New guidelines on fertility preservation also address transfolk

NEW guidelines on fertility preservation for people assigned female at birth have been published by the British Fertility Society (BFS).

Fertility preservation is a rapidly growing specialty and the BFS is keen that the very latest tools, techniques and opinions are considered when discussing future fertility with patients. The new guideline brings together available evidence for fertility preservation undertaken for medical reasons for both oncological and non-oncological causes, including treatments used for transfolk and patients affected by genetic, congenital and other conditions.

Among the techniques considered in the guideline are embryo and oocyte cryopreservation, ovarian tissue cryopreservation, GnRH agonist suppression and ovarian transposition.

Professor Adam Balen, Chair, British Fertility Society said "There are a number of situations where the preservation of fertility is needed. This has to happen at a time before a person is ready to start a family and can sometimes be the only hope for becoming a parent in the future. Our guidelines are designed to help our members and the wider fertility community to decide on the best course of treatment, in consultation with these patients."

Dr Melanie Davies, University College London Hospitals, an author on the guideline paper, published in the BFS journal, Human Fertility, said: “Embryo preservation is the most established technique but it isn’t suitable for people who don’t have the sperm of a partner to fertilise eggs or are as yet unsure about committing to having a child with their partner.

“It is far more common now to freeze unfertilised eggs, and this is now considered an established method of fertility preservation. But there are also promising experimental approaches coming to the fore. For example, a person can now have part of an ovary frozen that can later be transplanted back into their body. This may be a particularly suitable technique for patients who have not yet reached puberty or where there is not enough time to undergo ovarian stimulation and egg freezing. The birth rates following this new technique are looking good and we hope that soon it will be available nationwide.”

Women undergoing cancer treatment can be rendered infertile due to the damaging effects of chemotherapy drugs or the directed action of radiation treatment for pelvic and abdominal cancers. The BFS points out that people are now increasingly waiting until their 30s or 40s to start a family which means that the likelihood of a person having not given birth prior to cancer treatment is ever higher. Discussion of fertility preservation should happen as early as possible in the cancer treatment pathway to ensure such treatment is not delayed.

There are also a number of other conditions that lead to infertility, such as Turner Syndrome. The BFS Society is finding that mothers of children with Turner Syndrome are prepared to donate and freeze their own eggs so that their daughter has an opportunity to become pregnant, if and when the time is right for her.

People diagnosed with gender dysphoria who undergo medical interventions, such as hormone treatment and surgery, may also suffer reduced or lost fertility. Freezing eggs, embryos, or ovarian tissue allows the possibility of transfolk to have a child who is biologically related to them, through pregnancy or surrogacy.

Dr James Barrett, a clinician at the Gender Identity Clinic at Charing Cross Hospital, said "The number of people coming forward with gender dysphoria has increased rapidly over the past decade. But the consistent provision of NHS funding for fertility preservation for this group has yet to catch up. My clinic sees around half of the patients being referred for difficulties with gender identity in the UK and although we do discuss future fertility with them, they are not always able to self-fund for the necessary procedures and ongoing storage of material. Infertility is a real disease and it is hugely frustrating that the whole NHS is not always able to help our patients with that part of their lives."

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