Fertility Preservation For Transgender Pediatric Patients at UPMC Children’s

November 25, 2020

UPMC is a leading clinical and research center for fertility preservation technologies and protocols and assistive reproduction techniques. UPMC provides the most comprehensive range of fertility preservation options available anywhere in the country, including both standard of care and experimental options.

Fertility preservation options extend to pediatric patients, both male and female, for a variety of indications. The program has provided national and international leadership by offering experimental testicular and ovarian tissue freezing for children — specifically, those children with a clinical cancer diagnosis whose chemotherapy or radiation treatments put them at significant risk for future infertility as a consequence of gonadotoxic therapies.

UPMC Children’s Hospital of Pittsburgh, in collaboration with the Center for Fertility and Reproductive Endocrinology at UPMC Magee-Women’s Hospital and the Fertility Preservation Program of Pittsburgh of UPMC (directed by Kyle Orwig, PhD, professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UPMC Magee), has been offering these therapies to children and their families for the last decade.

More recently, IRB-approved experimental protocols and related research have commenced applying fertility preservation techniques to transgender male and female patients. UPMC's fertility preservation protocols for transgender pediatric patients are one of only a few in the world at present, with experimental protocols for harvesting and banking tissue from both pre-and peripubertal individuals.

Glenn M. Cannon, MD, chief of the Division of Pediatric Urology at UPMC Children’s has collaborated on the first few cases of transgender individuals to take part in the experimental protocols, and he has worked extensively on the protocols for pediatric cancer patients that have been in place for several years.

"For individuals that have reached puberty and can produce sperm, the process is fairly straightforward in obtaining semen samples for cryopreservation. It is best to obtain testicular tissue before individuals undergo estrogen therapy, as this has been shown to be highly detrimental to spermatogenesis, much like chemotherapy or radiation can be for our cancer patients. For prepubertal transgender girls, since they are too young to produce sperm, our protocols can extract spermatogonial stem cells for cryopreservation with the hope that in the future, technologies will be available for these individuals to use their frozen tissues to restore their fertility. Because those technologies do not exist yet, this work is aspirational, but it is the same as with our prepubertal cancer patients who bank tissues. We are preserving the potential for future fertility," says Dr. Cannon.

Peripubertal or adolescent transgender youth initiating gender-affirming hormone treatment may experience impairment of gonadal function, which can lead to infertility. Fertility preservation options are available that may preserve the chance to have a biological child in the future. Through the UPMC Center for Reproduction and Transplantation at Magee-Womens Hospital, the Fertility Preservation Program in Pittsburgh provides the following fertility care services for transgender children and adolescents: 

  • Semen cryopreservation
  • Oocyte cryopreservation
  • Testicular tissue freezing (with approval of the Institutional Review Board of the University of Pittsburgh)
  • Ovarian tissue freezing (with approval of the Institutional Review Board of the University of Pittsburgh)

For additional information or to refer a patient, please call 412-641-7475 or send an email to fertilitypreservation@upmc.edu.