United Kingdom data collection of semen quality in transgender adolescent females seeking fertility preservation

Abstract

Objective: Increasing numbers of adolescents with gender dysphoria start gonadotropin-releasing hormone agonists to halt puberty, minimizing psychological distress. The uncertainty of long-term effects of this medication, and the subsequent likelihood of accessing gender-affirming hormone treatment, highlights the importance of fertility preservation before starting hormone treatment. We investigated the take-up, hormonal profile, and sperm quality in adolescents undergoing fertility preservation via cryopreservation by masturbation or surgical sperm retrieval, before starting hormonal therapy.

Design: Data were prospectively maintained from a tertiary UK-based hospital. A total of 122 people <19 years, mean age 15.2 ± 1.7 years, referred by gender clinics and general practitioners, were included in this cohort study.

Subjects: Participants were counseled for fertility preservation, and serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels were recorded before providing semen samples.

Exposure: Masturbation semen samples were classified as normal (>15 mil/mL), oligozoospermia (1-15 mil/mL), cryptozoospermia (<1 mil/mL), or azoospermia. If the sample was insufficient or the person was unwilling to masturbate, surgical sperm retrieval was offered in a stepwise manner using electroejaculation, testicular sperm extraction (TESE) ± microdissection testicular sperm extraction (mTESE).

Main outcome measures: Quality of semen produced by participants, via masturbation or surgical sperm retrieval, was analyzed to determine if it was good enough to cryopreserve for future fertility use.

Results: Of 122 participants, 23 (19%) declined sample storage. In the masturbation group (average age, 16.3 years), 78 people produced 106 samples. Of 106 samples, 86 were stored-43.7% were normospermic, 35.9% oligozoospermic, 8.7% cryptozoospermic, and 11.7% azoospermic. Overall, semen parameters varied but were generally abnormal, illustrated by only 43.7% of the masturbation samples produced being normospermic. For surgical sperm retrieval subjects (average age, 15.2 years), electroejaculation was successful in 4 of 21 people, whereas the rest proceeded with TESE/mTESE. Encouragingly, 16 of 21 subjects had an average of 5 vials stored, and all participants had a testosterone level >8 nmol/L. Semen parameters in this subcohort were poor but possibly adequate for intracytoplasmic sperm injection.

Conclusions: In this large database of transgender girls referred for fertility preservation in the United Kingdom, fertility preservation is possible, even with those unwilling to masturbate. Long-term data are required to check the health of these gametes, observing live birth rates using these preserved gametes.

Keywords: Fertility preservation; adolescents; semen analysis; transgender.