nach oben

Journal of Assisted Reproduction and Genetics

Erschienen in:

20.05.2020 | Fertility Preservation

Oocyte retrieval outcomes among adolescent transgender males

verfasst von: Hadar Amir, Asaf Oren, Emilie Klochendler Frishman, Onit Sapir, Yoel Shufaro, Anat Segev Becker, Foad Azem, Avi Ben-Haroush

Erschienen in: Journal of Assisted Reproduction and Genetics | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females.

Methods

This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017–April 2019 and September 2013–April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups.

Results

Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261).

Conclusions

Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.

Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13:165–232.

Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72:214–31.

Edwards-Leeper L, Spack NP. Psychological evaluation and medical treatment of transgender youth in an interdisciplinary "Gender Management Service" (GeMS) in a major pediatric center. J Homosex. 2012;59:321–36.PubMed

Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health. 2015;57:374–80.PubMedPubMedCentral

Kreukels BP, Haraldsen IR, De Cuypere G, Richter-Appelt H, Gijs L, Cohen-Kettenis PT. A European network for the investigation of gender incongruence: the ENIGI initiative. Eur Psychiatry. 2012;27:445–50.PubMed

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:3869–903.PubMed

Futterweit W, Deligdisch L. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab. 1986;62:16–21.PubMed

Spinder T, Spijkstra JJ, van den Tweel JG, Burger CW, van Kessel H, Hompes PG, et al. The effects of long term testosterone administration on pulsatile luteinizing hormone secretion and on ovarian histology in eugonadal female to male transsexual subjects. J Clin Endocrinol Metab. 1989;69:151–7.PubMed

Pache TD, Chadha S, Gooren LJ, Hop WC, Jaarsma KW, Dommerholt HB, et al. Ovarian morphology in long-term androgen-treated female to male transsexuals. A human model for the study of polycystic ovarian syndrome? Histopathology. 1991;19:445–52.PubMed

10.

Caanen MR, Soleman RS, Kuijper EA, Kreukels BP, De Roo C, Tilleman K, et al. Antimüllerian hormone levels decrease in female-to-male transsexuals using testosterone as cross-sex therapy. Fertil Steril. 2015;103:1340–5.PubMed

11.

Van Den Broecke R, Van Der Elst J, Liu J, Hovatta O, Dhont M. The female-to-male transsexual patient: a source of human ovarian cortical tissue for experimental use. Hum Reprod. 2001;16:145–7.

12.

Ikeda K, Baba T, Noguchi H, Nagasawa K, Endo T, Kiya T, et al. Excessive androgen exposure in female-to-male transsexual persons of reproductive age induces hyperplasia of the ovarian cortex and stroma but not polycystic ovary morphology. Hum Reprod. 2013;28:453–61.PubMed

13.

Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013;87:89–93.PubMed

14.

Ethics Committee of the American Society for Reproductive Medicine. Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril. 2015;104:1111–5.

15.

Harada M, Osuga Y. Fertility preservation for female cancer patients. Int J Clin Oncol. 2019;24:28–33.PubMed

16.

De Roo C, Tilleman K, T'Sjoen G, De Sutter P. Fertility options in transgender people. Int Rev Psychiatry. 2016;28:112–9.PubMed

17.

Johnson EK, Finlayson C. Preservation of fertility potential for gender and sex diverse individuals. Transgend Health. 2016;1:41–4.PubMedPubMedCentral

18.

Auer MK, Fuss J, Nieder TO, Briken P, Biedermann SV, Stalla GK, et al. Desire to have children among transgender people in Germany: a cross-sectional multi-center study. J Sex Med. 2018;15:757–67.PubMed

19.

Jones CA, Reiter L, Greenblatt E. Fertility preservation in transgender patients. Int J Transgend. 2016;17:76–82.

20.

Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low fertility preservation utilization among transgender youth. J Adolesc Health. 2017;61:40–4.PubMed

21.

Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;61:120–3.PubMedPubMedCentral

22.

Riggs DW, Bartholomaeus C. Fertility preservation decision making among Australian transgender and non-binary adults. Reprod Health. 2018;25(15):181.

23.

Brik T, Vrouenraets LJJJ, Schagen SEE, Meissner A, de Vries MC, Hannema SE. Use of fertility preservation among a cohort of transgirls in the Netherlands. J Adolesc Health. 2019;64:589–93.PubMed

24.

James-Abra S, Tarasoff LA, Green D, Epstein R, Anderson S, Marvel S, et al. Trans people's experiences with assisted reproduction services: a qualitative study. Hum Reprod. 2015;30:1365–74.PubMed

25.

Chen D, Matson M, Macapagal K, Johnson EK, Rosoklija I, Finlayson C, et al. Attitudes toward fertility and reproductive health among transgender and gender-nonconforming adolescents. J Adolesc Health. 2018;63:62–8.PubMedPubMedCentral

26.

Chen D, Kyweluk MA, Sajwani A, Gordon EJ, Johnson EK, Finlayson CA, et al. Factors affecting fertility decision-making among transgender adolescents and young adults. LGBT Health. 2019;6:107–15.PubMedPubMedCentral

27.

Segev-Becker A, Israeli G, Elkon-Tamir E, Perl L, Sekler O, Amir H, et al. Children and adolescent with gender dysphoria in Israel: increasing referral and fertility preservation rates. Endocr Pract. 2020;26:423–8. https://doi.org/10.4158/EP-2019-0418.Onlineaheadofprint.CrossRefPubMed

28.

Fernández R, Esteva I, Gómez-Gil E, Rumbo T, Almaraz MC, Roda E, et al. The CA(n) polymorphism of ERβ is associated with FtM transsexualism. J Sex Med. 2014;11:720–8.PubMed

29.

Fernández R, Guillamon A, Cortés-Cortés J, Gómez-Gil E, Jácome A, Esteva I, et al. Molecular basis of gender dysphoria: androgen and estrogen receptor interaction. Psychoneuroendocrinology. 2018;98:161–7.PubMed

30.

Zulli K, Bianco B, Mafra FA, Teles JS, Christofolini DM, Barbosa CP. Polymorphism of the estrogen receptor β gene is related to infertility and infertility-associated endometriosis. Arq Bras Endocrinol Metabol. 2010;54:567–71.PubMed

31.

Ayvaz OU, Ekmekçi A, Baltaci V, Onen HI, Unsal E. Evaluation of in vivo fertilization parameters and estrogen receptor alfa gene polymorphism for women with unexplained infertility. J Assist Reprod Genet. 2009;26:503–10.PubMedPubMedCentral

32.

Anagnostou E, Mavrogianni D, Theofanakis C, Drakakis P, Bletsa R, Demirol A, et al. ESR1, ESR2 and FSH receptor gene polymorphism in combination: a useful genetic tool for the prediction of poor responders. Curr Pharm Biotechnol. 2012;13:426–34.PubMed

33.

de Mattos CS, Trevisan CM, Peluso C, Adami F, Cordts EB, Christofolini DM, et al. ESR1 and ESR2 gene polymorphisms are associated with human reproduction outcomes in Brazilian women. J Ovarian Res. 2014;20(7):114.

34.

Hines M, Brook C, Conway GS. Androgen and psychosexual development: core gender identity, sexual orientation and recalled childhood gender role behavior in women and men with congenital adrenal hyperplasia (CAH). J Sex Res. 2004;41:75–81.PubMed

35.

Sadr M, Khorashad BS, Talaei A, Fazeli N, Hönekopp J. 2D:4D suggests a role of prenatal testosterone in gender dysphoria. Arch Sex Behav. 2020;49:421–32.PubMedPubMedCentral

36.

