ReproTech, Ltd., the industry leader in safe storage of cryopreserved reproductive tissue, and Fertility Preservation Trust, a venture of Ashley W. Pittman, PLLC, have come together to offer the opportunity to create a special trust to reflect unique disposition wishes for families’ frozen reproductive tissues.
Fertility Preservation Trust, a recent addition to ReproTech services, connects reproductive tissue storage clients, including cancer patients storing for the purpose of fertility preservation, with Ashely W. Pittman, PLLC, founder of The Fertility Preservation Trust. As the leader in long term storage, ReproTech is offering this latest innovation in cryostorage planning. The Fertility Preservation Trust is a special legal document which allows clients to preserve and protect their reproductive material exactly as they wish.
The Fertility Preservation Trust is personalized to reflect the unique maintenance and disposition wishes of clients today and allows for future amendment of the trust to conform to changing life circumstances. By establishing a special trust for frozen embryos, eggs, sperm, or reproductive tissue, the client gains flexibility, control, and protection for the future.
Due to the long-term nature of cryopreservation, there are many options to consider concerning future maintenance, use, and disposition.The Fertility Preservation Trust team can help families navigate and explore their options for the future and clearly state their wishes in writing, providing peace of mind.
About Ashley W. Pittman, PLLC – Fertility Preservation Trust
Ashley W. Pittman has combined her knowledge of tax law, asset protection, and fertility law in her practice with the law firm of Ashley W. Pittman, PLLC. She also serves as Of Counsel attorney with the Reproductive Law Center, Inc. and the International Fertility Law Group, Inc., both located in La Mesa, California. She has traveled throughout the country to educate lawyers and judges about the legal issues surrounding fertility and surrogacy law.Ashley is a member of the American Bar Association (Member, Family Law, Assisted Reproductive Technology sections); Mississippi State Bar (member, Taxation and Probate sections); the Capital Area Bar Association; professional member of Resolve, the National Infertility Association; the American Society for Reproductive Medicine (Member, legal professionals group).To learn more and begin customizing your trust, visit www.trustfertility.com
The summer after high school, Kacey Cabanban came out as transgender and was about to begin the transition to live as a man.
But first the teen who grew up in north suburban Wauconda faced one more weighty choice: whether to preserve his fertility — having his eggs harvested and frozen — prior to starting hormone therapy.
“The idea of having my own kids with my own eggs was, I guess, a pretty easy decision,” said Cabanban, now 21 and a junior at Michigan State University. “Even just having the option available … I knew I wanted to do that.”
Historically, many transgender people simply accepted potential loss of biological fertility as the price they paid to live according to their gender identity, which can involve hormone regimens and surgeries that might damage or destroy fertility.
But this mindset is shifting with advancements in assisted reproductive technology, many rooted in cancer treatment, said Diane Chen, a pediatric psychologist with the Gender and Sex Development Program at Ann & Robert H. Lurie Children’s Hospital.
Lurie began incorporating discussions of fertility and family planning into standard counseling for transgender and gender nonconforming youth about four years ago, drawing from the hospital’s already-established fertility preservation program for pediatric cancer patients, as cancer treatments can also affect fertility.
Cabanban was among the first of Lurie’s transgender patients to undergo fertility preservation, which is still a fairly uncommon practice.
Of 105 transgender adolescents treated at Lurie from 2013 to 2016, only 13 decided to see a fertility specialist for a formal consultation and five had their sperm or eggs frozen, according to a study published in the Journal of Adolescent Health in July.
In a survey of transgender patients in Toronto, 21 percent of childless respondents expressed interested in having kids but many said they lacked information about their fertility options or had never discussed the issue with a physician. Only 3 percent said they had sperm or eggs banked before starting hormone treatments, according to the research that was led by an endocrinologist and assistant professor at the University of Toronto and reported last year.
The British Fertility Society issued guidelines in January that medical providers discuss fertility implications with patients making the transition from female to male and, when appropriate, have eggs or ovarian tissue preserved as early as possible in treatment. The ethics committee of the American Society for Reproductive Medicine in 2015 recommended fertility preservation options be offered to all patients before a gender transition.
