Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals

Objective: To query transgender and gender-diverse individuals on their desire for fertility preservation, perceived barriers to access care, and decisional regret. Design: Cross-sectional. Setting: Not applicable. Patient(s): A total of 397 gender-diverse individuals undergoing intake to the University of California Los Angeles Gender Health Program from January 2018 to March 2019. Seventy participated in a follow-up survey from September to October 2019 clarifying reproductive desires or intentions. Intervention: Multiple-choice questionnaire. Main Outcome Measure(s): Perceived barriers to access fertility preservation and decisional regret surrounding choice to pursue fertility preservation as measured with the use of the validated Decision Regret Scale (scored 0 to 100). Result(s): Barriers to accessing care were primarily cost of treatment (36%), discontinuation/delay of hormonal therapy (19%), or worsening of gender dysphoria with treatment/pregnancy (11%). Respondents indicated that their family planning goals were addressed by primary care providers and/or medical endocrinologists (multiple responses allowed), but 37% stated that their family planning goals were not adequately addressed. Those who had made a firm decision to pursue or not pursue fertility treatment had mild decisional regret. Moderate-to-severe decisional regret was noted in those who were undecided regarding the pursuit of fertility perseveration before transition and in those who were interested in referral to reproductive endocrinology. Conclusion(s): Consultation with a reproductive endocrinologist may reduce decisional regret as well as clarify perceived barriers to fertility preservation in transgender and gender-diverse individuals interested in fertility preservation. (C) 2020 by American Society for Reproductive Medicine.

Automated summary

The survey on fertility preservation desire and access care barriers among transgender and gender-diverse individuals revealed that cost of treatment, delay of hormonal therapy, and worsening of gender dysphoria with treatment/pregnancy were the primary barriers. Some respondents indicated that their family planning goals were not adequately addressed, and those who had made decisions on pursuing or not pursuing fertility treatment experienced mild decisional regret, while those who were undecided prior to transition and those interested in referral to reproductive endocrinology reported moderate-to-severe decisional regret. Consultation with a reproductive endocrinologist may help reduce decisional regret and clarify perceived barriers to fertility preservation in this population.