Transsexual pregnancy for those of you interested.

Fugs · Aug 12, 2012

Warning, contains graphic, and/or triggering content. Only proceed if you're over 13

Second Type Woman - Transsexual Pregnancy

To explain part of the desire for a MtF transsexual to get pregnant.

Medical advances have transformed the lives of transsexual woman over the last 50 years. Hormones provide huge physical and mental benefits, whilst surgery can provide effective female genitalia that permit a normal sex life - other than pregnancy.

One study found that transsexual women are as likely to have reproductive dreams and daydreams as any other women.

After Sex Reassignment Surgery it can be difficult to distinguish many genetically XY male-to-female (MTF) transsexual women from a XX woman without an intimate medical examination. Indeed, some transsexual women now lead their lives without their friends, work colleagues, and even husband ever having any inclination of their sex re-assignment.

Nevertheless, transwomen cannot bear children due to their lack of internal female reproductive organ. Fortunately most transsexual women seem to have no great desire to bear children - it's perhaps relevant that many western transwomen have often been married and have fathered children before they transition in their 40's and 50's.
However some transwomen - typically those who transitioned at very young age - experience extreme broodiness, jealousy of pregnant women, anger at the "unfairness of life" and even clinical depression. The denial of the basic female right to have children and enjoy the wonderful and unique experience of motherhood is a tragic loss for some transsexual women - as it is for other infertile women. Seeing other women having children or even worse complaining about their fertility and worse seeking abortions is often hard to bear. One very frustrated British MTF transsexual still her 20's said "I just want to be a Mum on a Council Estate with a pile of kids".

For transsexual women seeking to have children and be a mother, things are even harder than for XX women because of the additional barriers she faces in relation to adoption or the use of a surrogate mother. However, the situation may eventually improve.
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Possible procedures for MtF pregnancies.

Uterus Transplants

The most promising approach that could allow a transsexual woman to become pregnant is a uterus (aka womb) transplant. The uterus is the womb in which a baby normally forms and grows, and IVF is now commonly used to implant fertilised eggs in a woman's uterus. Because no other organs are transplanted, the chance of success is significantly increased. The baby will have to be delivered by Caesarean section because the transwomen lacks the organs and muscles involved in natural contractions and labour, but this is minor obstacle given that about quarter of all babies are already born by this method in Western Europe, and a third in the USA.

A huge medical effort is currently being undertaken to successfully a transplant a uterus into to a genetically female woman for fertility reasons, there is no reason why the same cannot be done for a genetically male transsexual woman.

For the transsexual women absolutely determined to start a family, uterine transplants offer some major advantages over surrogacy. The transsexual is gestationally and socially clearly the mother. She can also control lifestyle factors such as smoking and drinking alcohol, and is the person who takes the health risks with every pregnancy.

Until the 1990's uterus implants were not regarded as a viable approach - experiments with dogs and baboons had been unsuccessful as it was found that great difficulties lie in the fact that complex blood vessels that must be connected. Pregnancy also puts huge strain on these connections, with very dangerous consequences if something was to go wrong. Another major problem when transferring a uterus from one person to another is the possibility of rejection (i.e. the transplanted womb is recognised by the implanted body as being foreign material and "attacked"), especially if that occurred during a pregnancy. The risk of rejection can be reduced by taking large quantities of drugs to suppress the immune system and prevent rejection of the transplant, but most of these drugs are harmful to the early foetus development during a pregnancy.

It was thus thought that uterus implants must wait either until less intrusive immunology suppression drugs are developed, or until advances in cloning or genetic engineering allows the growth of female reproductive organs that are not "foreign" to the patient. However the concept of short-term uterus implants in order to bear a baby has emerged.

in March 2002 that doctors in Saudi Arabia had performed the world's first womb transplant.The operation was on a 26-year-old woman who had lost her own womb because of excessive bleeding after childbirth. The operation used the womb of a 46-year-old woman who needed a hysterectomy, and was performed on 6 April 2000. It was deemed a success by the Saudi doctors but the transplanted womb had to be removed 99 days later when scans revealed a blockage in one of the grafted vessels that cut off blood supply to the uterus. However, the uterus did produce two hormone induced (as would be done in a transsexual woman) menstrual periods before it had to be removed.

