TRANSGENDER FERTILITY

The unit specialises in effective fertility treatments without gender dysphoria or emotional impact.

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    New family and transgender fertility models

    Maternity and paternity in transsexual couples respond to the same genetic desire as in other people, specifically, the desire to start a family.

    The transition to a different gender is complex and unique to each individual. Transgender individuals may or may not choose to change their bodies with surgical or hormone-based treatment methods. Unfortunately, both options have a negative impact on fertility.

    Equipo Juana Crespo believes that the medical community has an important role to play in promoting systemic changes that provide equitable and gender affirming care for transgender people across all areas of reproductive health.

    Fertility planning for young transsexuals

    As society advances, new family models play an increasingly role, which helps to normalise gender identities.

    Increasingly, children and adolescents are aware of the incongruence between their sex and gender identity, which leads them to seek specialised medical care that includes multidisciplinary treatments focused on fully satisfying the young person or adolescent.

    All treatments focused on gender transition that are irreversible or partially reversible therapies, such as hormone therapy, have an impact on fertility. Therefore, fertility planning before initiating any therapy would be optimal.

    Equipo Juana Crespo knows that fertility planning in transgender people goes beyond mere fertility preservation (FP) by freezing eggs or sperm. Although the technique and technologies are the same as for other patients, protocols and procedures need to be adapted to minimise distress and gender dysphoria.

    Transgender fertility preservation methods

    Transgender women

    CTT is an experimental procedure consisting of surgical removal and cryopreservation of testicular tissue.

    Indicated in prepubertal transgender girls as it is the only fertility preservation option at this stage of development.

    The simplest and most effective FP (Fertility Preservation) method for transgender women from the post-pubertal stage onwards.

    Consists of freezing a sperm sample.

    However, for many transgender women, using their genitalia can generate significant dysphoria. Samples can also be obtained with the aid of vibratory stimulation or electroejaculation, sperm aspiration or microsurgical extraction of sperm directly from parts of the testes or epididymis.

    The youngest age of successful sperm collection for transgender fertility preservation is 11 years old.

    A testicular biopsy to recover testicular sperm. Consists of a surgical procedure in which several samples of testicular tissue are extracted to obtain optimal spermatozoa.

    Transgender men

    Treatments based on testosterone administration have a direct impact on ovarian reserve. Although it is reversible, it is always advisable to perform preservation before starting testosterone treatment.

     

    To carry out a successful preservation, i.e., to obtain a considerable number of eggs in a single treatment, “ovarian stimulation” is necessary.

    A medical procedure based on the menstrual cycle whereby the patient is injected daily with hormone medication for approximately 10 days. During this ovarian stimulation phase, gynaecological examinations such as transvaginal ultrasound are necessary and can cause emotional instability and psychological distress. Therefore, Equipo Juana Crespo has alternative methods such as ultrasound, transabdominal monitoring, or remote ultrasound probe

    If testosterone treatment has been started, its interruption should not exceed the duration of the stimulation. 

    Ovarian tissue cryopreservation is the only option available for individuals who were assigned female at birth and have not yet undergone innate puberty. It must be performed before receiving any gender affirming treatment to preserve transgender fertility. 

    This procedure involves the surgical removal, usually laparoscopically, of part of the ovarian cortex or an entire ovary.

    The tissue is dissected in the laboratory to obtain small fragments of cortex about 1 mm thick. Each fragment can be cryopreserved individually for long-term storage.

    Dr Juana Crespo was a pioneer in performing the first ovarian tissue cryopreservation treatment and its subsequent implantation in a woman, resulting in the birth of the first twins born healthily using this technique, which represented a success story for transgender motherhood.

    Transgender fertility treatment methods

    To achieve full-term gestation of a healthy baby in a transgender man, the following treatments are available:

    In certain cases, the option of intrauterine artificial insemination with donor or cisgender partner sperm could be considered for transgender parenthood.

    Indicated both for transgender men who have previously vitrified their oocytes or even for those who, once the testosterone treatment has been interrupted, can and want to perform an ovarian stimulation.

    An In Vitro Fertilization procedure can be performed with donor sperm or with sperm from the cis-male partner.

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    This would require IVF treatment with donated eggs or embryos that would be transferred to the transgender man’s uterus to achieve gestation.

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    For cases of a transgender man with a cis woman as a partner, there would be the option of both members of the couple being able to produce oocytes and gestate via the ROPA method. A unique opportunity to share the process medically and emotionally.

    For this, the transsexual male patient would provide the eggs that would be fertilised with donor sperm. The embryos generated would be transferred to the cis-woman partner, who would be ready to gestate them during the 9 months of pregnancy.

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    Frequently Asked Questions

    Is fertility preservation essential in transgender men?2023-01-03T12:13:39+01:00

    As explained above, if surgical sex reassignment has not taken place, it is possible to achieve a transgender pregnancy if hormonal treatments are put on hold to stimulate the ovarian reserve and facilitate transgender pregnancy.

    Do hormone treatments need to be put on hold?2023-01-03T12:14:01+01:00

    Testosterone treatments can directly affect ovarian reserve. Treatments should be put on hold to reverse this situation. However, it is advisable to perform oocyte preservation before starting testosterone treatment to ensure egg quality.

    When should we start considering transgender fertility?2023-01-03T12:14:29+01:00

    To preserve fertility in transgender people, the issue must be raised as early as possible. Particularly before any sex reassignment surgery is performed.

    For prepubertal transgender girls, the only fertility preservation option at this stage of development is CTT or Cryopreservation of Testicular Tissue. In later cases, there are other options.

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