A case of oligoasthenoteratozoospermia following genital tucking: Transgender fertility preservation

Abstract

Genital tucking is a behavioural practice facilitating gender expression by genitalia concealment. Genital tucking can be achieved by either pushing the testicles into the inguinal canal and/or securing the scrotum and penis between the legs towards the buttocks. Genital tucking has a negative impact on spermatogenesis, and therefore can result in a suboptimal sample and impaired sperm parameters. Fertility cryopreservation is recommended prior to hormone therapy or elective surgery, and therefore, the practice of genital tucking prior to fertility preservation could result in lesser quality and fewer samples being stored for future use. This case study presents a transwoman, aged 20-30, displaying severe oligoasthenoteratozoospermia derived from genital tucking. The case discusses how the cessation of genital tucking resulted in improved semen parameters, and therefore improved the quality and quantity of samples stored for future use. Fundamentally, the case highlights the necessity for health professionals to broaden their understanding and awareness of genital tucking, the impact it has on fertility, and how to better advise patients prior to fertility cryopreservation.