Reproductive functions and fertility preservation in transgender men: A French case series

Background: Transgender men face reproductive challenges due to the potential impact on fertility of gender-affirming hormone therapy (GAHT) and surgical interventions. Testosterone therapy during "female to male" transition leads to anovulation and amenorrhea. Although these effects are typically reversible upon stopping treatment, the long-term effects of androgens on future fertility and health of potential children remain poorly known. Despite being long overlooked, the desire for parenthood is a significant reality among transgender men. Advances in medical techniques and legislative changes now make fertility preservation (FP), primarily through oocyte cryopreservation, possible for transgender men. Yet, published data on FP outcomes for this population are still limited.

Design: We conducted a retrospective study to compare ovarian stimulation outcomes between transgender men and presumed fertile women from an oocyte donation program.

Results: Between June 2018 and February 2022, 118 transgender men were referred to the FP consultation, of whom 13 ultimately underwent FP through oocyte vitrification following ovarian stimulation. These 13 individuals were compared to a control group of 13 matched female oocyte donors. We did not observe any significant difference in the clinical and biological outcomes of ovarian stimulation, including duration of stimulation, total FSH dose administered, number of oocytes retrieved, and number of mature oocytes obtained.

Conclusion: Our experience suggests that FP through oocyte vitrification after ovarian stimulation is feasible and effective for transgender men, with outcomes comparable to those of cisgender women of the same age. Larger studies are necessary to validate these findings and assess the long-term success rates.