O-276 Fertility preservation and sperm quality in adolescent transgender patients prior to hormonal treatment
Authors: Ralph P , Mahmoud M , Schlager D , Lee W G , Wafa R , Williamson E , Butler G , Ralph D , Sangster P 
Published: June 2023

Abstract

Study question
This study investigated the take-up, hormonal profile and sperm quality in adolescents undergoing fertility preservation via different methods, prior to medical intervention for gender dysphoria.

Summary answer
Fertility preservation via surgical sperm retrieval (SSR) or masturbation, is possible in this group, however long-term data is required to check gamete health.

What is known already
As increasing numbers of adolescents with gender dysphoria (GD) start gonadotrophin-releasing hormone agonists (GnRHa) to delay puberty to minimise psychological distress. However, the uncertainty of the long-term effects of these medications highlights the importance of undergoing fertility preservation (FP) prior to starting any hormone treatment.

Study design, size, duration
Data for adolescents wanting to FP was prospectively maintained. A total of 122 patients were referred for FP, of which 23 declined (19%).

Participants/materials, setting, methods
Young people were counselled for FP and serum testosterone, FSH, and LH were recorded prior to providing semen samples. Semen samples were classified by concentration; normal &gt;15mil/ml, oligospermia &lt;15mil/ml, poor &lt;1sperm/slide, azoospermia. Insufficient samples, or unwillingness to masturbate, meant SSR was offered in a stepwise manner using electroejaculation (EE), TESE and mTESE.

Main results and the role of chance
Most patients (n = 78, 64% - median age 16.7) were able to produce semen by masturbation, cryopreserving an average of 6.6 straws. Sperm concentration was normal in 44% of samples produced, 36% were oligozoospermic, 9% were poor sperm concentration, and 12% were azoospermic. Mean blood results showed: testosterone 12.32nmol/l, FSH 3.83 IU/L, LH 4.39 IU/L.
21 patients required SSR - median age of 14.9. EE was successful in 4 patients, 9 underwent TESE, and 8 underwent mTESE. 4 mTESE patients were azoospermic. Success rate was 77%, with an average of 5.5 vials stored. Semen parameters in this cohort were poor - however possibly adequate for ICSI. Hormone levels were similar to the masturbation cohort: mean testosterone 11.7nmol/l, FSH 3.4 IU/L, LH 3.5 IU/L.
3 patients used GnRHa pre-SSR. Following a washout period, 1 patient remained azoospermic despite a testosterone of 21 nmol/l. The other 2 patients had sperm found with abnormal morphology and motility.
This is the largest UK cohort of transgender girls referred for FP. The results showed that semen parameters were abnormal in 67% of the masturbation samples produced, and within the SSR group, all patient’s testosterone levels were &gt;8nmol/l, with an average of 5.5 vials saved.

Limitations, reasons for caution
The quantity of long-term data on whether adolescents end up using their gametes post FP is a factor to consider with this study, as more evidence is needed in order to display the actual long-term usage of gamete cryopreservation.

Wider implications of the findings
Masturbation is often possible in this group, but alternatively, SSR provides patients with a safe opportunity to potentially have their own biological children in the future.

Trial registration number
not applicable