39 % translyčių vyrų ir nebinarių pranešė apie gailestį dėl vaisingumo sprendimų po dauginimosi organų pašalinimo

Vaisingumo išsaugojimo pasirinkimai ir sprendimo gailestis po lyties patvirtinamosios operacijos translyčių vyrų ar lyčiai nebinarių asmenų tarpe

Apklausos Atitraukimas ir gailestis Chirurgija

Authors: Austin Johnson, Asha B. McClurg, Janine Baldino, Rajeshree Das, Erin T. Carey
Journal: F&S Reports
Year: 2024
Source: https://doi.org/10.1016/j.xfre.2023.12.002

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 iš 112 trans vyrų ir nebinarinių žmonių (51 %), kuriems Šiaurės Karolinos universitete 2014–2023 m. buvo pašalinti reprodukciniai organai, atsakė į apklausą vidutiniškai apie 2,5 metų po operacijos.
Pagal patikrintą gailesčio klausimyną, 39 % gailėjosi dėl sprendimų dėl vaisingumo, priimtų prieš operaciją: 23 % lengvai ir 16 % vidutiniškai ar stipriai (balai iki 85 iš 100).
Medicininiai įrašai parodė, kad kiekvienam buvo suteikti patarimai dėl vaisingumo, tačiau tik 30 % prisiminė, kad jiems buvo pasakyta apie vaisingumą ar šeimos kūrimo būdus.
Įrašai parodė, kad 97 % buvo pasiūlytas vaisingumo specialistas, bet sutiko tik 3 žmonės (5,5 %), ir nė vienas vėliau neužšaldė kiaušialąsčių ar embrionų.
Dažniausia atsisakymo priežastis buvo tuo metu nenorėjimas turėti vaikų (68 %), toliau – planai įvaikinti, nerimas dėl testosterono nutraukimo ir baimė, kad nėštumas pablogins lyties distresą.
Gailestis buvo daug didesnis tarp žmonių, kurie manė, kad patarimai apie poveikį vaisingumui buvo prasti (tipinis balas 50 palyginti su 0), ir šiek tiek didesnis tarp manančių, kad patarimai dėl vaisingumo galimybių buvo prasti (12,5 palyginti su 0).
Daugiau žmonių apklausos metu vaikų ar šeimos ateityje turėjimą įvertino kaip svarbų nei prieš operaciją, o tai rodo, kad požiūriai po operacijos gali keistis.

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.)

Methodological limitations

Only half replied: Only 51% (57 of 112) answered, and those who did had more recent surgery than those who didn't (about 2 vs 4 years). So the regret figure could be too high or too low.
Short follow-up: Surgery was on average 2.5 years earlier (from 50 days to 6.7 years). Regret about fertility often appears later (up to about 10 years in studies of cancer patients), so regret is probably undercounted, as the authors admit.
Memory of past events: People were asked years later about the advice they got and their earlier feelings about children, so memories may be wrong. The big gap between advice recorded (100%) and advice remembered (30%) shows this.
Questions contradict each other: 84% said effects on fertility were discussed well enough, yet only 30% remembered getting fertility advice. This suggests problems with how the researchers' own untested questions were worded.
Small numbers: With 57 people (and 22 with any regret), the figures are imprecise, and the links found came from several simple tests that did not account for other factors.
One clinic only: Everyone came from one US university gynaecology service with a set routine for fertility advice. Results may differ where less advice is given.
Measured regret about fertility, not surgery: The questionnaire asked about regret over fertility choices, not about the surgery or transition. So the 39% figure should not be quoted as a surgery regret rate.
No before-surgery measure: Regret was measured only once, so changes in wanting children could not be tracked over time.

detrans.ai

Summary

Key findings

Abstract

Conclusion