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Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment

  • Male Reproduction: Original Article
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Abstract

The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).

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Authors and Affiliations

  1. Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel

    Hadar Amir, Shimi Barda, Daniel Lantsberg & Foad Azem

  2. Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Liat Perl, Anat Segev Becker, Galit Israeli & Asaf Oren

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hadar Amir, Liat Perl, Shimi Barda, Daniel Lantsberg, Anat Segev Becker, Galit Israeli, Foad Azem & Asaf Oren

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  1. Hadar Amir
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Contributions

H.A. was involved in the conception, study design, data acquisition and analysis, and manuscript preparation. A.O. and L.P. were involved in the conception, collected, and managed the database and provided their expertise in the critical reading of the manuscript. A.S.B. and G.I. collected the data and managed the database. S.B., D.L., and F.A. contributed in the interpretation of the data and provided their expertise in the critical reading of the manuscript. All contributors reviewed and edited the manuscript and gave their approval of the final version.

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Correspondence to Hadar Amir.

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Amir, H., Perl, L., Barda, S. et al. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod. Sci. 29, 260–269 (2022). https://doi.org/10.1007/s43032-021-00561-y

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