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Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy

  • Fertility Preservation
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Increasing numbers of transgender adolescents are receiving gender-affirming treatments (GAT). Given GAT can impair reproductive function, clinical guidelines advise prior counselling regarding fertility preservation (FP). For transgender adults assigned male at birth, FP is usually achieved via a masturbatory sample and sperm cryopreservation. This is less straightforward in transgender adolescents, since they may not be developmentally ready to masturbate and/or masturbation may cause unacceptable gender dysphoria. Testicular biopsy represents an alternative method for sperm retrieval in these adolescents, but for those in early/mid puberty, it is difficult to predict whether sperm will be found. The purpose of this study was therefore to identify factors that predict successful sperm retrieval for cryopreservation via testicular biopsy.

Methods

A retrospective cohort study was undertaken at a tertiary-referral pediatric gender service. Subjects were included if they’d received a testicular biopsy in association with the commencement of GAT between 2010 and 2019. The primary outcome measure was successful sperm retrieval, and potential predictors included age, testicular volume and serum testosterone, LH and FSH levels.

Results

Of 25 subjects who received a biopsy prior to starting any GAT, 17 had successful sperm retrieval. While age, testosterone, LH and FSH levels showed minimal differences, testicular volume was significantly higher in those with successful sperm retrieval, and a threshold of ≥ 10 mL showed 92% sensitivity and 71% specificity in predicting successful retrieval. An additional 6 patients received a biopsy after starting puberty suppression and before commencement of oestrogen, and one of these individuals had sperm successfully retrieved despite > 2 years of regular puberty suppression.

Conclusion

These findings suggest that testicular volume is most useful in predicting successful sperm retrieval following testicular biopsy in transgender adolescents and are likely to be of relevance to other young people undertaking FP, including those with cancer.

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Data availability

Data will be available upon reasonable request.

Code availability

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Acknowledgements

KCP is supported by the Hugh Williamson Foundation Trust and the Royal Children’s Hospital Foundation.

Author information

Author notes

  1. Angus Peri and Astrid Ahler contributed equally to this paper.

Authors and Affiliations

  1. Murdoch Children’s Research Institute, Parkville, VIC, Australia

    Angus Peri, Michele A. O’Connell, Michael Nightingale, Michelle Telfer, Yasmin Jayasinghe & Ken C. Pang

  2. Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland

    Astrid Ahler

  3. Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women’s Hospital, Parkville, VIC, Australia

    Debra Gook & Yasmin Jayasinghe

  4. Reproductive Services/Melbourne IVF, Royal Women’s Hospital, Parkville, VIC, Australia

    Debra Gook & Harold Bourne

  5. Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia

    Michele A. O’Connell, Michael Nightingale, Michelle Telfer & Ken C. Pang

  6. Royal Children’s Hospital, Melbourne, VIC, Australia

    Michele A. O’Connell, Michael Nightingale, Michelle Telfer, Yasmin Jayasinghe & Ken C. Pang

  7. Inflammation Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

    Ken C. Pang

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  1. Angus Peri
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  2. Astrid Ahler
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Corresponding author

Correspondence to Ken C. Pang.

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Ethics approval and consent to participate

This study was conducted with the approval of the RCH Human Research Ethics Committee (#36323). As a retrospective audit of clinical files, consent was not required. However, consent was obtained from the individual who had sperm identified despite being on GnRHa, given the information shared about their case made them potentially identifiable.

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The authors declare no competing interests.

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Peri, A., Ahler, A., Gook, D. et al. Predicting successful sperm retrieval in transfeminine adolescents after testicular biopsy. J Assist Reprod Genet 38, 2735–2743 (2021). https://doi.org/10.1007/s10815-021-02293-z

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  • DOI: https://doi.org/10.1007/s10815-021-02293-z

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