Fertility outcome and information on fertility issues in individuals with different forms of disorders of sex development: findings from the dsd-LIFE study

Fertility outcome is reduced in all types of disorders of sex development. In this study 14% had at least one child but only 3.5% had children without assisted reproduction technology.

Volume 108, Issue 5, Pages 822–831


Jolanta Słowikowska-Hilczer, M.D., Ph.D., Angelica Lindén Hirschberg, M.D., Ph.D., Hedi Claahsen-van der Grinten, M.D., Ph.D., Nicole Reisch, M.D., Claire Bouvattier, M.D., Ute Thyen, M.D., Ph.D., Peggy Cohen Kettenis, Ph.D., Robert Roehle, M.Sc., Birgit Köhler, M.D., Ph.D., Anna Nordenström, M.D., Ph.D., on behalf of the show dsd-LIFE Group 



To investigate fertility outcome in individuals with different forms of disorders of sex development (DSD), if assisted reproductive technology (ART) was used, and the patients' satisfaction with the information they had received.


A cross-sectional multicenter study, dsd-LIFE.


Not applicable.


A total of 1,040 patients aged ≥16 years with different DSD diagnoses participated.


A web-based questionnaire was filled out by all participants. The participants could chose to take part in somatic investigations including ultrasonography.

Main Outcome Measure(s)

Information on partner, number of children, ART, adoption and step-children, general health, presence of gonads and uterus, current education and economic situation, received information on fertility issues, and satisfaction with the information, was collected.


In the total cohort, mean age 32 years, 33% lived with a partner, but only 14% reported having at least one child including 7% with ART, 4% adopted. Only 3.5% of the total cohort had been able to reproduce without ART, most frequently women with congenital adrenal hyperplasia, and only 0.7% of participants with other diagnoses. Of the participants, 72% had received information on fertility, but 17% were not satisfied with the information.


Fertility outcome is significantly reduced in all types of DSD; however, fertility potential should be assessed individually. The satisfaction with how fertility problems have been discussed can be improved. The care of patients with DSD is complex, should be individualized, and new treatment possibilities incorporated. A close collaboration in multidisciplinary teams is therefore essential to improve the situation for individuals with DSD.

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