Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey

  • Amy C. TishelmanEmail author
  • Megan E. Sutter
  • Diane Chen
  • Amani Sampson
  • Leena Nahata
  • Victoria D. Kolbuck
  • Gwendolyn P. Quinn
Fertility Preservation



To examine provider perceptions of practice behaviors and barriers related to fertility counseling, fertility preservation, and family building among transgender patients.


Participants were medical and mental health professionals who treat adult and youth transgender patients. Recruitment occurred online and in person, via professional listservs for transgender professionals, conferences, and gender clinics. From August–November 2017, 110 participants representing nine countries responded to four open-ended questions included on a survey related to provider practice behaviors and perceived barriers to fertility counseling, fertility preservation, and family building with transgender patients. Thematic coding analysis was used to identify themes.


Multiple themes were identified including the following: access and cost issues; urgency for gender-affirming treatment; patient maturity and inability to make future-oriented decisions; and provider-related challenges pertaining to knowledge, role, and general lack of information in the nascent field of transgender reproductive health.


This study yielded insights into practice behaviors, challenges, and perceived barriers to fertility counseling with transgender individuals and can serve as a basis for intervention development to optimize clinical practices with this population.


Transgender Fertility preservation Fertility counseling Gender-affirming hormones Reproductive health Qualitative research 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study was deemed exempt.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of Endocrinology and PsychiatryBoston Children’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of Health Outcomes and BehaviorMoffitt Cancer CenterTampaUSA
  4. 4.Division of Adolescent MedicineAnn and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  5. 5.Department of Child and Adolescent PsychiatryAnn and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  6. 6.Departments of Psychiatry and Behavioral Sciences, and PediatricsNorthwestern University Feinberg School of MedicineChicagoUSA
  7. 7.Departments of OB-GYN and Population HealthNew York University School of MedicineNew YorkUSA
  8. 8.Division of Endocrinology and Center for Biobehavioral HealthNationwide Children’s HospitalColumbusUSA
  9. 9.The Ohio State University College of MedicineColumbusUSA

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