In vitro fertilization outcomes in transgender individuals with prior testosterone therapy

Area of Science:

• Reproductive Endocrinology
• Gender-Affirming Care
• In Vitro Fertilization

Background:

• Data on embryo outcomes for transgender and gender diverse (TGD) patients with prior testosterone gender-affirming hormone therapy (T-GAHT) is limited.
• Previous studies suggest good oocyte yields after T-GAHT, but blastocyst formation capacity remains unclear.

Purpose of the Study:

• To investigate if TGD patients with prior T-GAHT have different oocyte cryopreservation and IVF outcomes compared to those without prior T-GAHT.
• To assess the impact of T-GAHT on mature oocyte yield and blastocyst development.

Main Methods:

• Retrospective observational cohort study of 46 ovarian stimulation cycles in TGD patients (assigned female at birth) from January 2013 to March 2024.
• Compared outcomes between patients with and without prior T-GAHT, analyzing mature oocytes and blastocyst formation.
• Used electronic health records for data collection, with primary analysis on the first completed cycle.

Main Results:

• Prior T-GAHT was associated with a decrease in total blastocysts and top-quality blastocysts after adjusting for age.
• No significant difference was observed in the number of mature oocytes retrieved or maturity rate.
• Cumulative live birth rate in the first cycle was 60% for the prior T-GAHT group versus 87.5% for the no T-GAHT group.

Conclusions:

• Prior T-GAHT was not linked to differences in mature oocyte number, aligning with existing literature.
• Poorer embryo outcomes were associated with prior T-GAHT and shorter discontinuation periods.
• Most TGD patients undergoing IVF after T-GAHT achieved live birth, indicating generally reassuring fertility outcomes.