Resident Physician Icahn School of Medicine at Mount Sinai
Introduction: Fertility preservation (FP) should be an important step in health care prior to initiating gender affirming hormonal therapy (GAHT) or puberty blockade in transgender and gender diverse (TGD) people. However, FP is often not integrated into comprehensive gender affirming care. Prior studies show low rates of FP in transgender youth. The aim of this study was to understand how the integration of a pediatric urology team into our Center for Transgender Medicine and Surgery program would impact the overall number of transgender girls who pursue fertility preservation. Methods: To assess the success of fertility preservation, we performed a retrospective review of a database of all TGD patients who were 18 years or younger with testes, and sought GAHT. Patients were evaluated and followed in our Center for Transgender Medicine and Surgery from 4/2022 through 10/2022. Demographics, age, hormonal treatment, Tanner stages, and FP use were recorded from the medical record. Successful sperm banking was defined as freezing >1 vial of sperm. Results: Twenty seven patients ranging from ages 10-17 years old were referred to pediatric urology for FP. Of patients referred to the clinic, 20 (74.1%) were interested in pursuing/are in the process of sperm banking. Of the patients who didn’t pursue FP, 1 (3.7%) of the patients were prepubertal (Tanner I), 4 (14.8 %) patients declined to attempt FP because they wanted to avoid masturbation, and 2 (7.4%) patients declined referral altogether. Twelve patients began the process of FP with sperm banking - ten of whom successfully froze sperm within WHO reference ranges of semen parameters and 2 children were azoospermic. Upon review, these 2 patients with azoospermia were found to already have started hormonal suppression. Conclusions: Our data suggest that a large percentage of patients may be interested in fertility preservation. The integration of a pediatric urology team can help to increase access to this service. Importantly, that the children who already started pubertal suppression were azoospermic highlights the importance of the integration of pediatric urology and FP into the health care process prior to pubertal suppression therapy. In our program, counseling on GAHT and puberty blockers’ impact on fertility is introduced early and pediatric urology consultation is offered concurrently or even prior to endocrinology consultation. SOURCE OF Funding: N/A
