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

• 2014年から2023年にノースカロライナ大学で生殖器官を摘出したトランス男性とノンバイナリーの人112人のうち、57人（51%）が、平均して手術の約2.5年後に調査に回答しました。
• 検証された後悔の質問票で、39%が手術前に行った妊孕性に関する選択について後悔を持っていました。軽度が23%、中等度から重度が16%でした（スコアは100点中最大85点）。
• 診療記録では、全員が妊孕性に関する助言を受けていましたが、妊孕性や家族を持つ方法について説明を受けたことを覚えていたのは30%だけでした。
• 記録では97%が不妊の専門医を紹介されましたが、受け入れたのは3人（5.5%）だけで、卵子や胚を凍結した人はいませんでした。
• 断った最も多い理由は、当時は子どもを望んでいなかったこと（68%）で、次いで養子縁組の計画、テストステロンをやめることへの不安、妊娠が性別への苦痛を悪化させることへの恐れでした。
• 後悔は、妊孕性への影響についての助言が不十分だったと感じた人でははるかに高く（典型的なスコアが50対0）、妊孕性の選択肢についての助言が不十分だったと感じた人でもやや高くなっていました（12.5対0）。
• 調査時点では、将来子どもや家族を持つことを重要だと評価した人が、手術前よりも多くなっており、手術後に考えが変わりうることを示唆しています。

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.)