The Saudi approach has been avoided since while researchers sought better ways of "plumbing" in the transplanted uterus. In June 2003 a Swedish Team led by Dr Brännström of Sahlgrenska University in Gothenburg, told a "European Society of Human Reproduction and Embryology Conference" in Madrid that a better approach has now been found. In the new technique the transplanted womb is attached to two arteries and three veins on each side, with blood primarily coming from the external iliac artery. It would be attached to the vagina and to the round and sacral ligaments to hold in place, but not to the Fallopian tubes. This means that the woman would not be able to conceive naturally, but would have to have IVF. She would also have to give birth by Caesaeran. The new technique is considered simpler and less risky than most other transplant operations as no major blood vessels or vital organs are involved.

The donated womb would have to come from a woman with a close genetic match to the recipient in order to minimise the chance of rejection, as the womb does not deteriorate greatly from age it could come come from a post-menopausal woman. According to Dr Brännström "It could well be a relative. You could get it from your mother. You could give birth to a baby from the uterus that you yourself were birth from." Patients would need to take immunosuppressant drugs to help stop their body rejecting the womb, but researchers believe that modern immunosuppressant drugs do not have any negative effects on a feotus. Also, the drugs would not need to be taken for life, which might result in undesirable long term side-effect. After the woman has had her children, the transplanted womb could be removed.

(Above) Three graphics illustrating how a uterus transplant operation would work. The top graphic assumes an organ donation from a deceased woman, however the first transsexual woman to bear a child is far more likely to have the transplanted uterus of her sister, mother or another close relative. The lowest graphic is explicitly related to transwomen.

Dr Brännström says that it might be possible to transplant a womb in to transsexual women, allowing them to become pregnant with using donated eggs, though anatomical barriers would have to be overcome. "It should be technically possible, but I don't know if it's ethical. The pelvis of men also is not exactly the same shape as the pelvis of women, and that might pose problems."

In reaction to news that womb transplants may be imminent, a Hungarian newspaper expressed concern about womb peddling and the possibility of "gynecological care that routinely results in women going in for a check-up and only finding out later they've been given a hysterectomy" and "girls from the Hungarian countryside selling their wombs to rich yuppies from New York". Akció means 'for sale (special offer)'.
Also in November 2006 Dr Giuseppe Del Priore, from New York Downtown Hospital, said he had been given the go-ahead to carry out a womb transplant operation and claimed to have found a number of potential donors. Dr Del Priore said: "It is cautionary approval but it is approval. If the right patient shows up the [hospital] independent review board has stated we could go-ahead. Technically we are capable of doing it. If we had everything in order we could do it tomorrow." However any would-be patient will have to go through months of counselling and tests before approval - including seeing a psychologist and reconsidering adoption or surrogacy, as well as seeing a pregnancy risk specialist and transplant support team. The organ is likely to be sourced from a dead donor who had previously had a child. They would have to have the same blood group and be immunologically matched.

The long race for the first successful uterus transplant and pregnancy reached another small milestone when in October 2009 Dr Richard Smith- a consultant gynaecological surgeon at Hammersmith Hospital in London - claimed that his teams research on animals had “cracked” how to ensure a good blood supply to a transplanted womb.

The Hammersmith team now hope to be able to give women a new womb for long enough to allow them to conceive and give birth. They could use eggs from a donor fertilised by their partner and placed in the implanted uterus. After birth, they would then remove the organ, to reduce the women’s exposure to the high strength immune suppressing drugs most transplant patients have to take all their lives.
Procedure for the removal of a Uterus from a Living Donor

Step 1. The uterus is taken from the donor through an incision in the abdomen and placed on a bed of ice

Step 2. The blood vessels to the uterus is flushed with cold preservation solution

Step 3. The three hour operation of the donor ends after the top of the vagina is sewn up.

However Hammersmith and Gothenburg have apparently been overtaken in the race by doctors at Akdeniz University Hospital in southern Turkey. On 9th August 2011 they transplanted -in a seven hour operation - a uterus from a woman who had died in a car crash to a genetically XX 21 year old woman, Derya Sert, who was born without a uterus. Micro-surgeon Omer Ozkan, said: "The surgery was a success ... [But] we will be successful when she has her baby. ... For now we are happy that the tissue is living.'

