As Published in TGForum:
By Cerise Richards

  Since we as a community are continually contemplating the ingestion of hormones which will in most cases cause permanent physical changes, which we desire and some we do not desire, such as the inability to have children, we are being asked unnecessarily to give up our reproductive potential. We know that opposing hormones given after one to two years will destroy the normal production of sperm and eggs, so we have accepted that this is something we must relinquish. But in other areas of medicine such as cancer chemotherapy which has the same effect on reproductive tissue, it is unthinkable not to offer young patients from adolescence to forty years of age, the option to preserve their fertility by ART, Assisted Reproductive Techniques. I propose that these same techniques which I shall describe can preserve your DNA inexpensively and be used in almost all partnerships for the conception of children which are undeniably yours.

Since the birth of Baby Louise Brown in July 1978, the field of In Vitro Fertilization, IVF, has grown by leaps and bounds to where hundreds of thousands successful babies have been conceived. Today the insertion a single sperm into a single egg called ICSI, intracytoplasmic sperm injection, can produce multiple embryos, which can be frozen and introduced into a uterus at a later date. If we have partnered with the opposite sex before the onset of hormonal therapy and do not have children, the sperm or eggs may be cryopreserved separately, where you have total control or as small embryos which become a legal problem if you separate. But if you are single and have the strong maternal or paternal desire to raise children at a later date, this is something you must contemplate even though your plate is full thinking about your transition.

So my discussion will begin with the simplest proven techniques and proceed to the experimental, but nevertheless successful ARTs. For males contemplating sperm cryopreservation, the production by ejaculation of two specimens of motile sperm will usually be enough to produce 10 straws or individual tubes which are then frozen with added cryoprotectants to -196 C in liquid nitrogen for up to 20 years. The initial evaluation of you and your sperm quality will probably cost $700 and a monthly fee of about $30 until they are used. If you are going off to War in Iraq, it is free at this time. If your present sperm are not of sufficient numbers or motility other operative or non-operative measures can be taken to retrieve motile or mature sperm from the testes. If you are contemplating castration after one year of hormones and cannot ejaculate, the testes can be cryopreserved in thin slices with the sperm intact and then extracted when thawed at a later date.

Since sperm are normally recovered in the millions, numbers only become problematic when a few hundred are recovered, but pregnancies have been achieved with only 10 mature sperm by ICSI. Now if you have had GRS and partner with a man, your sperm or mixed sperm may be combined with an egg from a donor egg bank, frozen as an embryo and given to a surrogate mother in the future. But now your partner has insufficient sperm and he must under go operative procedures to retrieve the few sperm remaining and there you are the “heroine” of the day with all the sperm necessary for simple artificial insemination of a surrogate. No surgery or injections or IVF.

Now it’s always harder for women contemplating storing their eggs prior to male hormonal therapy. The highest pregnancy rates come from cryopreserved embryos, but pregnancies are now being achieved from cryopreserved oocytes if they are stored as mature eggs. Achieving maturity is realized at the time of ovulation when approximately 500 eggs mature and only 1 or 2 are released naturally. But in IVF dozens of mature eggs are produced and recovered using egg follicle stimulating hormones. This could all be done before the start of Testosterone therapy.

Interestingly it has been recently shown in women that drugs such as LHRH agonists, Tamoxifen and Clomiphene will stimulate FSH, Follicle Stimulating Hormone, causing oocyte, egg - maturation without using or increasing estrogens. We have used Clomiphene in a male milieu for years to increase sperm production without compromising masculinity, so why couldn’t it be used after female GRS. Recently in women at the time of oophorectomy or ovary removal, the ovaries have been thin sliced and cryopreserved with the thought of ovarian grafting at a later date to the area of the previous ovary, but of interest to the female TS who has had a hysterectomy, the ovarian tissue has been successfully grafted to the forearm for recovery of thousand of eggs.

Bringing those eggs to maturity at that site is the present area of research. What if the cryopreserved eggs could be brought to maturity in vitro outside the body? Now that will be the next step. All of this has been successfully done in animals, but I am not aware of a pregnancy from cryopreserved ovarian tissue in humans at this time. Now if you partner with a man, you will not need to seek out one of the hundreds of available sperm banks just a surrogate, but if you partner with a woman, it may require bringing up your child and her child together with donations from the same donor. Oh, there must be so many combinations of partners with children, which the law has not contemplated. We’ll leave that to our legal experts. This is our Brave New World, so who will take the first step.

Best of Luck in Your New Future,