Bütikofer A, Figlio DN, Karbownik K, Kuzawa CW, Salvanes KG. Evidence that prenatal testosterone transfer from male twines reduces the fertility and socioeconomic success of their female co-twin. Proc Natl Acad Sci U S A. 2019;116:6749–53.PubMedPubMedCentral

37.

Filippou P, Homburg R. Is foetal hyperexposure to androgens a cause of PCOS? Hum Reprod Update. 2017;23:421–32.PubMed

38.

Abbott DH, Kraynak M, Dumesic DA, Levine JE. In utero androgen excess: a developmental commonality preceding polycystic ovary syndrome? Front Horm Res. 2019;53:1–17.PubMedPubMedCentral

39.

Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22:687–708.PubMed

40.

Balen AH, Schachter ME, Montgomery D, Reid RW, Jacobs HS. Polycystic ovaries are a common finding in untreated female to male transsexuals. Clin Endocrinol. 1993;38:325–9.

41.

Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T, Ikeda H, et al. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod. 2007;22:1011–6.PubMed

42.

Vujovic S, Popovic S, Sbutega-Milosevic G, Djordjevic M, Gooren L. Transsexualism in Serbia: a twenty-year follow-up study. J Sex Med. 2009;6:1018–23.PubMed

43.

Baba T, Endo T, Ikeda K, Shimizu A, Honnma H, Ikeda H, et al. Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan. J Sex Med. 2011;8:1686–93.PubMed

44.

Domingo J, Guillen V, Ayllon Y, MartinezM ME, Pellicer A, et al. Ovarian response to controlled ovarian hyperstimulation in cancer patients is diminished even before oncological treatment. Fertil Steril. 2012;97:930–4.PubMed

45.

Pal L, Leykin L, Schifren JL, Isaacson KB, Chang YC, Nikruil N, et al. Malignancy may adversely influence the quality and behavior of oocytes. Hum Reprod. 1998;13:1837–40.PubMed

46.

Klock SC, Zhang JX, Kazer RR. Fertility preservation for female cancer patients: early clinical experience. Fertil Steril. 2010;94:149–55.PubMed

47.

Oktay K, Hourvitz A, Sahin G, Oktem O, Safro B, Cil A, et al. Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy. J Clin Endocrinol Metab. 2006;91:3885–90.PubMed

48.

Quintero RB, Helmer A, Huang JQ, Westphal LM. Ovarian stimulation for fertility preservation in patients with cancer. Fertil Steril. 2010;93:865–8.PubMed

49.

Almog B, Azem F, Gordon D, Pauzner D, Amit A, Barkan G, et al. Effects of cancer on ovarian response in controlled ovarian stimulation for fertility preservation. Fertil Steril. 2012;98:957–60.PubMed

50.

Robertson AD, Missmer SA, Ginsbug ES. Embryo yield after in vitro fertilization in women undergoing embryo banking for fertility preservation before chemotherapy. Fertil Steril. 2011;95:588–91.PubMed

51.

Quinn MM, Cakmak H, Letourneau JM, Cedars MI, Rosen MP. Response to ovarian stimulation is not impacted by a breast cancer diagnosis. Hum Reprod. 2017;32:568–74.PubMed

52.

Michaan N, Ben-David G, Ben-Yosef D, Almog B, Many A, Pauzner D, et al. Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients. Eur J Obstet Gynecol Reprod Biol. 2010;149:175–7.PubMed

53.

Knopman JM, Noyes N, Talebian S, Krey LC, Grifo JA, Licciardi F. Women with cancer undergoing ART for fertility preservation: a cohort study of their response to exogenous gonadotropins. Fertil Steril. 2009;91:1476–8.PubMed

54.

Turan V, Quinn MM, Dayioglu N, Rosen MP, Oktay K. The impact of malignancy onresponse to ovarian stimulation for fertility preservation: a meta-analysis. Fertil Steril. 2018;110:1347–55.PubMed

55.