Mrs Derya Sert

Mrs Sert then spent six months in hospital and was given powerful immunosuppressant drugs to stop her body rejecting the new womb. However her periods started just three weeks after the operation, a signal that the new womb was working well. Scans showed its lining to be healthy - Doctor Munire Erman Akar said "We can see it from the ultrasound that the endometrium lining is perfect", but added that if she did became pregnant "there are many risks like congenital anomalies because of the immunosuppressive (drugs), and intrauterine growth retardation, preterm labour." Lowering the dose of the drugs is critical for Mrs Sert to carry a healthy baby through pregnancy.

The next step will be an IVF procedure planned for September 2012, when up to two of the eight embryos created from Mrs Sert’s eggs and her husband’s sperm, and frozen ahead of the transplant, will be inserted into her womb.
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Ectopic Pregnancy

Ectopic pregnancy - the development of the baby outside the uterus (womb) - is another promising approach for transsexual women seeking to become pregnant. Natural occurrences of ectopic pregnancy do a occur, however they are considered very dangerous to the mother and subsequent live births are very rare (one pregnancy in millions). However it is possible that the first babies with transsexual mothers will be born this way because of the initial simplicity - no difficult transplants of a uterus or other organs.

The technique would involve attaching the foetus (the term used for developing babies under 8 weeks from conception) to the muscles inside the transsexual woman's abdomen, or even fashioning a [disposable] artificial womb from abdominal tissue. Attachment to the bowel, with its good blood supply, is another attractive option, but perhaps the worst in terms of post delivery trauma.

Preliminary female hormone treatment will be vital for supporting and encouraging the foetus' placenta to produce enzymes which then eat into whatever internal organ it is placed on, so that the placenta can attach and tap into the blood vessel to obtain nutrition. The baby will then develop inside the woman's abdomen, and the woman will carry the baby for its full term before giving birth by caesarean section.

Sustaining the pregnancy will require further large amounts of female hormones to be taken, in particular high levels of oestrogen and progesterone must be maintained during the first three month of pregnancy. The feminising effects of these may be a problem for a man who wants to become pregnant but doesn’t wish to develop breasts, but it's hardly a problem for a MTF transsexual woman who takes such hormones every day of her life!

There are though two main catches to this procedure:

Firstly, there is a severe risk of a massive haemorrhage (copious bleeding from damaged blood vessels) when the ectopic ruptures; this is actually the most common cause of women dying in pregnancy.
Secondly, if the foetus is implanted in a place where it can thrive without killing the mother, then it can grow to the point where it is a viable baby and can be delivered surgically. However, this leaves the big problem of what to do about the implantation site. While the uterus is designed to cope with the eight-inch wound left when the placenta separates; other organs have no mechanism for helping the placenta to separate and then contracting around themselves to stop the bleeding. Current medical practice with genetic women is to cut the umbilical cord close to the placenta and leave it inside the uterus. If all goes well, it will eventually shrink and be reabsorbed, however with transsexual women there would be a serious risk of infection and other complications with this approach, and surgical removal may be the marginally better option.
There is a real possibility that the mother will require urgent life saving surgery, either during her pregnancy, immediately after the caesarean, or during the recovery period afterwards.

Procedure
Assuming the mother and her medical team have determined that the risks are acceptable, the exact process for an ectopic pregnancy is:

Step 1: Hormones
Suitable doses of female hormones are administered to make the transsexual woman receptive to the pregnancy.

Hormone levels in a woman during pregnancy, after steadily building up for 9 months,
progesterone and oestrogen levels drop precipitously after the birth.

Step 2: Implantation
IVF (in vitro fertilisation) techniques are used to obtain and fertilise egg(s), and then induce an ectopic pregnancy by implanting an embryo and its placenta into the abdominal cavity, into or just under the peritoneum. The peritoneum is the smooth serous membrane which lines the cavity of the abdomen, it surrounds the large interior organs and forms a nearly closed sac.

Step 3: Embryo Growth
Once implantation is complete and the embryo is established, hormone treatment can be reduced because the pregnancy itself will take over. The embryo secretes sufficient hormones to maintain its own growth and development.

Step 4: Growth of the Foetus
The foetus will be carefully monitored during its development, i.e. foetal heart monitoring, chronic villus sampling, ultrasound scanning, and a constant watch kept over the mother's health.

