![]() In the case of prepubertal children, although no longer technically experimental, gonadal tissue cryopreservation remains a difficult decision to make. Additional methods that are also suitable for patients that cannot be recipients of the ovarian tissue transplant, due to risk of reintroducing malignant cells in case of cancer, or because the transplant is undesirable, such as the use of laboratory methods for culture of gametes aiming at in vitro maturing gamete cells up to maturation, are under development (Practice Committee of the American Society for Reproductive Medicine, 2019 Telfer & Andersen, 2021 Wyns et al., 2020). Indeed, future re-transplantation of gonadal tissue aiming at obtaining fully functional gametes is the standard utilization of the cryopreserved tissue. However, the future use in several patient populations is quite challenging and thus is still considered experimental in some settings. Recently, the cryopreservation of mature (postpubertal) ovarian tissue has also become a straightforward technique and is no longer considered experimental (Practice Committee of the American Society for Reproductive Medicine, 2019). The use of embryos, mature oocytes and sperm have all proven to be efficacious when used in assisted reproductive treatments (ART). Most of the reported data on FP in young patients and children have been provided by programs developed for patients with cancer undergoing gonadotoxic therapies, but the number of indications to preserve fertility have rapidly increased over the years, including also benign diseases and genetic conditions (Rodriguez-Wallberg et al., 2019a). Research protocols for ovarian and testicular tissue cryopreservation have also been developed at some centers and these methods can be also applied in children (Borgström et al., 2020 Nahata et al., 2019 Rodriguez-Wallberg et al., 2019a, 2019b). These methods may be also applicable to post-pubertal adolescents (Nahata et al., 2019 Rodriguez-Wallberg et al., 2019a). The most used and available at nearly all reproductive medicine clinics worldwide include the cryopreservation of embryos, oocytes, and sperm, which can be offered to adult patients. For individuals facing treatments that can affect their fertility potential several options for fertility preservation (FP) have been developed. ![]() It is therefore highly recommended to discuss the risk of infertility inherent to these interventions, as clearly stated in the current guidelines for gender-affirming medical treatment from the World Professional Association for Transgender Health (WPATH) (Coleman et al., 2012) and the Endocrine Society (Hembree et al., 2017). Gender affirming hormone treatments and surgical interventions provided to transgender and gender diverse people to align their bodies with their gender identity may limit or alter future reproductive options to varying degrees. ![]() Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. ![]() Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. ![]()
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