Sperm Freezing in Transsexual Women

Abstract

Gender Identity Disorder (GID) is a condition in which a personexperiencesdiscrepancybetweenthesexassignedatbirthandthegendertheyidentifywith.TranssexualismisconsideredthemostextremeformofGIDandischaracterizedbythedesiretoliveandbetreatedasamemberoftheoppositegender.Theprevalenceofmale-to-female transsexualism in Belgium is estimated at 1 per12,900males(DeCuypereetal., 2007).Thetreatmentconsistsofcross-sex hormone therapy and sex reassignment surgery inaccordancewith the Standards ofCare of the World ProfessionalAssociation for Transgender Health (WPATH) (7th Version)(www.wpath.org). At the center in Ghent, male-to-female trans-sexual persons, denoted as transsexual women, are treated in amultidisciplinaryapproach,includingcross-sexhormonetherapyand sex reassignment surgery for most. Hormone therapy withanti-androgens and estrogens is used in the majority of transsex-ual women. After at least 1year of hormonal therapy, sex reas-signment surgery can be offered, which includes orchidectomyandpenectomyincombinationwithvaginoplasty(Selvaggietal.,2005).Bothhormonalandsurgicalinterventionsnegativelyaffectthe male reproductive system. Hormonal therapy itself leads todecreased spermatogenesis and eventually to azoospermia(Lubbert, Leo-Rossberg, & Hammerstein, 1992; Schulze, 1988).Currently, it is unknown whether spermatogenesis will restoreafter prolonged estrogen treatment or not (Hembree et al., 2009).Sex reassignment surgery, on the other hand, results in an irre-versible loss of natural reproductive capacity in transsexualwomen.Current reproductive techniques can offer adult transsexualwomen the possibility of having ge netically related children (DeSutter, 2001). They can store their sperm for long-termcryopres-ervation before undergoing hormonal therapy for future use inassisted reproductive techniques (ART). Sexual orientation oftranssexual women may influence the future plans for using thefrozen sperm. If transsexual women have a female partner, theycan procure children through intrauterine insemination, in vitrofertilization or intracytoplasmic sperm injection, based upon thespermquality after thawing. Reproductive options for trans-sexual womenwithamalepartneraremoredifficultastheyneedoocytedonationaswellasasurrogatemother.Reproductive needs and rights of transsexual persons havealready been recognized for over 15years (Lawrence, Shaffer,Snow, Chase, & Headlam, 1996) and since 2001 the WPATHStandards of Care contains a paragraph that addresses the needto discuss reproductive issues with transsexual persons, prior tostarting hormonal treatment (Meyer et al., 2001). Also, the newWPATH Standards of Care (Seventh version) (2011) as well asthe Clinical Practice Guidelines of the Endocrine Society(Hembree et al.,2009) clearly state that transsexual personsshould be encouraged to consider fertility issues before startingcross-genderhormonaltreatment.Ontheotherhand,researchonthis topic is still scarce. In the past 10years, only two studieshave investigated the opinionsoftranssexualpersons themselvesconcerning this topic (De Sutter, Kira, Verschoor, & Hotimsky,2002;Wierckxetal., 2012)andfewhaveaddressedreproductivedifficulties(e.g.,accesstoARTintranssexualpatients)(Alvarez-