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Timing of testosterone discontinuation and assisted reproductive technology outcomes in transgender patients: a cohort study

Open AccessPublished:January 19, 2023DOI:https://doi.org/10.1016/j.xfre.2023.01.004
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      ABSTRACT

      Objective

      To determine if there is an association between the timing of testosterone discontinuation and ART outcomes.

      Design

      Retrospective cohort study.

      Setting

      Single academic center.

      Patients

      We included consecutive transgender patients seeking fertility preservation between October 2019 to April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included.

      Interventions

      None.

      Main outcome measures

      A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved.

      Results

      Eighteen patients (mean age 27.7 [SD 5.2] years, mean BMI 27.3 [SD 4.6] kg/m2, mean AMH 27.2 [SD 11.8], median AFC 20 [interquartile range (IQR) 14-32]) were included in the analysis. No patient underwent transition-related surgery (eg: oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time on testosterone was 44 (SD 29.6) months. Median time off testosterone until start of ovarian stimulation was 7.7 weeks (IQR 4.3-20.7) weeks. All patients underwent oocyte cryopreservation, except one who had embryo cryopreservation. Median total number of oocytes was 11 (IQR 7-14). Median number of mature oocytes was 7.5 (IQR 5-12) oocytes. The univariate regression model evaluating duration of time off testosterone prior to ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient 0.19, 95% CI –0.13 to 0.50, p=0.226).

      Conclusion

      In a retrospective analysis of transgender patients recently on testosterone undergoing ART, there was no association detected between timing of testosterone cessation and number of mature oocytes.

      Key words