Clinical Case Database / Category: Patient Management

Assisted Reproduction In Unusual Circumstances

Publication details

Andrew Knox, ST7, O&G, Neil McClure
Foundation Years Journal, volume 8, issue 9, p.6 (123Doc Education, London, October 2014)


This case highlights the unusual but real clinical and ethical dilemmas faced by both patients and clinicians involved in the treatment of a transgender couple wishing to conceive prior to sex reassignment surgery. We discuss the effects on fertility of taking exogenous sex steroids, the strategies available for conception and the role of the regulatory body the Human Fertilisation and Embryology Authority in maintaining ethical and legal standards.

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Andrew Knox, ST7, O&G

Belfast Health and Social Care Trust
Royal Jubilee Maternity Hospital
Grosvenor Road, Belfast, BT12 6DP

Neil McClure

Professor of Obstetrics and Gynaecology
Queen's University Belfast
Mulhouse Building
Grosvenor Road, Belfast, BT12 6DP


1. NHS England. Publications Gateway reference 00632. Interim Gender Dysphoria Protocol and service Guideline 2013/14. London: DOH; 2013.
2. Gender Recognition Act 2004. 2004 c7. London.
3. Human Fertility and Embryology Act 1990. 1990 c37. London.
4. Human fertilisation & Embryology Authority. Code of Practice Guidance note 8: The welfare of the child. HFEA;2008.
5. Lev AI. Transgender Emergence: Therapeutic Guidelines for Working with Gender-variant People and Their Families. Bringhamtom, NY: The Haworth Clinical Practice Press 2004.
6. Faccio E, Bordin E, Cipolletta S. Transsexual parenthood and new role assumptions. Culture Health &Amp; Sexuality 2013;15(9):1055-1070
7. Lubbert H, Leo-Rossberg I, Hammerstein J. Effects of ethinyl estradiol on semen quality and various hormonal parameters in a eugonadal male. Fertil. Steril 1992;58:603â€"608.
8. Schneider FJ, Kossack N, Wistuba J, et al. In-depth characterization of human testicular tissue from patients suffering from gender identity disorder (GID) undergoing sex-reassignment surgery (SRS). Fertil Steril 2013;100(3):S67-S68
9. Grynberg M, Fanchin R, Dubost G et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Repro BioMed Online 2010;20(4):553-558
10. Gidoni YS, Raziel A, Strassburger D, Kasterstein E et al. Can we preserve fertility in a female to male trangender after a long term testosterone treatment- case report Fertil Steril 2013;100(3):S169-S170


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.