Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons

Austin Johnson; Asha B McClurg; Janine Baldino; Rajeshree Das; Erin T Carey

doi:10.1016/j.xfre.2023.12.002

Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons

F S Rep. 2023 Dec 15;5(1):87-94. doi: 10.1016/j.xfre.2023.12.002. eCollection 2024 Mar.

Authors

Austin Johnson¹, Asha B McClurg², Janine Baldino², Rajeshree Das³, Erin T Carey²

Affiliations

¹ Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
² Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Abstract

Objective: To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs.

Design: Cross-sectional.

Setting: University-based pratice.

Patients: A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division.

Intervention: Survey or questionnaire.

Main outcome measures: The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment.

Results: The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion.

Conclusions: Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.

Keywords: Transgender; decisional regret; fertility preservation; gender nonbinary.