Fertility Preservation in Transgender Youth from Initial Counseling through Preservation Procedures: A Retrospective...

To assess the interest of transgender and nonbinary adolescents and young adults in fertility planning after an initial gender-affirming counseling appointment through completion of a fertility preservation procedure.

This was a retrospective cross-sectional study of patients aged 10-24 years seen for initial gender-related medical evaluations at the institution's Pediatric and Adolescent Gender Health Clinic between July 1, 2020, and August 31, 2023. The clinic uses a standardized interview template including questions about fertility goals. Data collected included referrals to reproductive endocrinology and infertility (REI) services, REI appointment attendance, and completion of fertility preservation. Patient demographic characteristics and previous use of gender-affirming mental health or medical services were also assessed.

Among 311 participants, 25 (8%) accepted an REI referral. Referral was positively associated with prior receipt of gender-affirming mental health or medical care. Of the 25 referred, 19 attended an REI appointment, and 8 ultimately underwent fertility preservation. All 8 were assigned male sex at birth and completed sperm cryopreservation. There was no association between previous gender-affirming care and completion of a fertility preservation procedure.

Although some transgender and nonbinary patients expressed interest in fertility preservation at their initial visit, only those assigned male sex at birth pursued preservation. This disparity likely reflects the relative simplicity and lower cost of sperm cryopreservation compared with oocyte preservation.