Isabelle Stuyver

Sperm freezing in transsexual women.

Gender Identity Disorder (GID) is a condition in which a person experiences discrepancy between the sex assigned atbirth and the gender they identify with. Transsexualism is considered the most extreme form of GID and is characterized by the desire to live and be treated as a member of the opposite gender. The prevalence of male-to-female transsexualism in Belgium is estimated at 1 per 12,900 males (De Cuypere et al., 2007). The treatment consists of cross-sex hormone therapy and sex reassignment surgery in accordance with the Standards of Care of the World Professional Association for Transgender Health (WPATH) (7th Version) (www.wpath.org). At the center in Ghent, male-to-female transsexual persons, denoted as transsexual women, are treated in a multidisciplinary approach, including cross-sex hormone therapy and sex reassignment surgery for most. Hormone therapy with anti-androgens and estrogens is used in the majority of transsexual women. After at least 1 year of hormonal therapy, sex reassignment surgery can be offered, which includes orchidectomy andpenectomy in combinationwith vaginoplasty (Selvaggiet al., 2005).Bothhormonalandsurgical interventionsnegativelyaffect the male reproductive system. Hormonal therapy itself leads to decreased spermatogenesis and eventually to azoospermia (Lubbert, Leo-Rossberg, & Hammerstein, 1992; Schulze, 1988). Currently, it is unknown whether spermatogenesis will restore after prolonged estrogen treatment or not (Hembree et al., 2009). Sex reassignment surgery, on the other hand, results in an irreversible loss of natural reproductive capacity in transsexual women. Current reproductive techniques can offer adult transsexual women the possibility of having genetically related children (De Sutter, 2001). They can store their sperm for long-term cryopreservation before undergoing hormonal therapy for future use in assisted reproductive techniques (ART). Sexual orientation of transsexual women may influence the future plans for using the frozen sperm. If transsexual women have a female partner, they can procure children through intrauterine insemination, in vitro fertilization or intracytoplasmic sperm injection, based upon the sperm quality after thawing. Reproductive options for transsexual women with a male partner are more difficult as they need oocyte donation as well as a surrogate mother. Reproductive needs and rights of transsexual persons have already been recognized for over 15 years (Lawrence, Shaffer, Snow, Chase, & Headlam, 1996) and since 2001 the WPATH Standards of Care contains a paragraph that addresses the need to discuss reproductive issues with transsexual persons, prior to starting hormonal treatment (Meyer et al., 2001). Also, the new WPATH Standards of Care (Seventh version) (2011) as well as the Clinical Practice Guidelines of the Endocrine Society (Hembree et al., 2009) clearly state that transsexual persons should be encouraged to consider fertility issues before starting cross-gender hormonal treatment. On the other hand, research on this topic is still scarce. In the past 10 years, only two studies have investigated the opinions of transsexual persons themselves concerning this topic (De Sutter, Kira, Verschoor, & Hotimsky, 2002; Wierckx et al., 2012) and few have addressed reproductive difficulties (e.g., access to ART in transsexual patients) (AlvarezK. Wierckx (&) G. T’Sjoen Department of Endocrinology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium e-mail: Katrien.Wierckx@ugent.be

Quality of Life and Body Mass Index in Overweight Adult Women with Polycystic Ovary Syndrome During a Lifestyle Modification Program

OBJECTIVE To evaluate changes in body mass index (BMI) and health-related quality of life (HRQoL), including an acne parameter, of overweight adult women with polycystic ovary syndrome (PCOS) during a lifestyle modification program. DESIGN Prospective longitudinal within-patient study. SETTING Department of Reproductive Medicine of the Ghent University Hospital (Belgium). PARTICIPANTS Thirty-three overweight (BMI ≥ 25 kg/m²) women with PCOS between age 18 and 43 years. METHODS Participants followed a 24-week lifestyle modification program consisting of a diet, exercise, and psychological subprogram. BMI was assessed at Weeks 0, 8, 16, and 24 of the program. The HRQoL was measured at Week 0, 12, and 24 of the program using the PolyCystic Ovary Syndrome Questionnaire (PCOSQ) and a Visual Analogue Scale (VAS) to evaluate the influence of acne on HRQoL. RESULTS During a 24-week period no significant decrease in BMI occurred (mean difference = 1.71, 95% confidence interval [CI] [-1.38, 4.81]. During that period, there was a significant positive evolution of the total PCOSQ score, F(2, 37.5) = 23.7, the emotions, F(2, 37.9) = 4.2, weight, F(2, 42.1) = 24.8, body hair, F(2, 35.6) = 3.3, and infertility problems domain scores, F(2, 43.1) = 15.64, of the PCOSQ, as well as of the acne VAS score, F(2, 29.3) = 4.2. These effects primarily occurred during the first 12 weeks. CONCLUSION In spite of no significant changes in BMI, the HRQoL of overweight adult women with PCOS significantly improved during a 24-week lifestyle modification program.

