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"I want to have a baby... " Note: Before you email me... none of the women pictured on this page are transsexual - as far I know! Surgical and medical advances have brought huge benefits to the transsexual woman over the last 50 years. For the male transsexual wanting to become female, hormone treatment provides huge physical and mental benefits, and it's now become fairly routine surgery to make effective female genitalia that permit her a normal sex life - other than pregnancy. The situation has now been reached where after Sex Reassignment Surgery it is sometimes impossible to distinguish a genetically XY male-to-female (MTF) transsexual women from a XX women without an intimate medical examination. Indeed, many transsexual women lead their lives without their friends, work colleagues, and sometimes even their husband or partner, ever having any inclination of their sex re-assignment.
However, this potentially relatively satisfactory situation is still marred by the inability of transsexual women to bear children due to their lack of internal female reproductive organs. While some transsexual women admit that they have absolutely no desire to bear children, at the other extreme a few - perhaps especially younger women (many older transwoman have previously have been fathers) - 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. Paraphrasing one frustrated young [British] MTF transsexual "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. Just ten years ago the idea of a genetically XY "male" (be they a transsexual woman or a non-transsexual man) having a baby was still science fiction, but soon it may be science fact - advances in fertility treatment are starting to hold out great hope. It could be only a few years before the first transsexual woman gives birth - assuming that someone desperate enough and rich enough hasn't very quietly done so already.
Before going any further it is necessary to consider, very briefly, what are the internal female reproductive organ? The normal female reproductive organs include the vagina (a muscular passage that connects the cervix with the external genital organs - one of which is a sensitive mound of tissue called the clitoris), the cervix (the lower part of the uterus that separates the body of the uterus from the vagina), the uterus (a hollow, muscular structure), the ovaries (two glands that produce certain hormones and contain tissue sacs in which eggs develop), and fallopian tubes (two muscular channels that connect the ovaries with the uterus). Finger-like projections called fimbriae (located at the opening of the fallopian tubes) sweep an egg released from an ovary into the tube where it can be fertilised by sperm before passage in to the uterus (womb) where it may settle and grow in to a baby. Additionally of course, women have a unique secondary sexual characteristic that becomes important after giving birth, their breasts.
Uterus Transplants There are two main approaches being researched which would allow a transsexual woman to become pregnant, the first and currently the most promising being by means of a uterus (aka womb) transplant.
Dr Brännström of Sahlgrenska University notes that uterine transplants would have major advantages over surrogacy - the main option for women without wombs (including transsexuals) who want to start a family. "There is no question about who is the mother: she is gestationally, genetically, socially and legally the mother. She can also control lifestyle factors such as smoking and drinking alcohol, and the mother is the one who takes the health risks with every pregnancy". Until the 1990's uterus implants had not really been 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. Transplant patients often require large quantities of drugs to suppress their immune system and prevent rejection of the transplant, and most of these drugs are harmful to the early foetus development during a pregnancy.
The technique has already successfully carried out on pigs. Dr Smith, is hoping the technique will become a routine treatment within the next few years, said the donor uterus' would come principally from women having hysterectomies, but could also be donations from mother to daughter or sister to sister. He plans trials with would-be mothers as early as 2002, but this has been rather pre-empted by a paper first published in the International Journal of Gynaecology and Obstetrics in March 2002 that doctors in Saudi Arabia had already 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.
Dr Wafa Fageeh - a professor at Abdulaziz University who performed the transplant with her team at King Fahad Hospital and Research Center in Jeddah, Saudi Arabia - called the operation "a good start" and said the technique could be a useful treatment in the future for infertile women without a womb whose only other chance of having children was through surrogacy. "Further clinical trials and development of the surgical techniques could make uterine transplantation useful in the treatment of infertility, especially in communities where the surrogate mother concept is unacceptable from a religious or ethical point of view" she stated. The Saudi approach has been avoided since while researchers sought better ways of "pluming" 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 technique has already been demonstrated by producing dozens of healthy mouse pups from females with donated wombs and Dr Brännström says that the first human transplants are expected by the end of 2005, if these are successful then pregnancies could follow soon after. 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 dont 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 late 2006 a series of hospitals announced plans to conduct womb transplants in the near future. Richard Smith, a gynaecological cancer surgeon, at Hammersmith Hospital in the UK said "We have had stunningly good results in the laboratory with good blood supply to the organ. We hope to move into human subjects within the next one to two years. The transplant would only be temporary, maybe for two or three years to allow the woman to have children, and then it would be removed to avoid the risks associated with a lifetime of immunosuppressant drugs."
