Ovarian response and outcomes of in vitro fertilization cycles in transgender men: Report of three cases with a live birth

Abstract

In vitro fertilization (IVF) treatments have broadened to cover a variety of scenarios, including those involving transgender individuals or couples who wish to become parents, posing new challenges for the field of reproductive medicine. While there are limited reports of successful IVF births involving transgender men, concerns remain regarding the impact of long-term testosterone use on ovarian function, oocyte and embryo quality and IVF reproductive outcomes. This study details a case series of three trans men and cis women couples at a fertility clinic, resulting in one live birth. The couples underwent IVF with frozen blastocyst-stage embryos transferred to the cis women partners. The trans men, aged 32, 35, and 38, received ovarian stimulation with gonadotropins and dydrogesterone for pituitary suppression, and a GnRH agonist for final oocyte maturation. All had been on 250 mg of testosterone and paused treatment to resume menstrual cycles before IVF. Eggs were fertilized with donor sperm, and despite a lower-than-expected response to stimulation after short-term testosterone discontinuation, high-quality blastocysts were produced, leading to two pregnancies. Given the uncertainty regarding the long-term effects of testosterone on overall fertility, patients should be advised to consider cryopreservation before starting gender-affirming hormone therapy. Our case reports contribute to the knowledge in this area, highlighting the feasibility of oocyte collection, embryo development, pregnancies, and births in these individuals even after prolonged use of testosterone.

Keywords: assisted reproduction in trans men and cis women couple; transgender in vitro fertilization reproduction; transgender reproduction.