Iris de Nie

44 C H A P T E R 3 When applying WHO semen criteria, a substantial percentage of the study population did not meet the reference value for semen volume ( < 1.5 ml, 18.1%), total sperm number ( < 39 million, 35.8%), sperm concentration ( < 15 million/ml, 33.5%) and progressive motility ( < 32%, 36.9%). In Figure 2, the classification of semen quality in our cohort is demonstrated using the descriptive diagnosis nomenclature. Figure 2. Classification of semen quality in the study sample of 260 trans women. The pie chart presents the descriptive diagnoses of trans women according to World Health Organization (WHO) reference values for human semen. For 228 trans women a post-thaw semen quality was assessed; the median TMSC was 1.0 million per vial (IQR 0.1-3.1). In only 26.4% of the post-thawed samples was the semen quality adequate for IUI, 13.4% was suitable for IVF and 60.2% required ICSI. In total, 21 trans women had an azoospermia. Three of these individuals reported to have used gender affirming hormones and stopped taking these 3 months prior to the first attempt of semen cryopreservation. Even 6 months after discontinuation of hormone treatment they still remained azoospermic. Seven hormone naïve trans women elected to undergo TESE, which resulted in cryopreserved spermatozoa in only three cases. Endocrine laboratory results for the azoospermic individuals were all in the normal range, except for FSH concentrations which were only available for three trans women but was elevated in one case (median 6.8 U/L, range 5.4-15.7 U/L). Logistic regression analyses showed no effect of BMI, alcohol consumption or cannabis use on the semen parameters. Smoking was found to correlate with a progressive motility below 32% (OR 2.35 95%CI 1.06-5.21) but within smokers no relation between the number of smoked cigarettes per day and semen parameters was found. A higher age at time of fertility preservation also correlated with an impaired progressive motility (OR 1.04 95%CI 1.00-1.08). The decreased semen quality in our cohort could not be explained by abnormal endocrine laboratory results, previous gender-affirming hormone use, a history of cryptorchidism or inguinal hernia repair, and a history of anxiety or depression. Data for all logistic regression analyses are shown in Table 2.