Parental desire and fertility preservation in assigned female at birth transgender people living in Belgium

Objective: To study the considerations and concerns of transgender people regarding fertility preservation and parental desire in a large, nonclinical sample. Gender-affirming care can reduce fertility. Previous research on fertility in transgender people (mainly focused on people visiting health care professionals) shows low fertility preservation use. Design: A web-based survey on fertility and parenthood. Setting: Not applicable. Patient(s): Transgender people assigned female at birth (AFAB) were selected for this analysis (n = 172 or 40.4% of the total sample) of which 116 (67.4%) self-identified as transgender men (TM) and 56 (32.6%) as gender nonbinary (GNB) people. Intervention(s): Not applicable. Main Outcome Measure(s): Data on parental desire and fertility preservation were assessed in a large, nonclinical sample of AFAB transgender people. Result(s): Sixty-seven (39.0%) respondents had a current/future parental desire. Parental desire rates did not differ between TM and GNB persons. Barriers for fulfilling the parental desire (multiple response) included assumed difficulties in the adoption procedure (41.3%), fear of discrimination against the child (38.0%) or being discriminated against as a transgender parent (32.6%), and the cost for using personal genetic material (32.6%). Nine percent had cryopreserved reproductive cells or tissue. Conclusion(s): Even though parental desire rates in this cohort are in line with earlier research, fertility preservation use was lower in the current study. These numbers reflect the barriers transgender people face when considering fertility options, including cost and the need to postpone hormone therapy. In addition, GNB persons have different needs for gender-affirming treatment and subsequently for fertility preservation. ((C) 2019 by American Society for Reproductive Medicine.)