Sperm Trans

Sperm Trans
Our team is actively reviewing the recent Roe v. Wade rulings and its implications. Our patients are our top priority - we will always ensure that you and your family always get the care you need. Your CCRM care team will keep you informed about any potential impacts to your treatment as we learn more.
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© 2021 CCRM Fertility. All Rights Reserved.

© 2022. CCRM Fertility. All Rights Reserved.

© 2022. CCRM Fertility. All Rights Reserved.

In order for fertilization to occur, sperm must successfully travel from the testes to the urethra through a series of tubes or ducts, the most important of which is the vas deferens. Some men have damage to their sperm ducts or are missing the ducts altogether, which can prevent conception from occurring. This is called obstruction. When there is no sperm in the ejaculated fluid, this is called azoospermia.
There are three main causes of sperm transportation (obstruction) issues: congenital disorders, surgical obstruction and acquired obstruction from infections or diseases.
There are certain conditions that are present at birth, which are known as congenital disorders. Examples of congenital disorders that can impact male fertility include:
When an obstruction or blockage occurs, it blocks sperm transportation to the urethra. Obstructions can occur from accidents or surgery (such as a vasectomy) and result in lowered sperm count or the absence of sperm altogether (azoospermia). The most common example of this is men who have a had a surgical procedure called a vasectomy where the vas deferens is cut or ligated for contraception.
Acquired disorders are caused by an infection or a disease of the male reproductive system. The disease/infection can lead to scarring, which can impact sperm transportation. If left untreated, sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, can lead to scarring and blockage of the ducts and other reproductive structures.
Most men do not have symptoms when there are sperm transportation problems. In some instances, the volume of semen ejaculated when there is a blockage may be less. Rarely men may have swelling in the testicular or scrotal areas.
Some obstructions that cause sperm transportation issues and affect male fertility can be treated with urologic surgery. In some instances relief of the obstruction is not possible, such as when there is a complete absence of the vas deferens congenitally. In this instance, there are surgical retrieval methods which can be used to retrieve the sperm directly from the testicle prior to in vitro fertilization (IVF). During IVF, the sperm fertilizes the egg(s) in a lab and the embryo is transferred back into the uterus.
If a man has had a vasectomy, a vasectomy reversal or sperm retrieval prior to IVF, are two fertility treatment options.

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Affiliations

1 Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.

2 Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden.

3 Department of Medicine/Huddinge, Karolinska Institutet and ANOVA Andrology, Sexual Medicine, Trans Medicine Karolinska University Hospital, Stockholm, Sweden.

4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Kenny A Rodriguez-Wallberg et al.

Andrology .

2021 Nov .

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Affiliations

1 Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.

2 Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska, University Hospital, Stockholm, Sweden.

3 Department of Medicine/Huddinge, Karolinska Institutet and ANOVA Andrology, Sexual Medicine, Trans Medicine Karolinska University Hospital, Stockholm, Sweden.

4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

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Reprod Biomed Online. 2021 Aug;43(2):339-345. doi: 10.1016/j.rbmo.2021.04.016. Epub 2021 Apr 30.
Reprod Biomed Online. 2021.

PMID: 34144898

Baram S, Myers SA, Yee S, Librach CL.
Baram S, et al.
Hum Reprod Update. 2019 Nov 5;25(6):694-716. doi: 10.1093/humupd/dmz026.
Hum Reprod Update. 2019.

PMID: 31633751

Li K, Rodriguez D, Gabrielsen JS, Centola GM, Tanrikut C.
Li K, et al.
Andrology. 2018 Nov;6(6):860-864. doi: 10.1111/andr.12527. Epub 2018 Aug 9.
Andrology. 2018.

PMID: 30094956
Free PMC article.

Liu W, Schulster ML, Alukal JP, Najari BB.
Liu W, et al.
Urol Clin North Am. 2019 Nov;46(4):487-493. doi: 10.1016/j.ucl.2019.07.003. Epub 2019 Aug 16.
Urol Clin North Am. 2019.

PMID: 31582023

Review.

