Original Report| Volume 33, ISSUE 6, P703-707, December 2020

Fertility Desires of Adolescent Females: Decreased Desire for Children in Those Identifying as Transgender/Gender Diverse and in Depressed Adolescents

Published:September 11, 2020DOI:


      Study Objective

      We aimed to describe fertility desires in healthy adolescent females and to explore associations of fertility desire with conditions and therapies potentially compromising fertility.


      This was a cross-sectional, anonymous survey.

      Setting and Participants

      A total of 323 female adolescents aged 13-19 years were recruited from clinic waiting areas at a children's hospital. We oversampled on days when clinics serving adolescents with potential fertility compromise were scheduled.

      Main Outcome Measures

      We measured fertility desire by agreement with the statement “I want to have children someday.” To measure compromised fertility we asked “In the past year, has a doctor, nurse or other medical professional ever talked to you about the possibility that you may have decreased fertility and may not be able to have your own biological child someday?” To measure depression severity, we used a validated scale, the PHQ-9, scores were dichotomized into no/mild and moderate/severe depression.


      Mean age was 16.06 ± 1.87 years. Of the 323 participants, 57% identified as Hispanic, 24% as Black, 93.5% as cisgender, 6.5% as transgender/gender diverse, 70% as heterosexual, and 30% as sexual minority. A total of 35% had moderate/severe depression, and 12% had compromised fertility. Overall, 89% wanted children. Fewer transgender/gender diverse than cisgender participants wanted children (67% vs 93%, P < .001), as did fewer with moderate/severe versus no/mild depression (83% vs 93%, P < .05), whereas those with compromised fertility versus those without and heterosexual versus sexual minority participants had similar fertility desires. Transgender/gender diverse identity (odds ratio, 0.33; 95% confidence interval, 0.11-0.97; P < .05) and moderate/severe depression (odds ratio, 0.45; 95% confidence interval, 0.22-0.93; P < .05) were independently associated with lower fertility desire.


      We found a high overall proportion of female adolescents desiring future children, and only 2 independent predictors of decreased fertility desire, namely, transgender/gender diverse identity and moderate/severe depression.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Quinn G.P.
        • Murphy D.
        • Wang H.
        • et al.
        Having cancer does not change wanting a baby: healthy adolescent girls’ perceptions of cancer-related infertility.
        J Adolesc Health. 2013; 52: 164
        • Klosky J.L.
        • Simmons J.L.
        • Russell K.M.
        • et al.
        Fertility as a priority among at-risk adolescent males newly diagnosed with cancer and their parents.
        Support Care Cancer. 2014; 23: 333
        • Coleman E.
        • Bockting W.
        • Botzer M.
        • et al.
        Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7.
        Int J Transgenderism. 2012; 13: 165
        • Hembree W.C.
        • Cohen-Kettenis P.T.
        • Gooren L.
        • et al.
        Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2017; 102: 3869
        • Isogna I.G.
        • Ginsburg E.
        • Srouji S.
        Fertility preservation for adolescent transgender male patients: a case series.
        J Adolesc Health. 2020; 66: 750
        • Taylor J.F.
        • Ott M.A.
        Fertility preservation after a cancer diagnosis: a systematic review of adolescents’, parents’, and providers’ perspectives, experiences, and preferences.
        J Pediatr Adolesc Gynecol. 2016; 29: 585
        • Chen D.
        • Simons L.
        • Johnson E.K.
        • et al.
        Fertility preservation for transgender adolescents.
        J Adolesc Health. 2017; 61: 120
        • Nahata L.
        • Tishelman A.C.
        • Caltabellotta N.M.
        • et al.
        Low fertility preservation utilization among transgender youth.
        J Adolesc Health. 2017; 61: 40
        • Nattabi B.
        • Li J.
        • Thompson S.C.
        • et al.
        A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery.
        AIDS Behav. 2009; 13: 949
        • Berrington A.
        • Pattaro S.
        Educational differences in fertility desires, intentions and behaviour: a life course perspective.
        Adv Life Course Res. 2014; 21: 10
        • Trent M.
        • Millstein S.G.
        • Ellen J.M.
        Gender-based differences in fertility beliefs and knowledge among adolescents from high sexually transmitted disease-prevalence communities.
        J Adolesc Health. 2006; 38: 282
        • Centers for Disease Control and Prevention
        Youth Risk Behavior Survey Questionnaire.
        (Available at:)
        Date: 2017
        Date accessed: February 27, 2019
        • Reisner S.L.
        • Conron K.J.
        • Tardiff L.A.
        • et al.
        Monitoring the health of transgender and other gender minority populations: validity of natal sex and gender identity survey items in a U.S. national cohort of young adults.
        BMC Public Health. 2014; 14: 1224
        • Strang J.F.
        • Jarin J.
        • Call D.
        • et al.
        Transgender youth fertility attitudes questionnaire: measure development in nonautistic and autistic transgender youth and their parents.
        J Adolesc Health. 2018; 62: 128
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606
        • Bloom T.L.
        • Mosher W.
        • Alhusen J.
        • et al.
        Fertility desires and intentions among U.S. women by disability status: findings from the 2011-2013 National Survey of Family Growth.
        Maternal Child Health J. 2017; 21: 1606
        • Shumer D.E.
        • Nokoff N.J.
        • Spack N.P.
        Advances in the care of transgender children and adolescents.
        Adv Pediatr. 2016; 63: 79
        • Hodax J.K.
        • Wagner J.
        • Sackett-Taylor A.C.
        • et al.
        Medical options for care of gender diverse and transgender youth.
        J Pediatr Adolesc Gynecol. 2020; 33: 3
        • Auer M.K.
        • Fuss J.
        • Nieder T.O.
        • et al.
        Desire to have children among transgender people in Germany: a cross-sectional multi-center study.
        J Sex Med. 2018; 15: 757
        • Price-Feeney M.
        • Green A.E.
        • Dorison S.
        Understanding the mental health of transgender and nonbinary youth.
        J Adolesc Health. 2020; 66: 684
        • Titchen K.E.
        • Maslyanskaya S.
        • Silver E.J.
        • et al.
        Sexting and young adolescents: associations with sexual abuse and intimate partner violence.
        J Ped Adolesc Gynecol. 2019; 32: 481
        • Blum R.W.
        • Li M.
        • Naranjo-Rivera G.
        Adverse child experiences among young adolescents globally: relationships with depressive symptoms and violence perpetration.
        J Adolesc Health. 2019; 65: 86
        • MacLeod A.K.
        • Salaminiou E.
        Reduced positive future-thinking in depression: cognitive and affective factors.
        Cognit Emot. 2001; 15: 99-107
        • Shapira M.
        • Dolmans M.M.
        • Silber S.
        • et al.
        Evaluation of ovarian tissue transplantation: results from three clinical centers.
        Fertil Steril. 2020.;