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. Any child would have to be delivered by Caesarean section because the transplanted womb is unlikely to be able to withstand the forces involved in natural contractions and labour. Michelle Harvey, from support group Couples Having Infertility Problems Solved, said: "There are so many people who have ... have been told there's no hope. This is a breakthrough for women like them. It sounds drastic but people get to the stage where they would try anything." In yet another recent development, doctors have created the first artificial womb lining. The specialists involved, from Cornell University's Weill Medical College in New York, have revealed that their final goal is to create an entire womb, this would let transsexual women carry babies themselves in artificial uteruses. In April 2007 it was revealed by Dr Brännström and
his colleagues at the Sahlgrenska Academy that they had now carried out autologous womb transplants (i.e. the
same womb is removed and replaced) in 14 sheep, reconnecting the womb to
different blood vessels. Four sheep had become pregnant after having
their wombs removed and then reconnected, with their lambs to be delivered
by Caesarean, but half of the sheep in the
study developed fatal complications. The team now plan to carry out a womb
swap between two ewes. It certainly now appears that medicine is close to first successful human womb transplant and pregnancy - with the New York Downtown Hospital publicly admitting that it is hoping to perform the procedure, and others undoubtedly seeking the same more quietly.
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.
There are though two main catches to this procedure:
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
Website Genetic Parentage Up until our current time, embryos have always been formed by the union of a sperm (supplied by a XY male) and an egg or ovum (supplied by a XX female). Both the sperm and the ovum provide DNA, but the ovum also provides a “house” in which the embryo grows during the early stages of development. An ovum is therefore absolutely essential for reproduction. A post-SRS transsexual woman faces two major problems in passing her genes on to a child, regardless of whether this is to be carried by a surrogate mother or [in the future] by the transsexual woman herself. Firstly she lacks her own ovaries to produce ovum containing her genes, and secondly having a baby with her husband or a male partner would involve the genetic union of two males - known as "same-sex parenting". One method for providing the embryo to be implanted is to obtain an egg from an unrelated woman and have it fertilised by sperm from the husband or partner. But while this method is already occasionally used (the baby being carried to term by a surrogate mother), this approach is unsatisfactory for transsexual woman as she has no genetic relationship with her baby.
In the next few years there may become available several new and exciting options which use a cloning technique called "membrane fusion" to create a fertilisable egg:
And finally, the most advanced and technically challenging option of all:
Approach 4 is perhaps the most promising in the short- to medium-term. On 5 Sept 1999 the UK's Sunday Times reported a major advance by a team headed by Zev Rosenwaks at the Cornell University Medical Center, New York. They had been able to take immature egg cells from the ovaries of a donor, remove the nucleus (containing the donor's genetic material) and replace it with genetic material taken from an ordinary body cell of another animal. The researchers have found they can reprogramme the DNA genetic blueprint from any living cell to make it behave like an unfertilised egg. The donor egg cell thus acts as an "envelope" for the prospective genetic mother's genetic material. Once the reconstituted egg cell is mature, it could be fertilised in the laboratory using IVF techniques and the embryo then implanted in to the womb or abdomen of the mother. Rosenwaks said: "We are primarily working with animals, but the work is also being pursued in humans. We have no human pregnancies yet.". In June 2001 the fertility researchers from Cornell University reported that they had now created viable manufactured human eggs using human eggs donated by women undergoing in-vitro fertilization. The experimental procedure uses genetic material from a cell taken from the infertile woman and transplants that material into a donor egg, which has had its genetic material removed. The process is somewhat similar to the cloning technique that was used to create Dolly, the first cloned sheep. There is, however, a crucial difference: Cornell is using only half of the genetic code contained in the adult cell - that of the mother. All adult cells carry two sets of chromosomes, one from the mother and a second from the father, so half have to be removed before fertilisation can occur. To do this, the researchers harness the natural ability of the egg to make this happen, using a tiny electrical current, or chemicals, to activate the process of splitting the normal cell's nucleus in half. One half is then taken away so that the reconstructed egg will - according to Professor Palermo, who an assistant professor at the Center for Reproductive Medicine and Infertility at Cornell University Medical Center - "closely resemble a natural, mature human egg", which has only one set of chromosomes. However success rate is low, out of 200 attempts, 17 of the eggs were "haploidised" or made to have the correct number of chromosomes. The second set of chromosomes will come from the fathers sperm, which also only carries a single chromosome set. To fertilise the eggs, sperm would have to be injected through the cell wall just before the electric shock. The Cornell team has not tried human eggs, but has tried fertilising artificial mice eggs with some success.
