Fertility Preservation Options for Transgender Patients: An Overview
Abstract
:1. Introduction
2. Fertility in Transgender Patients
3. Cryobiology of Gonadal Tissue Freezing
3.1. Sperm Freezing
3.2. Oocyte and Ovarian Tissue Freezing
3.3. Freezing of Embryos
4. Trends in Demand and Utilization
4.1. Demand for Fertility Preservation among Transgender Patients
4.2. Utilization of Preserved Tissues
5. Barriers to Access
5.1. Sociological Barriers
5.2. Financial Barriers
6. Legal and Ethical Dilemmas
6.1. The Importance of Informed Consent
- (1)
- A description of the procedures involved in freezing and thawing.
- (2)
- Procedural risks (failure of the tissue to survive freezing and thawing, and the theoretic risk of increased congenital anomalies; a mechanical failure of a catastrophic event leading to the loss of the frozen tissue, etc.).
- (3)
- The benefits (preservation of fertility).
- (4)
- Alternatives to cryopreservation (use of fresh donor tissue when available).
6.2. Legality and Inheritance for Nonstandard Familial Relationships
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Patient | Cryopreservation Option | Advantages | Disadvantages |
---|---|---|---|
Male at birth | Freezing sperm | Only feasible option for male-at-birth patients to preserve sperm | Cryopreservation may reduce sperm quality, necessitating expensive ART |
High rate of success | Patient may have difficulty producing a sample | ||
Relatively inexpensive compared to other cryopreservation options | Not feasible for prepubertal patients | ||
Female at birth | Freezing oocytes | Current standard practice | Only mature oocytes can be harvested |
High rate of success | Requires ovarian stimulation, usually multiple times, which can be time-consuming and difficult for the patient | ||
Freezing ovarian tissue | Viable for prepubertal patients | Tissue retrieval requires laparoscopic surgery | |
Faster than oocyte harvesting; does not require cycles of ovarian stimulation | Lower success rate than oocyte freezing | ||
Still novel, with optimal techniques not yet standardized; difficulties persist with in-vitro oocyte maturation and ovarian graft failure | |||
Both | Freezing embryos | May have higher live birth rates compared to oocyte freezing | Both partners share ownership, creating possible legal issues regarding use, storage, and disposition |
Tried-and-true; has been in use for decades | Potential difficulty finding a surrogate to carry pregnancy | ||
Requires both sperm and oocyte, necessitating either a partner or a donor |
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Mainland, N.; Ohl, D.A.; Assaly, A.R.; Azeem, N.; Cooper, A.; Beltsos, A.; Sindhwani, P.; Shah, T.A. Fertility Preservation Options for Transgender Patients: An Overview. Uro 2023, 3, 239-250. https://doi.org/10.3390/uro3040024
Mainland N, Ohl DA, Assaly AR, Azeem N, Cooper A, Beltsos A, Sindhwani P, Shah TA. Fertility Preservation Options for Transgender Patients: An Overview. Uro. 2023; 3(4):239-250. https://doi.org/10.3390/uro3040024
Chicago/Turabian StyleMainland, Natalie, Dana A. Ohl, Ahmed R. Assaly, Nabila Azeem, Amber Cooper, Angie Beltsos, Puneet Sindhwani, and Tariq A. Shah. 2023. "Fertility Preservation Options for Transgender Patients: An Overview" Uro 3, no. 4: 239-250. https://doi.org/10.3390/uro3040024