Advances in research may make it easier for trans-gender men to have children

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There are several options for those who choose such treatments, but one day want the option of having a biological child. Adults can freeze eggs, for example. However, this usually involves discontinuing testosterone treatment and allowing the menstrual cycle to return. This can take several months. Hormone-based medicines are used to stimulate the ovaries to release multiple mature eggs, which are then collected in a surgical procedure involving a vaginal probe. This procedure can be particularly painful for trans-gender men, Babaev says. In addition, suspending testosterone therapy for several months can cause fatigue, mood changes, and sleep disorders.

Many trans-gender men want to build their own family without such confusion, says D. Ogeda, senior national organizer of the National Center for Trans-Gender Equality in Washington, DC. ..

The options are further limited for young people who want to start sex-verifying medical care before they reach puberty. That is, the egg cannot be frozen because ovulation does not begin. They may choose to remove and freeze part or all of the ovaries. In that case, the tissue can theoretically be re-transplanted later, but because of the elevated levels of estrogen in the body, few transgenders choose that procedure. Wallberg, a reproductive oncology scholar at the Karolinska Institute in Sweden, saw Telfer present her work.

An alternative that Telfer and her colleagues are working on is to remove the egg from the ovaries and mature it in vitro in the laboratory. The team has already managed to do this to some extent with eggs taken from the ovaries of women, but it was unclear if the eggs could be matured from the ovaries of people who had already started sex-verifying medical care. ..

Hard ovaries

Telfer’s first job was to find out what testosterone therapy does to the ovaries. This is a matter of disagreement among clinicians.

To get a clearer idea, Telfer worked with two gender verification clinics in the UK. Trans-gender men who were taking testosterone and had surgery, including removal of the ovaries, were asked if they would like to donate them for research. In total, four people donated eight ovaries. The team compared eight sliver and ovarian fragments donated by a woman who underwent a caesarean section of the same age.

The ovaries of trans-gender men were certainly different. The tissue is harder because it is high in collagen and low in elastin. This stiffness can make it difficult for follicles to grow and release mature, ready-to-fertilize eggs.

More options [to start a family] We have better people as transgender people.

D Ojeda, Senior National Organizer of the National Center for Transgender Equality in Washington, DC

Telfer and her colleagues also evaluated 4,526 follicles from eight ovarian fragments exposed to testosterone. About 94% of follicles were not growing, compared to 85% in ovarian pieces of women who did not take testosterone.

The team then tried to mature the egg from the ovaries of a trans-gender male. Their method involves cutting out the tissue around each follicle and stretching it in a dish. This seems to induce signaling pathways within the tissue that allow the follicle to release mature eggs.

It worked — researchers were able to mature a small number of eggs until they were ready to be fertilized by sperm.

Theoretically, the team could use IVF technology to create embryos containing eggs and transplant them into the uterus of a partner or surrogate mother. To do this in the UK, the team must be licensed from the Department of Human Fertilization and Embryology. No such license is required in the United States.

This technique will appeal to some trans-gender men, Ogeda says. [to start a family] We have better people as transgender people. ”

But Telfer and her colleagues haven’t gone this far yet. The first eggs the team matured in the lab did not look perfectly normal. When an egg matures, it usually undergoes a special type of cell division that halves the number of chromosomes, ready for fertilization. Unused chromosomes are separated into small cells called polar bodies. The polar body of a mature egg in the laboratory looked unusually large.

Large polar bodies can be completely harmless. However, in case of emergency, the team is fine-tuning the content of the liquid in which the egg matures. More recent attempts have resulted in a more typical looking egg, cell telpher. The team has matured about 10 eggs so far, but the project is underway. “We want to make our culture system more robust before trying to fertilize,” says Telfer.

She wants to try the procedure with sheep before trying it out to people. These experiments will be conducted later this year. If they succeed, Babaev predicts that this technique will spread among clinics. Most fertility drugs bypass clinical trials before they are widely offered by the clinic.

“Obviously the twist needs to be resolved, but if she succeeds, I don’t think it will take a long time for others to implement it very quickly,” says Babaev. But he is waiting for further evidence to be confident that this technique will work clinically. “I will have to see the baby,” he says.

If trans-gender men can use it to help conceive a healthy baby, this technique could be useful in many other situations, says Rodriguez-Walberg. Children facing cancer treatments that can damage the ovaries should first freeze some of them to provide a way to give birth to their own biological child as they grow older. I can.

This method may also help others who are struggling to get pregnant, says Kutluk Oktay, a reproductive endocrinologist and fertility expert at Yale School of Medicine. Ovarian freezing may be an alternative to egg freezing. A single biopsy from the ovaries may be preferable to many of the procedures involved in egg collection.

Also, while egg collection tends to yield about 10 eggs each time, small ovarian pieces can be used to lay 100 eggs. “A small biopsy from the ovaries … may be enough for many babies,” says Oktay. “If you understand how to do this efficiently, it could be widely used.” Advances in research may make it easier for trans-gender men to have children

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