P-444 Outcomes of oocyte vitrification in trans masculine persons
Authors: Asseler J , Van Mello N , Knieriem J , Huirne J , Goddijn M , Verhoeven M 
Published: June 2022

Abstract

Study question
What are the outcomes of oocyte vitrification treatment(OVT) in trans masculine persons (TMPs) prior to, and after testosteroneuse? And how do these patients reflect on their treatment?

Summary answer
TMPs show a normal response to controlled ovarian hyperstimulation(COH). Even though the OVT was considered burdensome, most patients were satisfied with their treatment and outcome.

What is known already
The desire to parent genetic offspring is a relevant topic in the lives of many TMPs. To preserve their fertility prior to gender affirming hormone treatment or –surgeries, fertility preservation should be discussed by healthcare providers. However, the procedure may lead to an increase in dysphoric distress in TMPs. Only few studies have been published describing the outcomes of TMPs undergoing OVT. Their data suggest a comparable oocyte retrieval number in TMPs compared to cis gender women as well as similar fertilization and pregnancy rates. Outcomes of OVT in TMPs and their experiences undergoing said treatment remain under-explored.

Study design, size, duration
This single center, retrospective cohort study was performed by the Center of Expertise on Gender and the fertility clinic at the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands. Between January 2017 and June 2021, all TMPs who had undergone OVT where approached for participation and 24/30 TMPs were included in our cohort.

Participants/materials, setting, methods
Demographic characteristics and data on OVT were retrieved from the medical records. Oocyte vitrification at our center is performed in persons between the age of 16 and 39 using a long agonist COH protocol. TMPs who had initiated testosterone were advised 3 months cessation prior to stimulation. Evaluation of the oocyte vitrification procedure was collected via an online questionnaire comprising of 10 multiple choice and open ended questions.

Main results and the role of chance
The median age and BMI of participants was 21.1 years (IQR 19.4 – 24.1) and 22.1 kg/m2 (IQR 20.8 – 25.4), respectively. Seven persons were using testosterone, two persons were using puberty suppression (GnRH analogues) and seven persons were using other hormonal cycle regulation prior to their OVT.
The median anteral follicle count on cycle day three was 28(IQR 24.5 – 35.0). After a median of 12 FSH stimulation days (IQR 10 – 13), a trigger was administered. The mean peak serum estradiol(E2) was 11062 pmol/L (SD 5385). A median of 20 oocytes (IQR 16 – 26) were found and a median of 17 oocytes (IQR 14 – 22) were frozen. Six participants (25%) developed an ovarian hyperstimulation syndrome(OHSS). Four of which were classified as severe. There were no significant differences between the prior testosterone users and non-testosterone users.
The median time between OPU and taking the questionnaire was 19.2 months(IQR 3.2 – 27.5). The response rate was 100%. Almost half of participants(46%) were most anxious for the internal examination prior to starting OVT. Interestingly, afterwards only 13% described the internal examination as the most strenuous part of the treatment. Hormone injections were considered the most strenuous part of OVT (29%).

Limitations, reasons for caution
A limitation of this study is the small sample size, especially when comparing prior testosterone users to non-testosterone users. Another limitation is that the effect of previous testosterone on the chance of live birth rate remains unknown since no participants have chosen to pursue conception yet.

Wider implications of the findings
This is the first study describing OVT outcomes in the TMPs in the Netherlands. This study shows no difference between prior testosterone use or not. The survey results identify the most burdensome aspect of the procedure for TMPs and improve transgender specific fertility strategies.

Trial registration number
not applicable