Dr Ursula Eichenlaub-Ritter, who is a professor of gene technology at the University of Beilefeld in Germany, says that Palermo's technique has the same problems as cloning: It requires many, many failed experiments before a viable egg is produced. She says that she doesn't think the technology is an efficient way to produce this kind of egg.... "I don't see success in the near future.". Dr Palermo thinks that clinical trials on human women are perhaps still 5 years away. It has become clear (as of June 2002) that the increasingly common animal clones are subject to various genetic problems. It is also expected that while humans may well be cloned imminently, the resulting progeny will be subject to similar problems. There is also no reason to believe that the cloning related reproductive techniques just described above won't suffer such problems. However, it is also reasonable to expect that improvements in cloning techniques and new procedures will eventually overcome these issues.
Breastfeeding is in fact normally strongly recommended by doctors, it is by far and away the best and most convenient way to feed a baby. Not only will the baby be healthier, but it also helps the new mother lose weight more easily. Calories are burned during milk production; indeed some of the weight gained during pregnancy is intended to be used during lactation.
Breast augmentation, common in transsexual women, does not normally prevent breast feeding. The main reason that breastfeeding may not be recommended or encouraged by the physician is if the drugs and other hormones being taken by the mother may make the milk unsuitable for nursing. It's very probable that the pregnancy and birth, and the associated hormone levels, will in itself be enough to induce lactation in the mother. Inducing and maintaining lactation requires:
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Copyright (c) 2007, Annie Richards
Female
Reproductive Organs
With a
transsexual woman who has had good quality sex re-assignment
surgery (SRS), her vulva (external genitalia) - including the
clitoris and its hood and the opening to the vagina with its lips
- should be visually indistinguishable from other
women. However, the neo-vagina does not lead on to a
cervix. Indeed the cervix, uterus, ovaries, fimbria and
fallopian tubes are all missing. Transsexual woman can
though have natural (hormone induced) breast development ranging
from the slight to full, although as typically their breasts are
smaller than genetic women about 50% of transsexual women have
breast augmentations.
It is very
unlikely in the near future that a transsexual women will be able to have
transplanted in to her the full and very complicated reproductive
apparatus of a normal fertile woman. Certainly it is possible to
transplant individual organs but transplanting ovaries, fallopian tubes,
uterus et al - and then establishing ovulation, periods and
fertility - would be very major task, if not impossible. Far
more realistic is transplanting only the uterus, this is after all 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. And if a uterus
can be successfully implanted in to a genetically female woman for
fertility reasons (as is increasingly anticipated), there is no reason why the same cannot be done for a
genetically male transsexual woman. 
It was
once 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 recent
research has suggested that with the low-contradiction immunosuppression treatments now available,
uterus implants are possible as long as they are not long term. It would only
be necessary to avoid rejection of the uterus for some 30 weeks without
resorting to drugs likely to harm the foetus for a viable baby to
develop. Indeed, it was 
The
experiment indicated that a womb transplant was technically
achievable. "The fact that the patient developed an acute
vascular thrombosis (blood clotting) and required a hysterectomy is not
the equivalent of a clinical failure," Louis Keith of Northwestern
University Medical School and Giuseppe Del Priore of New York
University Medical Center said in an editorial in the same
journal. Peter Bowen-Simpkins, a doctor and spokesperson for the Royal
College of Obstetrics and Gynaecology in Britain, said that the
research was exciting and a major medical advancement. When asked if
he thought that it could be a treatment for fertility he said: "It is
an inevitability, but it is three to five years off."
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. 
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! 
However, there
are several other options that a transsexual woman can take in order to be
genetically related to her baby:
Clearly great
progress is being made with this technique which offers considerable hope
to transsexual women, but there are still some major potential
problems. If sperm is not available then there is concern that using
"old" DNA from cells in the mother's body could mean that the
new-born baby was the genetic age of the mother. Studies of Dolly
the sheep, the first animal to be wholly cloned, suggested that her cells
were much older than her chronological age - she prematurely suffered from
many medical problems normally associated with old age, and finally had to
be put down in 2003 while still relatively "young". Also,
some genes are chemically labelled as coming from the mother or the father
- a process called "imprinting". These labels would have
to be changed, otherwise the resulting embryo would be defective.
Finally there are problems with the sex chromosomes, it is possible to
produce embryos with an abnormal set of sex chromosomes and it would for
example be necessary to screen the individual sperms to make sure the
right combination of sex chromosomes was used. But this would have
the bonus of letting the couple choose whether to have a son or a
daughter.
Nursing
Not
a lot of milk will be produced unless suckling is frequent and
consistent, about every 2-3 hours. Less stimulation than that,
say once every 5-8 hours, will result in dramatically less milk
production. Even less than that will result in complete
cessation of milk production some 1-3 weeks after it
starts.
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