Fertility Preservation: Is There a Model for Gender-Dysphoric Youth?

Fertility Preservation: Is There a Model for Gender-Dysphoric Youth?
Michael K. Laidlaw, Jennifer Lahl, and Angela Thompson

Overview
Fertility preservation (FP) for children prior to the developmental stage of gamete maturation has been used in cases of patients diagnosed with cancer who require chemotherapy or radiotherapy to preserve their lives; many of these treatment modalities are gonadotoxic. It is imperative to understand that for this population, gametes are not mature and therefore the options they have for fertility preservation are very limited.

Immature oocytes can be preserved with ovarian tissue cryopreservation and autotransplanted at a later time to possibly undergo maturation in vivo to restore fertility; however for males, the cryopreservation of testicular tissue is still experimental and currently there is no method that is able to ‘mature’ spermatogonia to spermatocytes.

For children with a pediatric cancer diagnosis, where there exists a physical locus of disease that may cause them to succumb to death unless gonadotoxic treatment is administered, the limitations to these modalities of fertility preservation represent the only possible way to give these children the opportunity for future genetic offspring.For patients of more advanced pubertal stages, ova maybe harvested or sperm collected, or embryos created for cryopreservation in individuals.

Cryopreserved ovarian and testicular tissue collected in pediatric patients at early pubertal stages may be autotransplanted at a later time in attempt to try to restore patient fertility; for male children, testicular tissue cryopreservation remains experimental and unproven. However, the efficacy of assisted reproductive technology (ART) has been under scrutiny as to its limitations in success achieving pregnancies that result in live births. Applied to pre-pubertal and early pubertal children and adolescents medicalized with gender affirmative therapy (GAT) (those subjected to GnRH analogs followed in succession by cross-sex hormones), the utility of FP raises more questions than answers. The authors believe that FP in the context of GAT under these circumstances is experimental.