# Ovarian response and outcomes of in vitro fertilization cycles in transgender men: Report of three cases with a live birth

## TL;DR

This paper reports on three transgender men who successfully underwent IVF, resulting in a live birth, despite long-term testosterone use.

## Contribution

The study demonstrates the feasibility of IVF in transgender men after prolonged testosterone use, contributing to reproductive medicine knowledge.

## Key findings

- Three trans men produced high-quality blastocysts after pausing testosterone therapy.
- One live birth resulted from frozen embryo transfer in a cisgender female partner.
- Ovarian stimulation was successful despite a lower-than-expected response.

## Abstract

In vitro fertilization (IVF) treatments have broadened to cover
a variety of scenarios, including those involving transgender individuals or
couples who wish to become parents, posing new challenges for the field of
reproductive medicine. While there are limited reports of successful IVF births
involving transgender men, concerns remain regarding the impact of long-term
testosterone use on ovarian function, oocyte and embryo quality and IVF
reproductive outcomes. This study details a case series of three trans men and
cis women couples at a fertility clinic, resulting in one live birth. The
couples underwent IVF with frozen blastocyst-stage embryos transferred to the
cis women partners. The trans men, aged 32, 35, and 38, received ovarian
stimulation with gonadotropins and dydrogesterone for pituitary suppression, and
a GnRH agonist for final oocyte maturation. All had been on 250 mg of
testosterone and paused treatment to resume menstrual cycles before IVF. Eggs
were fertilized with donor sperm, and despite a lower-than-expected response to
stimulation after short-term testosterone discontinuation, high-quality
blastocysts were produced, leading to two pregnancies. Given the uncertainty
regarding the long-term effects of testosterone on overall fertility, patients
should be advised to consider cryopreservation before starting gender-affirming
hormone therapy. Our case reports contribute to the knowledge in this area,
highlighting the feasibility of oocyte collection, embryo development,
pregnancies, and births in these individuals even after prolonged use of
testosterone.