Philippa Ralph
University College London Hospital NHS Foundation Trust, UKPresentation Title:
UK data collection of semen quality in transgender adolescent females seeking fertility preservation
Abstract
Increasing numbers of adolescents with gender dysphoria start gonadotropin-releasing hormone agonists to halt puberty, minimizing psychological distress. The uncertainty of the long-term effects of this medication, and the subsequent likelihood of accessing gender-affirming hormone treatment, highlights the importance of fertility preservation (FP) prior to starting hormone treatment. We investigated the take-up, hormonal profile, and sperm quality in adolescents undergoing FP via cryopreservation by masturbation or surgical sperm retrieval (SSR), prior to starting hormonal therapy.
Design: Data was prospectively maintained from a tertiary UK-based hospital. 122 people under 19 years, mean age 15.2 +/- 1.7 years, referred by gender clinics and GPs, were included in this cohort study.
Intervention: Masturbation semen samples were classified as normal (>15mil/ml), oligozoospermia (1mil-15mil/ml), cryptozoospermia (<1mil/ml), or azoospermia. If the sample was insufficient or the person was unwilling to masturbate, SSR was offered in a stepwise manner using electroejaculation, TESE +/- mTESE.
Main Outcome Measurements: The quality of semen was analyzed against WHO criteria to determine if it was good enough to cryopreserve for future fertility use.
Results: 23/122 (19%) participants declined sample storage. Masturbation group (average age 16.3) - 78 people produced 106 samples. 86/106 were stored - 43.7% were normospermic, 35.9% oligozoospermic, 8.7% cryptozoospermic, 11.7% azoospermic. Overall, semen parameters varied but were generally abnormal. SSR group (average age 15.2) - electroejaculation was successful in 4/21 people, while the rest proceeded with TESE/mTESE. Encouragingly, 16/21 subjects had an average of 5 vials stored, and all participants had a testosterone level >8nmol/l. Semen parameters in this sub-cohort were poor but possibly adequate for ICSI.
Conclusions: In this large UK database of transgender females, FP is possible even with those unwilling to masturbate. Long-term data is required to assess the health of the gametes produced and to particularly observe live birth rates using the cryopreserved sperm.
Biography
Dr Philippa Ralph was awarded her MBBS degree from
Barts and The London School of Medicine and Dentistry in 2023, in addition to a
Masters in Global Health and Public Policy in 2021. She is currently a resident
doctor working in Oxford University, with an interest in pursuing a career in critical
care medicine.
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