Skip to main content

Advertisement

SpringerLink
Log in

Ethical issues involving fertility preservation for transgender youth

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To investigate ethical issues associated with fertility preservation (FP) in transgender youth based on reports of patients and their parents.

Methods

Our qualitative study involved in-person interviews with 54 subjects (35 patients and 19 parents). Interviews were audio recorded, transcribed, and verified. Each subject completed a demographic questionnaire, and each patient’s medical chart was reviewed for additional information. We analyzed the data using inductive thematic content analysis.

Results

Themes that emerged included a range of desires and ambivalence about having genetically related children, variability in understanding the potentially irreversible impact of gender affirming hormones (GAHs) on fertility, use of adoption, and the impact of age on decision-making. Subjects (patients and parents) noted barriers to FP, such as cost and insurance coverage. Several parents expressed concern that their transgender children may have future regret about not attempting FP. Both transgender youth and their parents felt FP was an important precaution.

Conclusions

Our study took advantage of the richness of personal narratives to identify ongoing ethical issues associated with fertility preservation in transgender youth. Transgender youth and their parents did not fully understand the process of FP, especially regarding the effects of GAHs, had fears that FP could reactivate gender dysphoria, and noted barriers to FP, such as cost, highlighting economic disparity and lack of justice. These findings highlight ethical issues involving the adequacy of informed consent and economic injustice in access to FP despite expressed interest in the topic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Harris RM, Frader JE. Ethical considerations of GnRHa treatment and consent process. In:Pubertal suppression in transgender youth, C. Ed. Elsevier: Finlayson; 2019.

    Google Scholar 

  2. Kimberly LL, et al. Ethical issues in gender-affirming care for youth. Pediatrics. 2018;142(6):1–9.

    Article  Google Scholar 

  3. Harris RM, Tishelman AC, Quinn GP, Nahata L. Decision making and the long-term impact of puberty blockade in transgender children. Am J Bioeth. 2019;19(2):67–9.

    Article  Google Scholar 

  4. T’Sjoen G, Van Caenegem E, Wierckx K. Transgenderism and reproduction. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):575–9.

    Article  Google Scholar 

  5. De Sutter P, Kira K, Verschoor A, Hotimsky A. The desire to have children and the preservation of fertility in transsexual women: a survey. Int J Transgen. 2002;6(3):1–12.

    Google Scholar 

  6. Wierckx K, van Caenegem E, Pennings G, Elaut E, Dedecker D, van de Peer F, et al. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483–7.

    Article  Google Scholar 

  7. 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(11):3869–903.

    Article  Google Scholar 

  8. 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 Transgenderism. 2012;13(4):165–232.

    Article  Google Scholar 

  9. Nielsen CT, et al. Onset of the release of spermatozia (supermarche) in boys in relation to age, testicular growth, pubic hair, and height. J Clin Endocrinol Metab. 1986;62(3):532–5.

    Article  CAS  Google Scholar 

  10. Radicioni AF, Anzuini A, De Marco E, Nofroni I, Castracane VD, Lenzi A. Changes in serum inhibin B during normal male puberty. Eur J Endocrinol. 2005;152(3):403–9.

    Article  CAS  Google Scholar 

  11. Schaefer F, Marr J, Seidel C, Tilgen W, Scharer K. Assessment of gonadal maturation by evaluation of spermaturia. Arch Dis Child. 1990;65(11):1205–7.

    Article  CAS  Google Scholar 

  12. Picton HM, Wyns C, Anderson RA, Goossens E, Jahnukainen K, Kliesch S, et al. A European perspective on testicular tissue cryopreservation for fertility preservation in prepubertal and adolescent boys. Hum Reprod. 2015;30(11):2463–75.

    Article  Google Scholar 

  13. Penzias A, et al. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019;112(6):1022–33.

    Article  Google Scholar 

  14. Barnard EP, et al. Fertility preservation outcomes in adolescent and young adult feminizing transgender patients. Pediatrics. 2019;144(2):1–6.

    Google Scholar 

  15. Pasquino AM, Pucarelli I, Accardo F, Demiraj V, Segni M, Di Nardo R. Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropin-releasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function. J Clin Endocrinol Metab. 2008;93(1):190–5.

    Article  CAS  Google Scholar 

  16. De Roo C, et al. Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment. Reprod BioMed Online. 2017;34(6):557–66.

    Article  Google Scholar 

  17. Lierman S, Tilleman K, Braeckmans K, Peynshaert K, Weyers S, T’Sjoen G, et al. Fertility preservation for trans men: frozen-thawed in vitro matured oocytes collected at the time of ovarian tissue processing exhibit normal meiotic spindles. J Assist Reprod Genet. 2017;34(11):1449–56.

    Article  CAS  Google Scholar 

  18. Schneider F, Neuhaus N, Wistuba J, Zitzmann M, Heß J, Mahler D, et al. Testicular functions and clinical characterization of patients with gender dysphoria (GD) undergoing sex reassignment surgery (SRS). J Sex Med. 2015;12(11):2190–200.

    Article  CAS  Google Scholar 

  19. Adeleye AJ, Reid G, Kao CN, Mok-Lin E, Smith JF. Semen parameters among transgender women with a history of hormonal treatment. Urology. 2019;124:136–41.

    Article  Google Scholar 

  20. Schneider F, Kliesch S, Schlatt S, Neuhaus N. Andrology of male-to-female transsexuals: influence of cross-sex hormone therapy on testicular function. Andrology. 2017;5(5):873–80.

