Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood

Transgender and gender diverse patients' experiences with pregnancy-related genetics discussions: A qualitative study

Reproductive healthcare experiences for transgender and gender diverse (TGD) individuals are often characterized by cisheteronormative biases and inadequate support. Despite growing recognition of the need for gender-inclusive care, there remains a dearth of research exploring TGD individuals' perspectives on pregnancy-related genetic discussions with healthcare providers. This study aimed to address this gap by investigating TGD individuals' experiences with pregnancy-related genetic discussions, focusing on the challenges they face and strategies for improving care. The study employed a qualitative approach, including demographic surveys and semi-structured interviews with questions centered on pregnancy-related genetic discussions, to gather data from 15 TGD participants. Data were analyzed using reflexive thematic analysis with a queer theoretical lens to identify key themes and insights. The findings revealed pervasive cisheteronormative biases in pregnancy-related genetics discussions, including providers misgendering patients during routine genetics explanations and conflation of sex and gender. Participants highlighted the lack of information on the effects of testosterone therapy on pregnancies and expressed discomfort in gendered clinic spaces. Participants advocated for gender-inclusive training for all healthcare staff and the adoption of affirming practices to create more inclusive healthcare environments. This study underscores the urgent need to address systemic biases and shortcomings in reproductive genetics healthcare for TGD individuals. By prioritizing gender-inclusive training and promoting affirming clinical environments, healthcare providers can work towards ensuring equitable access to reproductive and genetic healthcare for TGD patients.

Transgender and gender diverse individuals' perspectives on discussions of fetal sex chromosomes in obstetrics care

In the past decade, prenatal cell-free DNA screening (cfDNA) has become ubiquitous as a screening tool for fetal aneuploidy and sex chromosomes. Healthcare provider (HCP) discussions and public perceptions of sex and gender uniquely impact transgender and gender diverse (TGD) individuals, and existing cfDNA guidelines lack recommendations regarding how to discuss sex and gender prenatally. The aim of this exploratory qualitative study was to examine TGD individuals' opinions regarding fetal sex chromosome disclosure sessions. Twelve semi-structured virtual interviews were conducted with TGD individuals regarding their perspectives on the discussion of fetal sex chromosomes by HCPs within the prenatal setting. Interviews were coded and analyzed using a reflexive thematic approach, generating four major themes: (1) Current practices in prenatal care exclude gender diverse people; (2) HCPs' responsibility to de-gender discussions of sex chromosomes in prenatal care; (3) HCPs' responsibility to acknowledge gender diversity; and (4) HCPs' influence on societal perceptions of sex and gender. More guidance is needed from professional societies regarding best practices for HCP discussions of sex chromosomes, sex, and gender. Participants recommended HCPs educate patients about sex chromosomes and their relevance to health while avoiding the conflation of sex and gender terms. Additionally, there is an acute need for trans-inclusive prenatal healthcare. Ultimately, HCPs' and organizations are in a prime position to deconstruct rigid gender binaries and promote societal inclusion of TGD people.

Fatherhood experiences: A qualitative approach of cisgender and transgender fathers in assisted reproductive technologies (ART) situation with sperm donation

Assisted reproductive technologies have offered new ways and pathways to conceive a child. However, very few is known about insights into the complexities and challenges faced by trans fathers in contemporary parenthood journeys. This qualitative study explores the experiences of transgender and cisgender fathers who conceived children through donor sperm insemination (DSI) and natural conception (NC). The study will examine the recognition and challenges associated with paternal experiences. Seventy-nine interviews (one per child) were conducted with 16 transgender fathers who conceived trough DSI, 15 infertile cisgender fathers who conceived trough DSI, and 17 cisgender fathers who conceived through NC. The study employed thematic analysis and the Five-Minute Speech Sample to assess family dynamics. Results indicate that in the Trans-DSI group, fatherhood was often defined within the social role of masculinity, with some expressing 'intranquility' (i.e., feelings of unease or insecurity). The Cis-DSI group showed more tranquility but faced challenges regarding biological filiation. The NC group exhibited diverse experiences. Findings suggest that fathers' self-confidence, especially for transgender and non-biologically related fathers, can be challenged. Recognizing these challenges can guide better support for families navigating diverse parenthood journeys.

Endometriosis in Transgender Men: Bridging Gaps in Research and Care-A Narrative Review

Endometriosis is a debilitating gynecological condition commonly seen in individuals designated female at birth; however, there has been limited research focused on its prevalence and impact among transgender men. This narrative review aims to fill a critical knowledge gap by exploring the epidemiology, clinical manifestations, management strategies, and quality-of-life implications of endometriosis among transgender individuals who identify as male. Specifically, this study seeks to estimate the prevalence rates and describe the symptoms experienced by transgender men undergoing testosterone therapy. Additionally, it addresses the diagnostic challenges posed by hormonal treatments and the lack of culturally competent healthcare services for this population. Recent molecular studies indicate that hormonal imbalances, such as increased estrogen synthesis and progesterone resistance, are significant factors in the persistence of endometriosis symptoms despite testosterone therapy. Moreover, evidence suggests that testosterone therapy may not always suppress endometrial activity completely, contributing to the persistence of symptoms in some individuals. Endometriosis in transgender men requires personalized approaches that consider both testosterone therapy and its interactions with endometriosis, as well as fertility preservation and the psychosocial aspects of treatment. This review emphasizes the necessity of taking an inclusive approach in both research and clinical practice to improve healthcare outcomes for this underserved population. The results demonstrate how continued research, education, and healthcare services tailored specifically to transgender men are necessary to better understand and treat endometriosis, thus improving both their overall health and quality of life.

