In Mexico, according to INEGI 2021, 34.8% of LGBTI+ people are transgender. The term transgender refers to an individual whose gender identity does not correspond to the sex assigned at birth. Currently, the transgender population seeks counseling from reproductive endocrinologists for various family planning purposes, and therefore, the WPATH, ASRM, and ESHRE suggest that physicians provide guidance regarding reproductive prognosis.

A 29-year-old transgender male with a 21-year-old cisgender female partner, with no significant past medical history. He had undergone androgen transition hormone therapy for 5 years, which he discontinued in 2020 due to a desire for pregnancy. He visited a fertility center in 2021 for in vitro fertilization (IVF) using the ROPA method. Controlled ovarian stimulation was performed using a long protocol with a GnRH agonist, but no follicular response was achieved, and the cycle was canceled.

In January 2025, he returned due to a desire for fertility. Physical examination revealed vaginal atrophy, and he was unable to tolerate endovaginal ultrasound. He was prescribed vaginal estrogen. In April 2025, ovarian stimulation was restarted on day 3 of the cycle, with 15 antral follicles. rFSH and human growth hormone (HGM) were initiated. On day 8 of the cycle, medroxyprogesterone is added with estradiol levels of 502 pg/dl and progesterone 0.3 pg/dl. On day 12, 11 follicles >16mm are detected, estradiol 3699pg/dl, progesterone 0.9pg/dl and an endometrial line of 9 mm.

Oocyte maturation with rHCG was indicated. At 35 hours, follicular aspiration was performed, yielding a total of 17 oocytes (14 MII, 1 MI, 1 VG, 1 ZR). ICSI was performed with a heterologous sample. Fertilization of 12 oocytes was observed, and 6 blastocysts were obtained 5 days later (3 of good quality).

The recipient's endometrium was prepared using a substituted cycle, revealing an 11 mm type A endometrium on day 14 of the cycle. A fresh transfer was performed with P+5, yielding 2 BB/BB quality blastocysts. The transfer quality was A. A pregnancy test was performed on May 12, 2025, and was positive.

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