22/2017

Fertility preservation for transgender individuals

The field of oncofertility emerged to preserve the fertility
of cancer patients whose treatment might render them as infertile or sterile.
Today, the field of fertility preservation has expanded to other patient
populations whose medical treatment may affect their fertility. One such
population is transgender individuals undergoing gender affirming treatments.
Although research on transgender individuals is limited overall and in
particular regarding issues surrounding reproduction, transgender individuals
are interested in biological reproduction. Because various gender affirming
treatments will permanently affect their fertility, such as hormonal treatment
and surgical removal of the gonads, it is important for transgender individuals
to be offered fertility preservation before they start these treatments.

There are, however, some factors that may make fertility
preservation difficult or less attractive of an option for transgender
individuals. Healthcare professionals offering fertility preservation should be
aware of these factors so they can help mitigate them. Here I will discuss two
of them.

First, undergoing fertility preservation treatment can be
stressful for both transgender and cisgender people, but there are some unique
challenges for transgender individuals. Individuals with gender dysphoria may
find it particularly difficult to undergo procedures involving anatomy that is
discordant with their identity. For example, transgender women who are asked to
retrieve sperm via masturbation may find this request exacerbates their gender
dysphoria and may not be possible to do. Transgender men who are asked to
undergo vaginal ultrasounds may find this psychologically traumatic. In
recognizing how fertility preservation treatment can be particularly difficult
for transgender individuals, healthcare professionals should be prepared to
find ways to alleviate these difficulties, such as by offering surgical methods
of sperm retrieval for transgender women and sedating transgender men during
vaginal ultrasounds.

Second, the gametes retrieved and frozen will not match the
gender identity of transgender patients (i.e. a transgender woman will bank
sperm and a transgender man will bank eggs). This discordance may not matter
for some transgender individuals, but it could affect others. At least one
older study
found that having frozen discordant gametes made it difficult
for some transgender individuals to move forward with their lives in their
gender identity. More research is needed in this area to understand if and how
this discordance affects transgender individuals today. Healthcare
professionals should be aware of this potential discordance between gender
identity and frozen gametes, but it should not be a reason to deny fertility
preservation to transgender patients.

In addition to the two factors I have discussed here, there
are other factors at play in fertility preservation for transgender
individuals. Fertility preservation is becoming more common for transgender
individuals undergoing gender affirming treatment and consequently healthcare
professionals treating these individuals should be aware of some of the unique
challenges this patient population faces. For more information on this topic,
check out the “Proceedings
of the Working Group Session on Fertility Preservation for Individuals with
Gender and Sex Diversity
.”

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website.  

 

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