Sexual and relational satisfaction in couples where the woman has polycystic ovary syndrome: a dyadic analysis

STUDY QUESTION How are objective characteristics of polycystic ovary syndrome (PCOS) and PCOS-related concerns associated with the sexual and relational satisfaction of PCOS women and their partners? SUMMARY ANSWER Both objective PCOS characteristics (parity, womens body mass index (BMI) and current unfulfilled wish to conceive) and PCOS-related concerns (womens infertility-related and acne-related concerns) were associated with sexual and/or relational satisfaction, although some associations differed for PCOS women and their partners. WHAT IS KNOWN ALREADY There is some evidence indicating an association between objective PCOS characteristics and sexual satisfaction of PCOS women, but this evidence is conflicting, scarce, and often validated questionnaires have not been used to evaluate sexual satisfaction. No evidence is available about the association of: (i) PCOS with relational satisfaction; (ii) PCOS-related concerns with sexual and relational satisfaction; and (iii) PCOS with sexual and relational satisfaction as experienced by partners of PCOS women. STUDY DESIGN, SIZE, DURATION We set up a cross-sectional study from April 2007 until April 2009, including 31 overweight (BMI ≥ 25 kg/m(2)) women with PCOS and at a reproductive age as well as their partners with whom they had a committed intimate relationship at the time of recruitment. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was performed at the fertility center of the Ghent University Hospital. Objective PCOS characteristics were registered and PCOS-related concerns were evaluated by the PCOS Questionnaire. Sexual (SS) and relational (RS) satisfaction were measured by the Maudsley Marital Questionnaire (MMQ). Dyadic statistical analyses were performed using linear mixed models (α < 0.05). MAIN RESULTS AND THE ROLE OF CHANCE A lower parity tended to be associated with higher levels of sexual and relational satisfaction, with a significantly stronger association in PCOS women than in their partners (p(SS) = 0.015 and p(RS) = 0.009). A higher BMI tended to be associated with lower and higher satisfaction levels (sexual and relational) in PCOS women and their partners, respectively, with a significantly stronger association in the partners (p(SS) = 0.029 and p(RS) = 0.021). The presence of a current unfulfilled wish to conceive and a higher level of infertility-related concerns was significantly more strongly associated with a higher level of relational satisfaction for PCOS women than for their partners (p(RS) = 0.021 and p(RS) = 0.011, respectively). Higher levels of acne-related concern were significantly associated with lower levels of sexual satisfaction in both PCOS women (p(SS) = 0.025) and their partners (p(SS) = 0.002). LIMITATIONS, REASONS FOR CAUTION The fact that this study was performed in a sample of PCOS women who were all overweight and the small sample size are important limitations. Data were partially missing in some couples but this limitation was dealt with by using linear mixed models. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest a differential association of PCOS with sexual and relational satisfaction between PCOS women and their partners. This should be kept in mind during the psychological guidance of couples dealing with PCOS. STUDY FUNDING/COMPETING INTERESTS V.D.F. is holder of a Special PhD Fellowship of the Flemish Foundation for Scientific Research (FWO-Vlaanderen). P.D.S. is holder of a fundamental clinical research mandate of the Flemish Foundation for Scientific Research (FWO-Vlaanderen). This research also received financial support by Merck Serono and Artevelde University College Ghent. There are no competing interests.

Belgium: ISO 9001:2000 Certification as a Base for Total Quality Management in ART

The high demands and expectations of our patients are placed on our standards of work—and quite rightly too, because we would have to account for the consequences of any mistakes we might make. Although countless couples become pregnant and give birth to healthy children, the number of unsuccessful treatments still outweighs the successful ones. The ART clinics are therefore under constant pressure to improve the quality of their services and increase the percentage of successful treatment cycles. A quality control system is the tool with which this expectation is met. It is a concept adapted from the industry sector. The aim of this is to establish procedures (standard work methods), which ensure that these established levels of quality are reached and maintained. Furthermore, the result must be visible in order to prove that standards are being adhered to and met.