Step 5: Delivery
The delivery will requires open surgery (Caesarean section) to remove the baby and the placenta. Removal of the placenta is the real danger because it forms such intimate connections with surrounding vessels that a massive haemorrhage is likely. Implantation may have also involved other structures in the abdomen, including the bowel and it is possible that parts of other organs may need to be removed.

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I'm going to be doing whatever it takes to have my own children someday. This article looks very promising and I felt like I should share it and get your opinions on it. I also feel like not enough people are educated on the subject, and when it comes up in conversation that people look at me funny and don't understand why I would want to get pregnant. It's not a status symbol, it's not to be a 'real woman' I already am a 'real woman'. It's because I want my own children, I want to carry my partner's child, I want the conditions to be mine, and the risk to be my own not someone else's.

Sorry for the sloppiness, I'm still rooting around for hiccups in the thread I missed.
(づ｡◕‿‿◕｡)づ

---------- Post added 12th Aug 2012 at 09:18 AM ----------

Images are broken for some reason Y,Y Maybe a mod could fix them?

(links)

First image second spoiler http://www.secondtype.info/images/uterus.gif

First image third spoiler http://www.secondtype.info/diags/pregnancyhormones.jpg

second image third spoiler http://www.secondtype.info/diags/preg7.jpg

flyinhernikes · Aug 12, 2012

i never even knew womb transplants existed, thats amazing! (!)

Zontar · Aug 12, 2012

Not to be a downer but I don't think regular uterus transplants are going to happen in anyone's current lifetime. The barriers, even for genetic females, are huge and would indicate highly dangerous procedures for otherwise healthy individuals.

Needless to say, this is not the way forward. I think a far safer and better option would be to have your husband seek a surrogate mother. Perhaps you can bank some sperm beforehand and have "one of each". This would probably be the safest approach; you still want to be around to actually see your children.

Fugs · Aug 12, 2012

I don't really care how dangerous it is for me. If the embryo implant is successful this September it will mean that it's completely possible and a lot safer than previously thought.

prism · Aug 12, 2012

Zontar said: ↑

Not to be a downer but I don't think regular uterus transplants are going to happen in anyone's current lifetime. The barriers, even for genetic females, are huge and would indicate highly dangerous procedures for otherwise healthy individuals.

Needless to say, this is not the way forward. I think a far safer and better option would be to have your husband seek a surrogate mother. Perhaps you can bank some sperm beforehand and have "one of each". This would probably be the safest approach; you still want to be around to actually see your children.
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I'm going to have to agree. Plus, even if Mrs. Sert's surgery is successful, it doesn't mean the procedure will be legally available in any other country, especially the U.S.

& you should care how dangerous it is for you... You'd be a mother delivering a high-risk baby after a dangerous transplant surgery. Dying after giving birth doesn't exactly affirm the safety of the procedure.

It is interesting though. Thank you for sharing.

J Snow · Aug 12, 2012

This would be wonderful, and I don't doubt it will happen eventually. However, I highly doubt it will be available early enough to make a difference for any us.

Fugs · Aug 12, 2012

Yeah whatever, it wasn't worth the space to post. I'm just not a real person. fine

J Snow · Aug 12, 2012

Fugs said: ↑

Yeah whatever, it wasn't worth the space to post. I'm just not a real person. fine
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=( I'm glad you posted it! It really does seem optimistic. I just don't want to get my hopes up =/

MusicIsLife · Aug 12, 2012

I mostly skimmed the article, but I wonder if similar tests are being done for trans men, except a penis transplant instead. I suppose we'll see.

Hengrove22 · Aug 14, 2012

I can't see why you would go through all that danger and pain when you can adopt? There are literally thousands needing adoption.

Fugs · Aug 14, 2012

Hengrove22 said: ↑

I can't see why you would go through all that danger and pain when you can adopt? There are literally thousands needing adoption.
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I'm not shoving adoption. I'm willing to adopt; but I'd rather have my own child.

I want to sit there in my husband's arms with our hands on my stomach thinking of names you know? The intimacy that comes with carrying a child and seeing them take their first breath is so important to me. I, like a lot of women, dream of it. I don't know what to tell you, it's fine that you don't understand but you're a guy. I wouldn't expect you to

starfish · Aug 14, 2012

You know I understand how you feel. I too really wish I could carry a child.

I think it is really cool this is being researched. Not to mention how f$%#ing awesome it will be once we pull this off.

