Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Reproductive Endocrinology, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Rev Endocr Metab Disord. 2018 Sep;19(3):231-242. doi: 10.1007/s11154-018-9462-3.
Gender affirming procedures adversely affect the reproductive potential of transgender people. Thus, fertility preservation options should be discussed with all transpeople before medical and surgical transition. In transwomen, semen cryopreservation is typically straightforward and widely available at fertility centers. The optimal number of vials frozen depends on their reproductive goals and treatment options, therefore a consultation with a fertility specialist is optimal. Experimental techniques including spermatogonium stem cells (SSC) and testicular tissue preservation are technologies currently under development in prepubertal individuals but are not yet clinically available. In transmen, embryo and/or oocyte cryopreservation is currently the best option for fertility preservation. Embryo cryopreservation requires fertilization of the transman's oocytes with a donor or partner's sperm prior to cryopreservation, but this limits his future options for fertilizing the eggs with another partner or donor. Oocyte cryopreservation offers transmen the opportunity to preserve their fertility without committing to a male partner or sperm donor at the time of cryopreservation. Both techniques however require at least a two-week treatment course, egg retrieval under sedation and considerable cost. Ovarian tissue cryopreservation is a promising experimental method that may be performed at the same time as gender affirming surgery but is offered in only a limited amount of centers worldwide. In select places, this method may be considered for prepubertal children, adolescents, and adults when ovarian stimulation is not possible. Novel methods such as in-vitro activation of primordial follicles, in vitro maturation of immature oocytes and artificial gametes are under development and may hold promise for the future.
性别肯定手术会对跨性别者的生殖潜力产生不利影响。因此，在进行医学和手术过渡之前，应该与所有跨性别者讨论生育保存选项。对于跨性别女性，精子冷冻保存通常很简单，并且在生育中心广泛可用。冷冻的小瓶数量取决于他们的生殖目标和治疗选择，因此与生育专家咨询是最佳选择。包括精原干细胞 (SSC) 和睾丸组织保存在内的实验技术是目前在青春期前个体中开发的技术，但尚未在临床上应用。对于跨性别男性，胚胎和/或卵母细胞冷冻保存是目前生育保存的最佳选择。胚胎冷冻保存需要在冷冻保存之前将跨性男性的卵母细胞与供体或伴侣的精子受精，但这限制了他未来用另一个伴侣或供体受精卵子的选择。卵母细胞冷冻保存为跨性别男性提供了在冷冻保存时不承诺与男性伴侣或精子捐赠者生育的机会。然而，这两种技术都至少需要两周的治疗过程、镇静下的卵子采集和相当大的费用。卵巢组织冷冻保存是一种很有前途的实验方法，可以在进行性别肯定手术的同时进行，但目前仅在全球有限数量的中心提供。在某些地方，当无法进行卵巢刺激时，这种方法可能会被考虑用于青春期前儿童、青少年和成年人。新的方法，如原始卵泡的体外激活、未成熟卵母细胞的体外成熟和人工配子的开发，正在开发中，可能为未来带来希望。
