Aging. Waiting to try to get pregnant can lower the chance of being able to conceive. As you move closer to your 40s, you lose eggs at a faster rate. And the eggs you have are less likely to become fertile.
Try not to work the night shift. Working the night shift all the time might affect your hormone levels. This can raise the risk of not being fertile. If you do work the night shift, try to get enough sleep when you're not working.
Stress isn't likely to keep you from getting pregnant. But stress isn't good for your health. Think about ways to lower stress. Try meditation, deep breathing, yoga or other activities to lower and manage stress when you try to conceive.
Limit or avoid alcohol when trying to conceive. Heavy drinking is linked with an higher risk of problems ovulating. To help when you're trying to get pregnant, stop drinking alcohol. Not drinking is the best choice when you conceive and during pregnancy.
Don't exercise too hard or too long. For people at a healthy weight, too much hard exercise can affect ovulating and lower levels of the hormone progesterone. If you want to become pregnant soon, think about limiting hard exercise, such as running or fast cycling, to less than five hours a week and less than 60 minutes a day.
Avoid toxins. There are many toxins in the environment. These include pesticides, dry-cleaning solvents and lead. They can harm fertility. Be aware of these toxins and discuss ways to limit exposure to them with a member of your healthcare team.
STUDY QUESTION Is there evidence of a plateau in the cumulative live birth rate (cLBR) after a certain number of consecutive transfers of untested embryos? SUMMARY ANSWER In our cohort of 11 463 women, the cLBR continues to increase with each additional transfer of an untested embryo, reaching 68.3% after six blastocyst ...
STUDY QUESTION Can a video clip detailing the patient journey decrease women’s anxiety on the day of their first oocyte retrieval? SUMMARY ANSWER The video clip does not affect women’s anxiety on the day of their first oocyte retrieval. WHAT IS KNOWN ALREADY IVF triggers anxious reactions in women and men, with peaks of ...
STUDY QUESTION Do serum estradiol (E2) levels on the day of frozen blastocyst transfer (FBT) affect pregnancy outcomes in hormonal replacement therapy (HRT) cycles using transdermal estrogens? SUMMARY ANSWER E2 levels ≥313 pg/ml on the day of FBT are associated with increased early miscarriage rates (EMRs), but do not ...
STUDY QUESTION Is semen quality associated with the lifespan of men? SUMMARY ANSWER Men with a total motile sperm count of >120 million could expect to live 2.7 years longer than men with total motile sperm count of >0–5 million. WHAT IS KNOWN ALREADY Male infertility and semen quality have been suggested to be ...
STUDY QUESTION Does the intravenous administration of Atosiban around the time of frozen blastocyst transfer to reduce uterine contractility increase the likelihood of live birth in individuals undergoing ART treatment? SUMMARY ANSWER In individuals with a history of one previous implantation failure, Atosiban did not ...
STUDY QUESTION Does the objective and quantitative assessment of uterine tissue stiffness via ultrasound shear wave elastography (SWE) predict the outcome after single euploid frozen embryo transfer (FET)? SUMMARY ANSWER Uterine SWE data might be predictive of clinical pregnancy in good prognosis patients undergoing single ...
STUDY QUESTION Could real-time monitoring of volatile organic compounds (VOCs) in the embryology laboratory provide meaningful early warning for potential harm from the environment? SUMMARY ANSWER Even in a laboratory environment with a total VOC concentration lower than the recommendation of the Cairo Consensus, the ...
STUDY QUESTION How does two-consecutive single embryo transfer (2xSET) affect reproductive outcomes of IVF and ICSI compared to double embryo transfer (DET)? SUMMARY ANSWER Two-consecutive SET may provide greater or comparable live birth rate (LBR); with lower multiple birth, preterm birth, and pregnancy loss or neonatal ...
STUDY QUESTION Can a large-scale genome-wide association study (GWAS) meta-analysis identify genomic risk loci and likely involved genes for female genital tract (FGT) polyps, provide insights into the biological mechanism underlying their development, and inform of potential overlap with other traits, including ...