Pirtea P, Ayoubi JM, Desmedt S, T'Sjoen G.
Pirtea P, et al.
Fertil Steril. 2021 Oct;116(4):936-942. doi: 10.1016/j.fertnstert.2021.07.1206. Epub 2021 Sep 2.
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Mattelin E, Strandell A, Bryman I.
Mattelin E, et al.
Hum Reprod Open. 2022 Feb 21;2022(2):hoac008. doi: 10.1093/hropen/hoac008. eCollection 2022.
Hum Reprod Open. 2022.

PMID: 35309678
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Background:

Due to recent changes in the legal framework, access to fertility preservation (FP) for transgender individuals has opened up in several countries. In Sweden and the Nordic countries, fertility preservation for medical reasons is fully reimbursed as part of the established tax-funded healthcare services. As this issue is relatively new, procedures for FP have seldom been reported in the transgender patient population. The very limited literature has indicated that transgender women may have poorer sperm quality than cisgender men when assessing samples aimed at semen banking.

Objectives:

To assess sperm quality parameters of semen samples provided for FP by transgender women before or after gender affirming hormone therapy (GAHT), and to compare sperm quality with a reference population of unscreened men defined by the World Health Organization (WHO). Additionally, we aimed to describe referral patterns over calendar time and estimate time from referral to semen cryopreservation.

Material and methods:

Prospective cohort study of 212 transgender women referred for FP to the Reproductive Medicine Clinic of Karolinska University Hospital, Sweden, between 2013 and 2018. Among 177 individuals that provided semen samples for cryopreservation, 16 had previously received GAHT.

Results:

Individuals with previous GAHT presented with significantly lower total sperm count than individuals without GAHT (p = 0.002). However, higher proportions of sperm abnormalities were also noted among individuals who had not undergone previous GAHT, compared to the WHO reference population (p < 0.001). Referrals of transgender women for FP increased over time. The median time from referral to semen cryopreservation was 27 days.

Conclusions:

A high occurrence of sperm abnormalities was found in transgender women, especially among individuals who had previously received GAHT. The results underline the importance of thoroughly discussing parenthood options and FP with patients early after diagnosis and referring the patients for semen banking preferably before starting GAHT.

Keywords:

fertility preservation; gender affirming hormone therapy; gender dysphoria; semen sample; sperm quality; transgender women.

© 2021 The Authors. Andrology published by Wiley Periodicals LLC on behalf of American Society of Andrology and European Academy of Andrology.

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2 semen analyses 1 STI Test Kit 5-year cryostorage
3 semen analyses 1 DNA fragmentation analysis 1 STI Test Kit Lifetime cryostorage
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Intrauterine insemination (IUI) : IUI is a process in which a sperm sample, produced via masturbation, is injected through the cervix directly into the uterus at the time of ovulation. Before IUI, the sperm are “washed” to isolate them from the seminal fluid; this step along with giving sperm a “head start” on the fertilization process increases the monthly chance of pregnancy, especially for patients with lower sperm quality. In vitro fertilization (IVF) : During IVF, egg(s) are retrieved directly from the uterus and fertilized in a lab. The female-bodied partner or egg donor will typically be prescribed hormone medications to prompt their body to produce multiple eggs in one menstrual cycle, increasing the chances that one or more will be healthy and fertilize. The fertilized eggs are monitored as they develop for 3–6 days and then 1–2 are placed into the uterus of a parent or surrogate, where they will hopefully implant and result in pregnancy. Intracytoplasmic sperm injection (ICSI) : In traditional IVF, the egg and sperm are combined in a lab dish to encourage fertilization. During ICSI, a single sperm is instead injected directly into the egg. This is a helpful procedure for those with severe male-factor infertility such as very low sperm count, motility, or morphology Traditional surrogacy : Traditional surrogacy is an arrangement in which the surrogate or “carrier” (the person who carries a pregnancy on behalf of the intended parents) is also the biological parent of the baby, and no egg donor is required. While this arrangement involves fewer expenses than gestational surrogacy (see below), in part because you can use IUI instead of IVF, it’s also more legally complicated Gestational surrogacy : During gestational surrogacy, the surrogate or gestational carrier is not genetically related to the baby — the pregnancy is created via IVF with an egg from an intended parent or an egg donor, and sperm from an intended parent or sperm donor.
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