Abstract
OBJECTIVE: To compare the outcomes of oocyte cryopreservation in transgender patients with and without prior testosterone use. DESIGN: Retrospective cohort study. SUBJECTS: Transmasculine/non-binary patients assigned female at birth who were referred for fertility preservation from January 2012 to March 2024 at a multicenter health maintenance organization. EXPOSURE: Gender-affirming hormone therapy with testosterone. MAIN OUTCOME MEASURES: The primary outcome measure was the number of mature oocytes collected. Secondary outcomes included the total number of oocytes, percentage of mature to total oocytes, total dose of gonadotropins used, baseline antimüllerian hormone, baseline antral follicle count, and baseline endometrial thickness. RESULTS: Data from 50 transgender oocyte cryopreservation cycles were analyzed in the time period studied. A total of 34 subjects (68%) had no exposure to testosterone, whereas prior testosterone use was reported in 16 subjects (32%). The mean duration of testosterone was 4.1 ± 2.6 years. Testosterone was discontinued 3 weeks to 3 months before cycle start. There were no significant differences in baseline demographics, such as age and body mass index, between the two patient groups. The total number of oocytes retrieved was statistically the same between transgender patients with prior testosterone use (17.3 ± 10.1) and those without (21.3 ± 10.1). Additionally, there were no differences in the number of mature oocytes (12.0 ± 7.5 vs. 16.1 ± 9.1) or ratio of mature/total oocytes between the two groups (72.3% ± 18.3% vs. 70.9% ± 22.4%). Secondary outcomes such as baseline antral follicle count, baseline antimüllerian hormone, total dose of gonadotropins used, and baseline endometrial thickness demonstrated no significant difference between the two study groups. CONCLUSION: Our study suggests that prior testosterone use does not appear to impact oocyte cryopreservation outcomes in transgender patients. As a growing number of transgender patients seek fertility care, there is a need for evidence-based research that can guide clinical practice and empower this population to realize their aspirations for parenthood.