This systematic review is inspired by the large discordance between the high number of transgender individuals who express a desire for genetic parenthood compared to the very low number who ultimately seek fertility preservation. Possible hurdles for effective fertility counseling are explored.
The literature search learned that up to 70% of trans individuals aspire to parenthood, and many desire biologically related offspring. However, according to most studies, only 0-10% of transgender girls and boys pursue fertility preservation, but with wide differences across centres. The reasons are manifold. Many clinicians lack specific knowledge and training for effective fertility preservation counseling. Hormonal treatments need to be postponed or interrupted. The technologies required for gamete cryopreservation are extremely stressful for adolescents and may increase their gender dysphoria, whereas cryopreservation of immature gonadal tissue remains highly experimental. In addition, many of those who sought fertility preservation or pregnancy report negative experiences. Cost may also be an important factor, as most fertility procedures in trans individuals will not be reimbursed. But perhaps the most important and challenging factor is the developmental inability of teens to consider future parenthood. Impaired mental health status may further limit an adolescents ability to make such long-term decisions.
Despite their wish for biological offspring, many adolescents ultimately seek alternatives, such as adoption, fostering or donor gametes. These authors conclude that the development of clinical practice guidelines for fertility preservation counseling in young trans individuals, together with education and professional development, are needed to make progress in this important area of transgender care.