Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Curr Opin Urol. 2020 May;30(3):349-354. doi: 10.1097/MOU.0000000000000748.
An update on the latest advances in fertility preservation for transgender women, with an emphasis on the attitudes, access, and techniques.
With recent warming in perception toward transgendered individuals, fertility preservation services are becoming increasingly available. Although new multidisciplinary transgender clinics are appearing in North America, a 2018 report shows a referral rate for fertility preservation of only 13.5%. Despite interest in child rearing, uptake of fertility preservation is still low as patients are transitioning at increasingly younger ages. Sperm cryopreservation, ideally prior to hormonal therapy, continues to be the mainstay of fertility preservation in transwomen. It is used in conjunction with other assisted reproductive technologies such as intrauterine insemination or in-vitro fertilization with intracytoplasmic sperm injection depending on the quantity of sperm available. Recent research reporting successful autologous grafting of cryopreserved prepubertal testis leading to sperm production and offspring in macaques show great promise in the context of fertility preservation in prepubertal patients.
Despite the increasing accessibility of fertility preservation, referral rates and usage continue to be low, suggesting that barriers are still in place for these individuals. Clinicians must continue to counsel patients regarding the process of fertility preservation and advocate for reduction of financial and infrastructural barriers.
本文就 transgender women（跨性别女性）的生育力保存的最新进展进行更新，重点介绍态度、途径和技术。
随着对跨性别者的看法逐渐升温，生育力保存服务越来越普及。尽管北美出现了新的多学科跨性别诊所，但 2018 年的一份报告显示，生育力保存的转诊率仅为 13.5%。尽管有育儿意愿，但由于患者的转变年龄越来越小，生育力保存的接受率仍然很低。精子冷冻保存，理想情况下是在激素治疗之前，仍然是跨性别女性生育力保存的主要方法。它与其他辅助生殖技术（如宫腔内人工授精或卵胞浆内单精子注射的体外受精）结合使用，具体取决于可用精子的数量。最近的研究报告称，在猕猴中成功地进行了冷冻保存的未成熟睾丸的自体移植，导致精子产生和后代的出现，这在未成熟患者的生育力保存方面显示出巨大的前景。
尽管生育力保存的可及性不断增加，但转诊率和使用率仍然较低，这表明这些患者仍然存在障碍。临床医生必须继续就生育力保存的过程向患者提供咨询，并倡导减少经济和基础设施方面的障碍。
