Abstract (~75 words)
Introduction (~600 words)
Fertility preservation options
- Oocyte, embryo or ovarian tissue freezing (focussing mainly on oocyte vitrification as in this case).
- Success rates of each for example how approximately many oocytes needed for 1 live birth?
- Challenges of oocyte collection in patients which are often virgins and therefore only have transabdominal scans
Case report
18 year old transgender male referred for oocyte freezing for fertility preservation prior to commencing hormone therapy to transition. Patient has had female partners previously but still uncertain of sexuality so does not know in what capacity they may be using oocytes in future treatment. Could be any of the following circumstances:
- with a male partner who will provide sperm sample for ICSI to create embryos followed by surrogacy if patient is unwilling to carry pregnancy or unable to due to undergoing hysterectomy as part of bottom surgery (unsure if they will undergo bottom surgery at this point) .
- With female partner who will be gestational carrier. Embryos to be created with sperm donor.
- Without partner or with female partner who is unable to carry pregnancy. Sperm donor and surrogate required.
Patient declined additional screening for surrogacy due to cost. They were made aware of how this may impact future treatment options but was highly distressed so did not want to discuss further.
Underwent counselling at the unit and proceeded with ovarian stimulation. This resulted in 8 oocytes being collected 6 of which were mature (MII) and vitrified for future use. Oocytes stored in separate cryo-vessels in line with HFEA fertility preservation requirements.
Patient consented to 55years storage as likely to become prematurely infertile due to gender affirming treatment. Aware NHS funding is only for 10 years after which patient will have to self-fund.
Discussion (~700 words)
Beyond simply the choice of fertility preservation method whether that be oocyte, embryo or ovarian tissue freezing, there are many other difficult factors involved in preservation for FtM patients….
- Need for counselling
- Social and ethical considerations/challenges
- Also Psychosocial Considerations for instance how patients confusion of sexuality makes it difficult to plan for future treatment at this stage.
- Potential worsening of dysphoria if patient had to carry child in future?
- Social pressures?
- Possible legal issues with future treatment.
- Screening- What are the screening requirements for oocyte freezing and future treatment. If surrogacy is needed surrogate would need to be aware of risk as full screening was not performed prior to freezing. Patient could be retrospectively screened in line with donor requirements but still theoretical risk of infection as full status at point of treatment was not known.
- HFEA consent forms
- Explain which would be required for initial oocyte freezing and for specific future treatment circumstances (as outlined in case report section). Why they are necessary etc.
- NHS Funding & cost implications
- CCG eligibility and restrictions
- Cost implications (for example: screening for surrogacy not funded)
- What could be done to improve pathway for these FP patients
- Should multiple rounds of egg freezing be offered to improve success rates however could this delay in hormone initiation worsen dysphoria? patient specific
Conclusion (~50 words)
