The Impact of a Formalized Fertility Preservation Program on Access to Care and Sperm Cryopreservation Among Transgender and Nonbinary Patients Assigned Male at Birth

Objectives: This study aimed to evaluate the implementation of a formalized fertility preservation (FP) program for transgender and nonbinary patients assigned male at birth (TGNB-AMAB) at our institution. Methods: We reviewed TGNB-AMAB patients who were referred to the FP program at our academic institution between 2016 and September 2023. We compared the number of referrals and the percentage of patients who underwent FP per year. Clinical and demographic information including age at referral, time from referral to banking, semen parameters, and serum hormone values were evaluated. Results: In total, 154 TGNB-AMAB patients were referred to the FP program since 2016; 131 (85.1%) met with a reproductive urologist or advanced practice provider for FP consultation; and 124 (94.7%) completed sperm cryopreservation. The number of annual referrals significantly increased over time (p = 0.001). The average age (+/- standard deviation) at referral was 20.5 +/- 5.7 years. The median time from referral to sperm cryopreservation was 14 days. The average semen parameters among all the patients were volume 2.7 +/- 1.7 mL, sperm concentration 36.0 +/- 31.6 M/mL, sperm motility 56.8 +/- 19.0%, and sperm morphology 4.7 +/- 2.9%. There was no significant difference in semen parameters between TGNB-AMAB patients previously on gender-affirming hormonal therapy prior to banking and those not on prior hormonal treatment (p > 0.05). Conclusions: Our fertility preservation program significantly increased the number of TGNB-AMAB patients who received consultation and underwent sperm cryopreservation. The institution of a formalized FP program can be used to increase access for TGNB-AMAB patients who desire future fertility.