Bree · Aug 14, 2012

Fugs said: ↑

Yeah whatever, it wasn't worth the space to post. I'm just not a real person. fine
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Hey, how does not being able to carry your own children not make you a real person? I don't think that anyone is trying to demean you, they just don't want you to get your hopes up.
I hear how hard it is. Sometimes I just stand in front of the mirror and cry, because I'll never be whole. I promise you though, I'm going to make sure the world knows I'm real.

redstormrising · Aug 14, 2012

Fugs said: ↑

I don't really care how dangerous it is for me. If the embryo implant is successful this September it will mean that it's completely possible and a lot safer than previously thought.
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that something is possible does not necessarily mean that it is safe - do not confuse the two. also, you may not care about the danger to yourself -- although arguably, you should, if you want to survive to raise your child -- but what about the potential danger to your unborn child? i would hope that if there was a high risk of harm to the unborn baby, you would put his/her health and safety above your own desire to carry him/her.

if this becomes possible and it is safe, great. but i wouldn't discount all risks to get there. and not being able to carry your own child doesn't make you less of a person. i have a health condition that would make it dangerous for both me and the baby if i were to become pregnant, so i can't do it. i don't consider myself any less than the next woman.

Hot Pink · Aug 14, 2012

Hengrove22 said: ↑

I can't see why you would go through all that danger and pain when you can adopt? There are literally thousands needing adoption.
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Because I've dreamed of getting pregnant and being a birth mother since I was a little girl. That's why. Just thinking about how I'll never have that gift of being someone's natural birth mother is heartbreaking. I cry about it sometimes, like now.

Hengrove22 · Aug 15, 2012

I'd completely disagree with you, anyone who wants children would love to have the option to give them the best start in life with thE most normal type of birth and be able to create a genetic baby purely from two peoples love.

But thats life. Thats anatomy. That's what straight people do.

LGBT have the advantage of being able to adopt and this is an amazing opportunity to genuinely change a child's life rather than having one sewn to your abdominal muscles. I'm from the UK and know this will never be an option, it is too ethically contraversial as well as expensive and un needed.

My cousins wife couldn't carry childrn biologically. She got over it. They adopted. They are happy.

Be thankful that you are in a country that accepts LGBT+ and gives them the rights to adopt.

GreenRaven · Aug 15, 2012

look, i know you guys are more than welcome to disagree with her wanting to be able to have a baby thing...but do you really have to be so harsh? she merely posted an article about this research being done, and said that it gave her hope that she might be able to have this lifelong dream of hers fulfilled....and you go and start saying how it will never happen in this generation, or that she should just not take any risks and adopt or find a surrogate...essentially saying she should just not even try to reach for her dreams

how the hell do you think medical advancement happens? people take risks. before they do so, however, they are fully educated on anything and everything that can possibly happen, and they are given the option to decline if they so wish. she's not saying that if the next step of this research results in a positive outcome, she's gonna go get it done right away. jesus.

i think it's amazing that research has come this far on this particular subject. i didn't even know they WERE doing research on this, and anyone who takes part in advancing things like this are a hero in my book. paving the way for the future. this will never come to pass if people DON'T take risks, so don't try and talk her out of it just because it might not come to pass with this generation. it will NEVER come to pass if people like her didn't exist.

so back off, and let the lady keep her dreams alive.

<3

Hot Pink · Aug 15, 2012

I don't understand why people are getting so argumentative over this. So we want to be able to get pregnant, what's that have to do with you? So what if I want to be be able to get pregnant, feel another life within me, give birth, and hold a baby in my arms that came from me? How is that a negative thing? Why do you hate it so much? I would do anything for that. Anything. It's not up for disagreement. I'm sure Fugs would agree with me and nearly any other MTF.

castle walls · Aug 15, 2012

I also didn't know that any research was being done on this subject. You never know. This research could lead to a breakthrough. I really hope it paves the way for advancement in the future

starfish · Aug 15, 2012

Hot Pink said: ↑

I don't understand why people are getting so argumentative over this.
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You know I think this is one of those thing where if you don't have these desires you just don't get it.

Now don't get me wrong. I think adoption is a wonderful thing. If I have decide to have kids I would adopt wrong because kids do need a loving caring home. That still dosen't change this deep desire that I have to be able to carry a child. I've resigned myself that I will never be able to.

Transsexual pregnancy for those of you interested.

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