1) The study compared IVF outcomes between female-to-male transgender patients and cisgender patients matched for age, BMI, and AMH. 2) It found that transgender patients had a higher number of oocytes retrieved compared to cisgender patients, though they required a higher gonadotropin dose. 3) Among transgender patients who underwent embryo transfer, all achieved pregnancy and most had live births, providing support for fertility preservation and family building options for these patients.

1. RESEARCH SEMINAR:
Assisted Reproductive Technology Outcomes in
Female-to-Male Transgender Patients Compared
with Cisgender Patients: A New Frontier in
Reproductive Medicine
(leung et al., 2019) By
M.Vharshini
M.Sc. Clinical Embryology & PG

2. Research Paper for the Presentation
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3. Contents
 Introduction
 Objectives of the study
 Study design
 Methodology
 Outcomes and Statistics
 Results
 Conclusion
 Critical Appraisal
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4. Introduction
 Previous assumptions of transgender individuals not interested in maintaining their reproductive potential.
 ASRM, ESHRE and the World Professional Association For Transgender Health (WPATH) strongly recommended
offering fertility preservation for all the patients before initiating gender affirming hormone therapy or sterilizing
surgeries.
 A retrospective study found very low rate of utilization of fertility preservation services (Nahata et. al.,2017). This
may be due to
 Lack of prioritization of fertility preservation
 IVF treatment procedures seemed emotionally and psychologically traumatizing
 Interest in adoption
 No anticipation in having biological children.
 Recent studies have demonstrated the increasing interest in parenthood among these patients, however there is
a knowledge gap on the optimal way to provide effective care to these patients and their response.
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5. Objectives of the study
1. Examine IVF outcomes in a female-to-male transgender (also referred to as
transgender male) cohort.
2. Compare the results with matched cisgender cohort.
HYPOTHESIS:
“The subset of transgender patients who had testosterone therapy would have poorer
egg yields compared with the matched cisgender patients”
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6. Study Design
 Matched retrospective cohort study.
 Ethical Approval: Approved by the Institutional Review Board of the private medical centre.
 Transgender Male Patients: Female-to-male transgender patients (n = 53) who sought care
from 2010 to 2018. Out of this 26 patients who completed treatment were included.
 Oocyte Cryopreservation (n = 16)
 Embryo Cryopreservation (n = 3)
 Embryo Transfer (n = 7)
 Cisgender Patients: A cohort of cisgender patients (n = 130) with male-factor (80%) or tubal-
factor (20%) infertility, undergoing IVF treatment at the same time period was chosen for
comparison.
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7. Study Design
 Inclusion Criteria: Transgender males who have completed ovarian stimulation cycle
with successful oocyte retrieval. Only first ovarian stimulation cycles were used for
comparison.
 Exclusion Criteria: No exclusion in transgender patients. Cisgender patients with
ovulatory dysfunction such as polycystic ovary syndrome (PCOS).
 Matching Procedure: Cisgender patients were matched with transgender male patients
according to
 Age
 BMI by obesity class categories
 AMH
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8. Methodology
Transgender male
patients (n=26)
Cisgender patients
(n=130)
Ovarian Stimulation:
GnRH Antagonist cycle
with adjusted
gonadotrophin dose
Oocyte Retrieval
Conventional
IVF/ICSI
Oocyte
Cryopreservation
Embryo Transfer
Embryo
Cryopreservation
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9. Outcomes and Statistics
 Primary Outcome: Number of oocytes retrieved.
 Secondary Outcomes: Number of mature oocytes, total gonadotropin dose and
peak E2 levels.
 Pregnancy outcomes were described in transgender cohort but not compared.
STATISTICS:
 Transgender patient characteristics & cycle characteristics: Descriptive statistics.
 Matching Analysis: Student t test, with p values < .05 defined as significant.
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10. Results
Patient Variable
All Patients
(n = 26)
Oocyte
cryopreservation
(n = 16)
Embryo
cryopreservation
(n = 3)
IVF with
Transfer
(n = 7)
Age (years) 28.3 ± 6.7 25.3 ± 6.2 35.6 ± 3.5 32.06 ± 4.2
BMI (Kg/m2) 26.0 ± 7.0 24.7 ± 7.3 29.4 ± 6.8 27.7 ± 6.4
AMH (ng/mL) 3.4 ± 1.9 3.6 ± 2.2 3.1 ± 1.4 2.7 ± 1.5
Initiated androgen therapy
(%)
61.5 43.8 100 85.7
Time on testosterone
(mo)
43.9 ± 31.0 39.7 ± 19.2 126 ± 110.3 48.0 ± 52.3
Time off testosterone
(mo)
4.5 ± 3.5 4.4 ± 3.7 4.0 ± 2.6 5.0 ± 4.3
Resumed menses (%) 81.2 85.7 100 66.7
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Table 1: Patient characteristics of transgender males undergoing COH
The data were expressed as mean±S.D. or %

