Transgender persons' view on previous fertility decision-making and current infertility: a qualitative study

Area of Science:

• Reproductive Health
• Gender Studies
• Psychology

Background:

• Until 2014, Dutch law mandated sterilization for legal gender recognition, causing irreversible infertility in transgender adolescents.
• The long-term psychological impact of this iatrogenic infertility on adult transgender and gender diverse (TGD) individuals is not well understood.

Purpose of the Study:

• To explore how adult TGD individuals, infertile due to past gender-affirming treatments, perceive their current infertility.
• To understand their reproductive decisions made in adolescence under coercive legal circumstances.

Main Methods:

• A qualitative study involving 21 in-depth, semi-structured interviews with adult TGD individuals.
• Participants had undergone gender-affirming treatment before 2014 and were in an age group where family planning is relevant.
• Thematic analysis of interview transcripts was conducted using a modified version of Braun and Clarke's six-step theory.

Main Results:

• Six themes emerged, covering past and present considerations of fertility, decision-making, coping with infertility, and future family building.
• Participants generally affirmed their past choices, prioritizing gender affirmation over fertility preservation.
• Despite some emotional difficulties related to infertility, a majority indicated they would make the same decision today.

Conclusions:

• Adult TGD individuals largely stand by their adolescent decisions to prioritize gender affirmation over fertility preservation, even with current infertility.
• The findings underscore the critical need for comprehensive, tailored counseling on fertility preservation options for adolescents undergoing gender-affirming care.
• Improved support and information are essential for TGD individuals navigating reproductive health decisions and potential infertility.