Family Building in Transgender Patients: Modern Strategies with Assisted Reproductive Technology Treatment

Purpose

Transgender and gender diverse (TGD) individuals continue to face adversity, stigma, and inequality, especially in health care. This study aimed to characterize the experience of TGD people and partners of TGD people with regard to fertility treatment.

Methods

All TGD patients presenting to a single academic center between 2013 and 2021 were included. Baseline demographics collected included patient age, body mass index, anti-Mullerian hormone, basal antral follicle count, history of gender-affirming surgery, and/or gender-affirming hormone therapy. Outcomes included total patients who progressed to treatment, cycle type(s), and clinical outcomes.

Results

In total, 82 patients who identified as TGD or had a partner who identified as TGD presented to care seeking fertility treatment. Of the 141 planned cycles, 106 (75.2%) progressed to treatment. Of the 15 in vitro fertilization (IVF) and co-IVF cycles, 12 achieved live birth. Of the 76 intrauterine inseminations 7 patients were discharged with ongoing pregnancies and one achieved live birth.

Conclusion

These findings reaffirm that TGD individuals utilize the entire array of fertility services. With recent advances in access to care and modern medicine, assisted reproductive technology treatment has the power to support TGD patients in building contemporary family structures.

Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review

Purpose

Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics.

Methods

We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families.

Results

We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid.

Conclusions

There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.

'My choice, my responsibility': views of Danish and Israeli female students on financing egg-freezing

Over the past decade, egg freezing has evolved from being an experimental medical technology to become a commercial enterprise, accompanied by heated feminist debate. This study examined the views of Danish and Israeli female students regarding the financing of social egg freezing (SEF) (self, state, employer or family), and their correlation with country and feminist identity. A total of 569 female students (283 from Denmark and 286 from Israel) completed a questionnaire composed of closed and opened-ended questions on SEF financing under different circumstances (e.g. career advancement, lack of a partner, lack of money). The majority of female students in both countries supported SEF self-financing. They wanted to keep fertility choices in the private domain, in part by separating the bodies of women from the state and the employer. We conclude that SEF exemplifies a neoliberal and gendered responsibilisation of women's reproductive futurity, yet self-identification as a feminist was found to be correlated with stronger support for state financing. In contrast, we found no correlation between feminist identity and support for company-sponsored egg freezing. Our findings suggest a relationship between holding a feminist worldview and public policy preferences.

And When I Die: Theory of Planned Behavior as Applied to Sperm Cryopreservation

The present study investigates fertility intentions of men, aged 18-59, as expressed in willingness to cryopreserve sperm for future use in procreation. An economic stated-preference framework is combined with the Theory of Planned Behavior (TPB) to investigate which attributes are important in the decision to cryopreserve sperm, what is the Willingness to Pay (WTP) for cryopreservation, and which attributes influence it. A structured, two-part questionnaire was used, based on WTP and Conjoint analysis (CA) applied in tandem to elicit respondents' preferences in evaluating utility. Findings show which attributes are important in the decision to cryopreserve sperm among them Risk of Infertility, Personal monthly income, Chance of pregnancy from frozen semen, Age and what are significant predictor variables for the WTP which are Personal monthly income, Importance of the risk of infertility, Initial registration fee to sperm bank and cryopreservation, and Degree of religious observance. The findings further demonstrate that respondents value sperm cryopreservation and have a positive WTP for it as it seems to contribute to improving well-being. As a result of these findings, governments should consider state funding for cryopreservation as part of national health policy.

Gender Transition: Is There a Right to Be Forgotten?

The European Union (EU) faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented.

Reprint: Where has the quest for conception taken us? Lessons from anthropology and sociology

Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.

Ten years of fertility treatment experience and reproductive options in transgender men

BACKGROUND

Up to 2018, the Belgian law stated that transgender people who wanted to change their legal sex had to undergo physical gender affirming treatment. This included gonadectomy to a medically possible and justified extent, which entailed that they had to accept the fact that they could no longer reproduce. However, research has shown that many transgender people desire to have children.

AIMS

(1) to describe a cohort of transgender men and their respective cisgender female partners, to share our experiences with their request for donor conception, and to evaluate their disclosure intentions to the child, (2) to explore how the couples approach current and future reproductive options.

METHODS

This mixed method study presents data from a retrospective analysis of patient records and from a qualitative interview study. The couples were selected from the group of transgender men who - together with their respective cisgender female partners - applied for sperm donation at Ghent University Hospital between 2002 and 2012.

RESULTS

Forty-seven transgender men with a cisgender female partner requested treatment with anonymous donor sperm for a first child as a couple. Forty-one requests were accepted for treatment. We found that most couples requesting treatment intended to disclose the use of donor sperm to their future child (n = 34) while 24 couples were planning to inform the child about the parent's transgender identity. The six couples we interviewed saw donor conception as the preferred route to become parents. Adoption was seen as less obvious. The couples' attitudes toward stem cell-derived gametes reflected the significance of the genetic link with the child for both parents.

DISCUSSION

Not all participants in our study were aware of their reproductive options. To be able to make a well-informed decision, transgender people should be counseled about all options at the time of transition.

Where has the quest for conception taken us? Lessons from anthropology and sociology

Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.