STUDY QUESTION How does the burden of somatic disorders compare between women with surgically verified endometriosis diagnosed in adolescence or early adulthood, and matched women without a history of endometriosis? SUMMARY ANSWER Women with endometriosis diagnosed at a young age had a higher incidence of several somatic ...
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Fertility counseling for transgender and gender diverse (TGD) people is a crucial aspect of their healthcare journey, since puberty suppression (PS) induced by a gonadotropin-releasing hormone (GnRH) agonist, gender affirming hormone treatment (GAHT) using testosterone or estrogen and an anti-androgen, and gender affirming surgery (GAS) affect the reproductive function. Fertility counseling can help individuals to make informed decisions about their reproductive goals and options, including options for preserving fertility. By providing comprehensive fertility counseling, healthcare providers can support the reproductive autonomy and overall well-being of TGD people.
The World Professional Association for Transgender Health (WPATH), American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE) and American College of Obstetricians and Gynecologists (ACOG) guidelines all stress the importance of fertility counseling, but lack specific recommendations for healthcare providers (Anderson et al., Citation2020; Coleman et al., Citation2022; Ethics Committee of the American Society for Reproductive Medicine, Citation2021; Silva, Citation2022).
Dr Eliran Mor MDThis editorial aims to provide the most up-to-date guidance based on the latest literature from scientific guidelines (Coleman et al., Citation2022; Ethics Committee of the American Society for Reproductive Medicine, Citation2021; Silva, Citation2022), a recent systematic review (Stolk et al., Citation2023), and acDelphi study of Kolbuck et al. involving 80 experts in reproductive and pediatric transgender health care who consented on what to inform TGD adolescents and young adults concerning fertility (Kolbuck et al., Citation2020).
We consider that fertility counseling is effected by the legal, ethical and cultural background in every country. Therefore this guide has no strict rules or fixed regulations. The recommendations are based on the latest evidence and are a proposal for a counseling framework. The first part focuses on communication, and the second part focuses on the impact of medical transition on fertility and fertility preservation options.
Timing; Offer fertility counseling as early as possible, at least before the start of PS, GAHT or GAS. Continue offering fertility counseling repeatedly over time since reproductive wishes might changes over time. However, it’s important to note that offering fertility counseling should not be pronatalist nor gatekeeping (Chen et al., Citation2019; Light et al., Citation2018; Stolk et al., Citation2023).
Language; Use chosen names and pronouns correctly and consistently. Use gender-neutral, non-binary and gender-sensitive language where appropriate. For example, try to replace semen and oocytes with gametes to make less reference to gendered assumptions about gametes. Make sure to know and understand the basic terms and concepts within TGD communities or ask the patient the (medical) terms they would like to use during the consultation (Armuand et al., Citation2017).
Environment; Provide a safe, non-judgmental and culturally sensitive environment. This may inclue the provision of appropriate information pamphlets, bathrooms, and training of (non)medical staff. In the consultation room make sure that TGD people feel respected and heard and be open to engage in discussion that may cause some discomfort for you as clinician (Ellis et al., Citation2015; Lai et al., Citation2021).
Developmental stages; Assess current fertility knowledge, understanding and ability to consider the future. Provide developmentally appropriate information for adolescents and young adults. Evaluate the adolescent’s ability to consider their future and explore their understanding of the consequences of their decision (Harris et al., Citation2020; Kyweluk et al., Citation2018).
Information; Act as knowledgeable providers of objective information and do not encourage or discourage fertility preservation based on your own assumptions. Make sure that TGD people keep their autonomy and give notice to their own view on parenthood (Armuand et al., Citation2017; Bartholomaeus & Riggs, Citation2020; Kerman et al., Citation2021).
Journey to parenthood; Include the whole journey to parenthood in the conversation. Pay attention to their reproductive capacity, the option to carry a pregnancy, the importance of genetic offspring, and parenting desire and partnering possibilities (i.e. sexual attraction). Identify other parenting options, including choosing not to parent, adoption, fostering, donor gametes or surrogacy, and discuss the legal and financial implications of each option (Boguszewski et al., Citation2022; Chen et al., Citation2019; Lai et al., Citation2021; Stolk et al., Citation2023).