“Trans people are just as interested in having children as other people,” said Timothy Murphy, a professor of philosophy in the biomedical sciences at the University of Illinois College of Medicine at Chicago who has written on the topic.
Even with counseling, Chen said it can be difficult for young patients to contemplate their fertility a decade or more before they might want to conceive, without knowing what new reproductive options might emerge. Expense is also a barrier, with fertility procedures and storage fees potentially costing thousands of dollars and typically not covered by insurance.
For some, the intimate and invasive aspects of retrieving sperm and eggs can also magnify feelings of gender dysphoria, an intense discomfort with one’s biological sex.
“It’s not easy emotionally, it’s not easy physically,” Chen said. “Weighing the benefits and costs, that’s going to be different for each young person. How important is biological fertility to each young person — and how distressing would that process be?”
‘Making things better’
Cabanban remembers childhood nights lying awake in bed with his hands folded.
“I would pray to God to wake up a boy,” he said.
Whenever he played house with other little kids, he always wanted to be the dad. At 13, he typed “I’m a girl but I feel like a boy” into an online search engine and the word “transgender” appeared.
He kept the label to himself for roughly four years, before coming out to his parents and sister in 2015.
“I was never scared of anyone’s bad reaction,” he said. “Just the action of doing it was terrifying to me.”
Internet research taught him so much, from how to change a name legally to what side effects hormone therapy can cause. But he was surprised when Chen brought up his fertility, something he’d never thought of in relation to a gender transition.
Until about five years ago, egg banking was considered experimental, but this changed with improvements to freezing and thawing techniques.
Harvesting the eggs was a physically taxing process, requiring several weeks of daily estrogen injections that felt counter-productive to Cabanban, who longed to look and feel more masculine.
The day they were retrieved was one of the most uncomfortable moments of Cabanban’s life. With his still-feminine form covered in only a thin paper sheet, he watched his eggs on the ultrasound screen, white orbs that felt like foreign objects trespassing in his body.
The outpatient surgery was performed on Father’s Day. Around 20 of his eggs were harvested and remain frozen in a warehouse in Minnesota, waiting.
Now that they are no longer inside him, Cabanban says he views the eggs only as a tool for reproduction, the potential to pass down his DNA; that they are female in nature doesn’t really bother him.
Chen says this isn’t the case for everyone.
“There’s been some research … of adult transgender individuals who have reported that it’s difficult for them to leave behind their birth-assigned sex and live authentically in their affirmed gender knowing they have eggs or sperm — something that doesn’t match or isn’t in alignment with their gender identity — saved,” she said. “That idea to them didn’t feel right or was distressing.”
Cabanban hopes to one day have a hysterectomy and sex reassignment surgery, which would render him infertile. He doesn’t know if he’ll ever have biological children, but he’s grateful for the option.
Perhaps someday he’ll get married, he said, and his wife will carry the eggs he saved in her womb.
“I want to teach my kids what my parents have taught me,” he said. “My dad always says … you want to take the mistakes your parents made and make it better for your kids, and just keep making things better and better as life goes on. I want to take what I learned from them and try to make things as good as I can for my kids and future generations.”
Chen said it’s often the parents of patients who broach the topic of fertility.
Cabanban’s mother, Carolyn Cabanban, recalled some of her first words to her son after his eggs were harvested.
“I’m a grandmother,” she said.
Concept of parenthood
It was during middle school that Juniper Schenone of Naperville realized her sense of self and then-male body were in conflict.
“Imagine waking up every single day and you look in the mirror and you just feel off,” she said. “You didn’t really know why, but you look in the mirror and you would just not like what you see, and you want to change things about yourself.”
By high school, she identified as a transgender woman, growing out her hair and wearing makeup and dressing more femininely.
Schenone, 18, went on estrogen in August before starting as a freshman at Columbia College. She was in a long-term relationship when she began treatment at Lurie, which she says gave context to her decision to bank sperm over the summer.
“Biological fertility was definitely important to me, having the availability to pass down my genes and have that emotional connection,” she said.
Although she lives as a woman, Schenone said she identifies more with the concept of parenthood than motherhood.
