Desire for children and fertility preservation in transgender and gender-diverse people: A systematic review

The decision to pursue one's desire for children is a basic human right. For transgender and gender-diverse (TGD) people, gender-affirming care may alter the possibilities to fulfill one's desire for children due to the impact of this treatment on their reproductive organs. We systematically included 76 studies of varying quality describing the desire for children and parenthood; fertility counseling and utilization; and fertility preservation options and outcomes in TGD people. The majority of TGD people expressed a desire for children. Fertility preservation utilization rates were low as there are many barriers to pursue fertility preservation. The most utilized fertility preservation strategies include oocyte vitrification and sperm banking through masturbation. Oocyte vitrification showed successful outcomes, even after testosterone cessation. Sperm analyses when banking sperm showed a lower quality compared to cis male samples even prior to gender-affirming hormone treatment and an uncertain recovery of spermatogenesis after discontinuing treatment. •Transgender and gender diverse (TGD) people may have a (future) desire for children, biologically or otherwise.•All TGD people should receive fertility counseling prior to puberty suppression and gender affirming treatment.•Oocyte vitrification outcomes in TGD people are comparable to cis population, even with prior testosterone use.•Semen preservation before gender affirming hormone treatment is strongly recommended.•TGD people’s journey to parenthood is related to their mental reproductive capacity, sexual attraction and gametes.