Pregnancy; Oocyte maturation and ovulation is possible during or after testosterone treatment and (un)intended pregnancies may occur. When retaining uterus and ovaries most individuals are physically able to conceive and carry a pregnancy even after long-term testosterone use (Ellis et al., Citation2015; Light et al., Citation2014; Moseson et al., Citation2021). However, testosterone therapy may be contraindicated during pregnancy or while attempting to become pregnant given its potential virilizing effects on the fetus (Muthusamy et al., Citation2010). Therefore, testosterone should be discontinued 3 months before trying to conceive.
Pre-, peri- and postpartal care; Since there is an increased risk of depression and dysphoria during and after pregnancy (Hoffkling et al., Citation2017; van Amesfoort et al., Citation2023), we advise gender-affirming preconception care, prenatal counseling, obstetric care, labor and delivery, chest/breast feeding supportive services and postpartum guidance (Coleman et al., Citation2022).
Retaining ovaries; Studies show mixed results but overall no damage to the ovarian tissue and an active ovarian functioning after long term testosterone treatment. Therefore we suggest it is safe to retain ones ovaries to preserve fertility (Kumar et al., Citation2022).
Timing of oocyte/embryo vitrification; Studies show no difference in outcomes between TGD people who pursued oocyte cryopreservation prior to or after starting testosterone, even after long-term testosterone exposure of more than 10 years (ranging from 10 to 17 years) (Amir, Yaish, Samara, et al., Citation2020; Israeli et al., Citation2022; Leung et al., Citation2019). Therefore, it is mostly a personal choice for people to pursue fertility preservation before or after the start of GAHT. For example, barriers for pursuing fertility preservation after the start of testosterone are temporarily discontinuation of testosterone or the future wish for GAS.
Oocyte/embryo vitrification; Prepare TGD people for internal vaginal examinations (if transrectal or transabdominal ultrasound is not feasible/available), daily hormone (FSH, hMG, GnRHa, r-hCG) injections, resulting in elevated estradiol levels, return of blood loss and the ovarian pick-up method which is transvaginal. The ovarian pick-up can be either with or without sedation depending on the availability of anesthesia. When anesthesia is not available the ovarian pick up might cause severe distress and pain (Asseler et al., Citation2023).
Result of oocyte/embryo vitrification; Discuss the number of retrieved and vitrificated oocytes. In cis women, the oocyte-to-baby rate/live birth rate is around 20 oocytes (Martin et al., Citation2010; Stoop et al., Citation2012). However, this is largely depended on age. A more recent observational study found a similar live birth rate in the group between 6 and 15 oocytes compared to 16–25 (Bahadur et al., Citation2023). So far, this is not studied in TGD people. In a case series of seven TGD people, the live birth rate was 100% with a mean retrieved oocytes of 14.3 ± 6.1 SD (Leung et al., Citation2019). As a consequence, multiple rounds of hyperstimulation are sometimes necessary to obtain the desired amount of oocytes.
Testosterone use; For both oocyte/embryo cryopreservation and pregnancy we suggest a cessation of approximately 3 months (time of full oocyte maturation/taking into account the ∼70 days from antral follicle formation to ovulation) when using testosterone. Though, the optimal wash-out period is unknown, testosterone exposed oocytes from TGD people show an impaired fertilization rate and embryo development (Bailie et al., Citation2023; Lierman et al., Citation2021). However, several cases show successful oocyte vitrification without discontinuation (Cho et al., Citation2020; Gale et al., Citation2021; Greenwald et al., Citation2022; Moravek et al., Citation2023; Stark & Mok-Lin, Citation2022). So, when the dysphoria of cessation testosterone is too much, after shared-decision making and counseling for the unknown effects of testosterone on the oocyte, one can opt for continuing testosterone during ovarian stimulation preferably within a research protocol, until better evidence is provided. Testosterone or other masculinizing hormone therapy should be discontinued prior to and through any pregnancy.
Blood loss; To prevent (potential) distress due to menses during testosterone cessation a progestins or GnRH agonist can be used (Stolk et al., Citation2023). Before ovarian stimulation a menses is not required when a direct embryo transfer into the uterus is not planned (Moravek et al., Citation2023).
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