Adeleye AJ, Cedars MI, Smith J, Mok-Lin E. Ovarian stimulation for fertility preservation or family building in a cohort of transgender men. J Assist Reprod Genet. 2019;36:2155–61.PubMed

56.

De Roo C, Tilleman K, Vercruysse C, Declercq H, T'Sjoen G, Weyers S, et al. Texture profile analysis reveals a stiffer ovarian cortex after testosterone therapy: a pilot study. J Assist Reprod Genet. 2019;36:1837–43.PubMedPubMedCentral

57.

Maxwell S, Noyes N, Keefe D, Berkeley AS, Goldman KN. Pregnancy outcomes after fertility preservation in transgender men. Obstet Gynecol. 2017;129:1031–4.PubMed

58.

Insogna IG, Ginsburg E, Srouji S. Fertility preservation for adolescent transgender male patients: a case series. J Adolesc Health. 2020. https://doi.org/10.1016/j.jadohealth.2019.12.004.

59.

Leung A, Sakkas D, Pang S, Thornton K, Resetkova N. Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine. Fertil Steril. 2019;112:858–65.PubMed

60.

Ng EH, Yeung WS, Fong DY, Ho PC. Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum Reprod. 2003;18:2169–74.PubMed

61.

Cooper AR, Parker A, Lambert-Messerlian G, French A, White A, Odem RR, et al. Should we be utilizing transabdominal antral follicle count (AFC) ovarian reserve screens in prepubertal and pubertal girls. J Pediatr Adolesc Gynecol. 2011;24:e51.

62.

LabCorp. Expected values and S.I. unit conversion tables. 2019 https://www.esoterix.com/sites/default/files/Endocrine%20Sciences%20Expected%20Values%20%281%29.pdf

63.

Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol. 2015;125:605–10.PubMedPubMedCentral

64.

Vita R, Settineri S, Liotta M, Benvenga S, Trimarchi F. Changes in hormonal and metabolic parameters in transgender subjects on cross-sex hormone therapy: a cohort study. Maturitas. 2018;107:92–6.PubMed

65.

Gessler M, Poustka A, Cavenee W, Neve RL, Orkin SH, Bruns GA. Homozygous deletion in Wilms tumours of a zinc-finger gene identified by chromosome jumping. Nature. 1990;343:774–8.PubMed

66.

Gao F, Zhang J, Wang X, Yang J, Chen D, Huff V, et al. Wt1 functions in ovarian follicle development by regulating granulosa cell differentiation. Hum Mol Genet. 2014;23:333–41.PubMed

67.

Wang H, Li G, Zhang J, Gao F, Li W, Qin Y, et al. Novel WT1 missense mutations in Han Chinese women with premature ovarian failure. Sci Rep. 2015;11(5):13983.

68.

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004;19:41–7.

Titel: Oocyte retrieval outcomes among adolescent transgender males
verfasst von: Hadar Amir
Asaf Oren
Emilie Klochendler Frishman
Onit Sapir
Yoel Shufaro
Anat Segev Becker
Foad Azem
Avi Ben-Haroush
Publikationsdatum: 20.05.2020
Verlag: Springer US
Erschienen in: Journal of Assisted Reproduction and Genetics / Ausgabe 7/2020
Print ISSN: 1058-0468
Elektronische ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-020-01815-5

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Auf Antibiotika verzichten? Was bei unkomplizierter Zystitis hilft

15.05.2024 Harnwegsinfektionen Nachrichten

Welche Antibiotika darf man bei unkomplizierter Zystitis verwenden und wovon sollte man die Finger lassen? Welche pflanzlichen Präparate können helfen? Was taugt der zugelassene Impfstoff? Antworten vom Koordinator der frisch überarbeiteten S3-Leitlinie, Prof. Florian Wagenlehner.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Oocyte retrieval outcomes among adolescent transgender males