Summary

Surgeons at the University of North Carolina surveyed trans men and nonbinary people who had their womb and/or ovaries removed. They asked about regret over the fertility decisions made before surgery, not regret about the surgery itself. Of 57 people who replied, about 2.5 years after surgery, 39% had at least mild regret and 16% moderate to severe regret. Nearly everyone had turned down seeing a fertility specialist, most often because they did not want children at the time, and no one froze eggs or embryos. Records said all had been given fertility advice, but only 30% remembered it, and those who felt the advice was poor had more regret. More people rated having a family in future as important after surgery than before. With only half replying, one clinic and short follow-up, the true level of regret is uncertain and could be higher or lower.

Key findings

• 57 نفر از 112 مرد ترنس و فرد غیرباینری (51%) که در دانشگاه کارولینای شمالی در 2014 تا 2023 اندام‌های تولیدمثلشان را برداشتند به نظرسنجی پاسخ دادند، به‌طور میانگین حدود 2.5 سال پس از جراحی.
• در پرسشنامهٔ آزموده‌شدهٔ پشیمانی، 39% دربارهٔ انتخاب‌های باروری پیش از جراحی پشیمانی داشتند: 23% خفیف و 16% متوسط تا شدید (نمرات تا 85 از 100).
• پرونده‌های پزشکی نشان داد به همه مشاورهٔ باروری داده شده بود، اما فقط 30% به یاد داشتند دربارهٔ باروری یا راه‌های داشتن خانواده به آن‌ها گفته شده است.
• پرونده‌ها نشان داد به 97% متخصص باروری پیشنهاد شد، اما فقط 3 نفر (5.5%) پذیرفتند، و هیچ‌کدام تخمک یا جنین منجمد نکردند.
• رایج‌ترین دلیل نه گفتن نخواستن فرزند در آن زمان بود (68%)، و پس از آن برنامهٔ فرزندخواندگی، نگرانی از قطع تستوسترون، و ترس از اینکه بارداری ناراحتی جنسیتی را بدتر کند.
• پشیمانی در کسانی که مشاوره دربارهٔ اثرات بر باروری را ضعیف می‌دانستند بسیار بیشتر بود (نمره معمول 50 در برابر 0)، و در کسانی که مشاوره دربارهٔ گزینه‌های باروری را ضعیف می‌دانستند تا حدی بیشتر بود (12.5 در برابر 0).
• افراد بیشتری داشتن فرزند یا خانواده در آینده را در زمان نظرسنجی مهم ارزیابی کردند تا پیش از جراحی، که نشان می‌دهد دیدگاه‌ها پس از جراحی ممکن است تغییر کند.

Abstract

OBJECTIVE: To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs.

DESIGN: Cross-sectional.

SETTING: University-based pratice.

PATIENTS: A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division.

INTERVENTION: Survey or questionnaire.

MAIN OUTCOME MEASURES: The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment.

RESULTS: The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion.

CONCLUSIONS: Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.

Conclusion

Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret. (Full text adds that care should include equitable access to family-building options in the context of decreasing access to gender-affirming care.)