    Article  CAS  Google Scholar 

  21. Futterweit W, Degligdisch L. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab. 1986;62(1):16–21.

    Article  CAS  Google Scholar 

  22. 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(2):453–61.

    Article  CAS  Google Scholar 

  23. Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol. 2014;124(6):1120–7.

    Article  CAS  Google Scholar 

  24. Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility preservation for transgender adolescents. J Adolesc Health. 2017;61(1):120–3.

    Article  Google Scholar 

  25. Nahata L, Tishelman A, Caltabellotta N, Quinn G. Low fertility preservation utilization among transgender youth. J Adolesc Health. 2017;61:40–4.

    Article  Google Scholar 

  26. von Doussa H, Power J, Riggs D. Imagining parenthood: the possibilities and experiences of parenthood among transgender people. Cult Health Sex. 2015;17(9):1119–31.

    Article  Google Scholar 

  27. Chen D, Simons L. Ethical considerations in fertility preservation for transgender youth: a case illustration. Clin Pr Pediatr Psychol. 2018;6(1):93–100.

    Google Scholar 

  28. Wierckx K, Stuyver I, Weyers S, Hamada A, Agarwal A, de Sutter P, et al. Sperm freezing in transsexual women. Arch Sex Behav. 2012;41(5):1069–71.

    Article  Google Scholar 

  29. Schmidt L, Levine R. Psychological outcomes and reproductive issues among gender dysphoric individuals. Endocrinol Metab Clin N Am. 2015;44(4):773–85.

    Article  Google Scholar 

  30. Payne JG, Erbenius T. Conceptions of transgender parenthood in fertility care and family planning in Sweden: from reproductive rights to concrete practices. Anthropol Med. 2018;25(3):329–43.

    Article  Google Scholar 

  31. Chiniara LN, Viner C, Palmert M, Bonifacio H. Perspectives on fertility preservation and parenthood among transgender youth and their parents. Arch Dis Child. 2019;104(8):739–44.

    Article  Google Scholar 

  32. Chen D, et al. Factors affecting fertility preservation decision-making among transgender adolescents and young adults. LGBT Heal. 2019;64(3):107–15.

    Article  Google Scholar 

  33. Strang JF, Jarin J, Call D, Clark B, Wallace GL, Anthony LG, et al. Transgender youth fertility attitudes questionnaire: measure development in nonautistic and autistic transgender youth and their parents. J Adolesc Health. 2018;62:128–35.

    Article  Google Scholar 

  34. Murphy TF. The ethics of fertility preservation in transgender body modifications. J Bioeth Inq. 2012;9(3):311–6.

    Article  Google Scholar 

  35. Bartholomaeus C, Riggs DW. Transgender and non-binary Australians ’ experiences with healthcare professionals in relation to fertility preservation. Cult Health Sex. 2019:1–17.

  36. Kyweluk MA, Reinecke J, Chen D. Fertility preservation legislation in the United States: potential implications for transgender individuals. LGBT Heal. 2019;6(7):331–4.

    Article  Google Scholar 

  37. Burnard P, Gill P, Stewart K, Treasure E, Chadwick B. Analysing and presenting qualitative data. Br Dent J. 2008;204(8):429–32.

    Article  CAS  Google Scholar 

  38. “Dedoose Version 8.3.17, web application for managing, analyzing, and presenting qualitative and mixed method research data.” SocioCultural Research Consultants, LLC, Los Angeles, 2020.

  39. Chen D, Kolbuck VD, Sutter ME, Tishelman AC, Quinn GP, Nahata L. Knowledge, practice behaviors, and perceived barriers to fertility care among providers of transgender healthcare. J Adolesc Health. 2019;64(2):226–34.

    Article  Google Scholar 

  40. Meiser B, et al. Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress: a study of families with multiple cases of bipolar disorder. Psychol Med. 2007;37(11):1601–11.

    Article  Google Scholar 

  41. Tishelman AC, Sutter ME, Chen D, Sampson A, Nahata L, Kolbuck VD, et al. Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey. J Assist Reprod Genet. 2019;36:579–88.

    Article  Google Scholar 

  42. Rothenberg SS, Witchel SF, Menke MN. Oocyte cryopreservation in a transgender male adolescent. N Engl J Med. 2019;380(9):886–7.

    Article  Google Scholar 

Download references

Funding

This study was supported by endowed fellowship funds from the Academic General Pediatrics Division, Ann & Robert H. Lurie Children’s Hospital of Chicago and by the National Institutes of Health [grant R01-HD082554-01A1].

Author information

Authors and Affiliations

  1. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Irini N. Kolaitis & Joel E. Frader

  2. Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA

    Rebecca M. Harris

Authors
  1. Rebecca M. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irini N. Kolaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joel E. Frader
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Interviews were completed by Rebecca Harris. Coding was completed by all authors. The first draft of the manuscript was written by Rebecca Harris, and all authors commented on versions of the manuscript.

Corresponding author

Correspondence to Rebecca M. Harris.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harris, R.M., Kolaitis, I.N. & Frader, J.E. Ethical issues involving fertility preservation for transgender youth. J Assist Reprod Genet 37, 2453–2462 (2020). https://doi.org/10.1007/s10815-020-01873-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-020-01873-9

Keywords

Search

Navigation