“Because I feel motherhood sort of has the process of being pregnant and going through that state, through the nine months, that gives you that connection with your child,” she said. “Whereas I’ll never be able to experience that.”
While Schenone said these physical limitations don’t bother her— she’s not even sure she’d desire to carry a child or give birth — Chen said this can be painful for others.
“I have had some of my younger trans girls — these are 9-, 10-, 11-year-old birth-assigned boys who identify and are living as girls — they really associate motherhood and being pregnant with being a girl, a woman,” she said. “And that’s a difficult conversation for us as practitioners and also for parents to navigate with youth, in terms of what it means to be a parent and what it means to be a mother.”
Some youth are hoping for scientific and medical breakthroughs by the time they’re ready to start families.
Very young transgender patients sometimes freeze tissue from their ovaries or testes for later use, a method that’s still considered experimental. In November, a woman with a uterus transplant delivered a healthy baby boy at Baylor University Medical Center at Dallas, another highly experimental procedure.
Scientists at Northwestern University Feinberg School of Medicine announced recently that they’d created 3-D printed bioprosthetic ovaries allowing mice to ovulate, give birth and nurse their young, said Teresa Woodruff, director of the Women’s Health Research Institute at Northwestern. The hope is to restore fertility and hormone production in cancer survivors, but transgender patients might also one day benefit.
While these prospects are exciting, Chen said she tries to focus on technology that’s available today when helping youths make decisions, because she doesn’t want to give them false hope. Even though discussing fertility is important, Chen also explores different forms of parenthood with patients, including adoption and surrogacy.
“We know there are a lot of different ways to have a family,” she said. “Biological parenthood is just one of those ways.”
In 2012, the American Society for Reproductive Medicine finally lifted the “experimental” tag from egg freezing, since the process had become safe and extremely effective for using harvested eggs for in-vitro fertilization. Now it seems that egg freezing is all the rage with working women across the U.S., but why? Is it because working women are simply focusing on their careers right now? Is egg freezing cheaper than having a baby? Have they not had the time to find the right mate? Is it because of Google, Apple and Facebook? The answer is yes.
Women Freeze Their Eggs To Allow for Career Advancement
For working women, the effort and focus required to advance their career in today’s fast paced business world doesn’t leave a whole lot of time for raising a baby. Many women looking to climb the corporate ladder and break through the glass ceiling, place having a child behind their careers. That’s why so many women are now choosing to freeze their eggs — leaving the option of motherhood available at a later date. And as it turns out, giants of the corporate world such as Apple, Google and Facebook support their female employees’ decision to freeze their eggs and they’re paying for it. These companies and many others are now gladly paying for the perk of having their female employee’s eggs frozen. This benefit helps younger female employees’ who want to further their career in their 20s, but want to avoid the risks that come with delaying childbirth into their 30s and sometimes 40s. Many call it a win-win, since the female employee gets to preserve her desire to start a family, while the employer gets a laser-focused and career driven worker. So yes, we now live in a world where casual Fridays, free beer and free egg freezing are the corporate perks of the day. Obviously we think that’s pretty great.
Freezing Your Eggs Is Cheaper Than Having A Baby
Despite what you may have heard from egg freezing centers in large cities such as New York, Miami and Los Angles, the shipping, freezing and storage of a woman’s eggs can be affordable. This fact especially rings true when you factor in that it costs approximately $30,000 a year to raise a baby in large cities such as Manhattan. Freezing your eggs and storing them with ReproTech — the safest and most cost effective cryostorage company on earth (sorry had to throw that in there) — costs a fraction of that $30,000 price tag. So for many financially responsible women, it makes a lot of sense to store their eggs now and start a family when it won’t break the bank.
Why Wait? So you can find the right mate!
No one wants to settle. No one wants to settle for a job they dislike and no one wants to settle for Mr. Right Now, when Mr Right could be a few years down the road. A significant portion of working women who choose to freeze their eggs do so because their work life has not left a whole lot of time to find the perfect partner. By freezing their eggs, working women have time for focus on their career and time to pursue a healthy and lasting relationship, without the added pressure of that ever-ticking biological clock.
