Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden.
Andrology. 2021 Nov;9(6):1773-1780. doi: 10.1111/andr.12999. Epub 2021 Mar 23.
Due to recent changes in the legal framework, access to fertility preservation (FP) for transgender individuals has opened up in several countries. In Sweden and the Nordic countries, fertility preservation for medical reasons is fully reimbursed as part of the established tax-funded healthcare services. As this issue is relatively new, procedures for FP have seldom been reported in the transgender patient population. The very limited literature has indicated that transgender women may have poorer sperm quality than cisgender men when assessing samples aimed at semen banking.
To assess sperm quality parameters of semen samples provided for FP by transgender women before or after gender affirming hormone therapy (GAHT), and to compare sperm quality with a reference population of unscreened men defined by the World Health Organization (WHO). Additionally, we aimed to describe referral patterns over calendar time and estimate time from referral to semen cryopreservation.
Prospective cohort study of 212 transgender women referred for FP to the Reproductive Medicine Clinic of Karolinska University Hospital, Sweden, between 2013 and 2018. Among 177 individuals that provided semen samples for cryopreservation, 16 had previously received GAHT.
Individuals with previous GAHT presented with significantly lower total sperm count than individuals without GAHT (p = 0.002). However, higher proportions of sperm abnormalities were also noted among individuals who had not undergone previous GAHT, compared to the WHO reference population (p < 0.001). Referrals of transgender women for FP increased over time. The median time from referral to semen cryopreservation was 27 days.
A high occurrence of sperm abnormalities was found in transgender women, especially among individuals who had previously received GAHT. The results underline the importance of thoroughly discussing parenthood options and FP with patients early after diagnosis and referring the patients for semen banking preferably before starting GAHT.
由于法律框架的最新变化，几个国家的跨性别者获得生育力保存（FP）的机会已经开放。在瑞典和北欧国家，出于医疗原因的生育力保存作为既定的税收资助医疗服务的一部分全额报销。由于这个问题相对较新，因此在跨性别患者群体中很少有关于 FP 程序的报道。非常有限的文献表明，在评估旨在进行精液库存储的样本时，跨性别女性的精子质量可能比顺性别男性差。
评估接受过或未接受过性别肯定激素治疗（GAHT）的跨性别女性为 FP 提供的精液样本的精子质量参数，并将精子质量与世界卫生组织（WHO）定义的未筛选男性参考人群进行比较。此外，我们旨在描述随时间的转诊模式，并估计从转诊到精液冷冻保存的时间。
对 2013 年至 2018 年间在瑞典卡罗林斯卡大学医院生殖医学诊所接受 FP 转诊的 212 名跨性别女性进行了前瞻性队列研究。在 177 名提供冷冻精液样本的个体中，有 16 名之前接受过 GAHT。
之前接受过 GAHT 的个体的总精子计数明显低于未接受过 GAHT 的个体（p=0.002）。然而，与 WHO 参考人群相比，未接受过 GAHT 的个体的精子异常比例也更高（p<0.001）。接受 FP 转诊的跨性别女性人数随时间增加。从转诊到精液冷冻保存的中位数时间为 27 天。
在跨性别女性中发现了很高的精子异常发生率，尤其是在之前接受过 GAHT 的个体中。这些结果强调了在诊断后尽早与患者彻底讨论生育选择和 FP，并在开始 GAHT 之前为患者进行精液库存储的重要性。
