ACCESS, BARRIERS, AND REGRET SURROUNDING FERTILITY PRESERVATION AMONG TRANSGENDER AND GENDER DIVERSE INDIVIDUALS

Professional organizations agree that transgender and gender diverse persons should be counseled on the effects of surgery and hormonal treatments on their fertility as well as options for fertility preservation and family building prior to transition.1,2 A recent study demonstrated that female to male transgender individuals perceived financial and psychological barriers to family planning, including cost of using cryopreserved gametes and assumed difficulties in the adoption process.3 Another study demonstrated a significant percentage of transgender men would have considered cryopreservation of gametes had the technique been available at the time of transition.4 To query transgender and gender diverse individuals participating in a multidisciplinary gender health program on their desire for fertility preservation, perceived barriers to access as well as regret that may surround their decision to or not to pursue fertility preservation. The UCLA Gender Health Program (GHP) is a multidisciplinary medical, surgical and behavioral health team that supports transgender and gender diverse individuals in their transition. An IRB-exempt survey was created using Qualtrics and disseminated to GHP patients who had previously indicated willingness to participate in research. Descriptive statistics was then performed. Decisional regret was measured using the validated Decision Regret Scale (DRS).5 Responses are between 0-100, with 100 indicating the highest regret. Of the 145 patients who agreed to be contacted for research, 70 responded to our online survey. The average age was 38.5 years (SD 16.8). Of these, 66% were assigned male at birth and 34% were assigned female at birth. Gender identities included male (12.5%), female (18.1%), gender non-binary (12.5%), transmale (11.1%), transfemale (33%), gender fluid (2.8%), and other (8.3%). A majority of the population was Caucasian (65.2%), employed (62.1%), and had completed at least high school (97.0%). Forty-five (66%) respondents stated they had no intention to pursue fertility preservation; while eighteen (27%) were undecided. One (1%) individual had intention to pursue and four (6%) had already completed fertility preservation. Of those who had completed fertility preservation, all had performed sperm cryopreservation. Perceived barriers to accessing care are listed in Table 1, with a majority citing cost of treatment (36%) and discontinuation or delay in hormonal therapy (19%). Another 13% stated no perceived barrier to accessing fertility preservation. Eighteen (33%) stated they would accept a consultation with a reproductive endocrinologist for fertility preservation counseling if it was offered. Regret surrounding a past decision to pursue or not pursue fertility treatment is listed in Table 2. The highest regret (score: 36.4) was among those currently undecided about fertility preservation. Although there is an interest in fertility preservation among transgender and gender diverse individuals, over half of our cohort indicated no current interest in fertility.