11. Results
Patient Variable
All Patients
(n = 26)
Oocyte
cryopreservation
(n = 16)
Embryo
cryopreservation
(n = 3)
IVF with Embryo
Transfer
(n = 7)
Oocytes retrieved (n) 19.4 ± 8.4 22.7 ± 8.4 15.6 ± 7.3 14.3 ± 6.1
Mature oocytes (n) 75.4 ± 20.7 75.4 ± 22.5 59.0 ± 8.8 88.0 ± 11.7
Oocytes frozen (n) _ 17.7 ± 6.1 _ _
Embryos frozen (n) 4.2 ± 0.6 _ 3.8 ± 4.2 4.7 ± 1.4
Embryos transferred
(n)
_ _ _ 1.3 ± 0.8
Pregnancy rate (%) _ _ _ 83.3
Live birth rate (%) _ _ _ 59.3
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Table 2: IVF cycle characteristics of transgender male patients undergoing COH
 Among 7 planned IVF
transfers, five underwent
reciprocal IVF.
 All seven patients with
embryo transfer had
successful pregnancy
outcomes and delivery.
The data were expressed as mean±S.D. or %

12. Results
Variable
Cisgender
(n = 130)
Transgender male
(n = 26)
P value
Age (years) 30.4 ± 3.8 28.3 ± 6.7 .12
AMH (ng/mL) 4.0 ± 3.7 3.4 ± 1.9 .22
BMI (Kg/m2) 26.2 ± 6.6 26.0 ± 7.0 .90
Oocytes retrieved (n) 15.9 ± 9.6 19.9 ± 8.7 .04
Mature oocytes (%) 82.1 ± 17.1 78.3 ± 20.3 .38
Peak E2 level (pg/mL) 2715.9 ± 1515.2 2755.5 ± 1297.7 .89
Total gonadotropin dose (IU) 2599.1 ± 1313.6 3891.8 ± 1577.6 <.001
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Table 3: Comparison of cisgender and transgender ovarian stimulation cycles

13. Results
Variable
Cisgender
(n = 130)
Transgender male
(n = 26)
P value
Oocytes retrieved (n) 14.4± 8.9 18.6 ± 9.3 .11
Mature oocytes (%) 84.4± 16.1 77.0± 23.3 .24
Peak E2 level (pg/mL) 2713.2 ± 1487.4 2943.1 ± 1364.7 .55
Total gonadotropin dose (IU) 2707.0 ± 1452.1 4155.5 ± 1507.6 .002
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Table 4: Comparison of transgender patients with androgen exposure and matched cisgender cycles

14. Conclusion
 The study demonstrated that female-to-male transgender patients respond better to
the ovarian stimulation when compared to cisgender patients.
 The preliminary findings showed high rate of success in pregnancy among patients
with embryo transfer.
 This provides a supportive evidence for counselling these patients for fertility
preservation or family building.
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15. Critical Appraisal
 This study provides new insights on the fertility outcomes in the marginalized patient
population.
 The study found the stated hypothesis not true, as the egg yields were high in the
transgender patients whom have started or undergone testosterone treatment.
 Statistically not powerful due small sample size and only stimulation outcomes were
compared.
 The data provide by the study showed the oocyte yield is higher in transgender
patients which justifies the author’s conclusion.
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16. Critical Appraisal
Strengths:
 First study to describe transgender cycle parameters and outcomes in detail.
Analysis of transgender patients with previous androgen exposure to asses their
effects on ovarian outcomes.
Limitations
Retrospective study
Selection of cisgender patients with infertility as comparison group (Selection bias)
Testosterone levels were not measured in all the transgender patients in the study.
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17. Thank You