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LGBT Health. 2019 Apr;6(3):107-115. doi: 10.1089/lgbt.2018.0250.

Factors Affecting Fertility Decision-Making Among Transgender Adolescents and Young Adults.

Chen D1,2,3,4, Kyweluk MA5,6, Sajwani A1, Gordon EJ7,8,9, Johnson EK8,10,11, Finlayson CA4,12, Woodruff TK13,14.

Author information

1
1 The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
2
2 Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
3
3 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
4
4 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
5
5 Department of Anthropology, Northwestern University, Chicago, Illinois.
6
6 Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
7
7 Division of Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
8
8 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
9
9 Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
10
10 Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
11
11 Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
12
12 Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
13
13 Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
14
14 Division of Reproductive Science in Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

PURPOSE:

This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP).

METHODS:

Participants completed a semistructured interview between December 2016 and June 2017 to inform improvements in fertility counseling and the development of a fertility decision aid targeted to transgender youth. Interviews included open-ended questions within the following domains: (1) gender-affirming medical care received, (2) knowledge of gender-affirming hormone effects on fertility and FP options, (3) FP decision-making, and (4) how, when, and what information AYA prefer to receive regarding FP. The interviews were analyzed thematically.

RESULTS:

Eighteen transgender AYA (ages 15-24) participated (60% participation rate). The majority was White (61%) and assigned female at birth (67%). Half received specialized FP counseling (50%). Few of the transgender AYA pursued FP (33%). Five key themes reflecting factors affecting transgender AYA's FP decision-making were identified: (1) future parenthood desires, (2) individual experiences of gender dysphoria, (3) family values around biological parenthood, (4) financial considerations, and (5) fertility information provision.

CONCLUSIONS:

Transgender AYA consider numerous factors in deciding whether to pursue FP. Although individual desires for and family values around biological parenthood influenced whether AYA pursued specialized FP counseling, individual experiences of gender dysphoria and costs of FP were barriers. AYA also identified shortcomings in fertility counseling with providers, highlighting the need to establish standardized counseling protocols and develop patient decision aids.

KEYWORDS:

gamete cryopreservation; gender dysphoria; oocyte cryopreservation; qualitative research; reproductive health; sperm cryopreservation

PMID:
30985275
DOI:
10.1089/lgbt.2018.0250

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