To find a freezing center near you, please click on the link below.
March 21, 2019/ Source: Associated Press – For the first time, scientists used cryogenically frozen testicular tissue from monkeys to produce functional sperm, which was then used to produce a healthy macaque infant. This experimental method could one day provide a way to preserve fertility in boys treated for cancer—which often results in infertility that lasts into adulthood.
Scientists are closing in on a way to help young boys undergoing cancer treatment preserve their future fertility — and the proof is the first monkey born from the experimental technology.
More and more people are surviving childhood cancer, but nearly 1 in 3 will be left infertile from the chemotherapy or radiation that helped save their life. When young adults are diagnosed with cancer, they can freeze sperm, eggs or embryos ahead of treatment. But children diagnosed before puberty can’t do that because they’re not yet producing mature eggs or sperm.
“Fertility issues for kids with cancer were ignored” for years, said University of Pittsburgh reproductive scientist Kyle Orwig. “Many of us dream of growing up and having our own families. We hope our research will help these young patients to do that.”
Orwig’s team reported a key advance Thursday: First, they froze a bit of testicular tissue from a monkey that hadn’t yet reached puberty. Later, they used it to produce sperm that, through a monkey version of IVF, led to the birth of a healthy female monkey named Grady. The technique worked well enough that human testing should begin in the next few years, Orwig said.
“It’s a huge step forward” that should give hope to families, said Susan Taymans of the National Institute of Child Health and Human Development, which helped fund the research published in the journal Science. “It’s not like science fiction. It’s something that seems pretty attainable.”
University of Pittsburgh Medical Center and a handful of other hospitals already freeze immature testicular tissue from young cancer patients, in hopes of knowing how to use it once they’re grown and ready to have their own children.
Boys are born with stem cells inside little tubes in the testes, cells that start producing sperm after puberty’s testosterone jolt. Orwig’s goal: Keep sperm-producing stem cells safe from cancer treatment by freezing small pieces of testicular tissue, and using them to restore fertility later in life.
How? Enter the monkey research.
Orwig’s team froze tissue from young male monkeys, and then sterilized them. Once the monkeys approached puberty, the researchers thawed those tissue samples and gave them back to the original animal — implanting them just under the skin.
“We’re not hooking it up to the normal plumbing,” Orwig cautioned.
Boosted by hormones, the little pieces of tissue grew. Months later, the researchers removed them. Sure enough, inside was sperm they could collect and freeze.
Colleagues at the Oregon National Primate Research Center injected some of that sperm into eggs from female monkeys and implanted the resulting embryos. Last April, Grady was born, and “she plays and behaves just like every other monkey that was grown the normal way,” Orwig said.
If the technique sounds a little bizarre, it’s similar to a female option.
Girls’ eggs are in an immature state before puberty. Researchers have removed and frozen strips of ovarian tissue harboring egg follicles from young women before cancer treatment, in hopes that when transplanted back later the immature eggs would resume development. It’s considered experimental even for young adults but some births have been reported. Now some hospitals bank ovarian tissue from girls, too.
Surgery involving the boys’ testicular tissue is less invasive, noted Orwig, who also is researching ways to reinsert sperm-producing stem cells where they belong rather than the more roundabout technique.
The new research shows “immature testicular tissue may become an option” to preserve boys’ fertility, Nina Neuhaus and Stefan Schlatt of the Center of Reproductive Medicine and Andrology in Muenster, Germany, wrote in an accompanying editorial.
Meanwhile, “it’s important for parents to know about this,” said Christine Hanlon of Holiday, Florida, who took her son Dylan to Pittsburgh to have his tissue stored when he was newly diagnosed with Ewing’s sarcoma at age 9.
Today Dylan is a healthy teen, and no one knows if he’ll ever need the stored tissue, one of more than 200 samples Orwig’s study has preserved. But Hanlon was thrilled to learn the research is moving along, just in case.
“You lose part of your childhood in cancer treatment,” Hanlon said. “If there was a chance I could help him have normalcy in his future, with the potential of having a family if that’s what he decided to do, I wanted to be able to.”
Cryostorage tank failures: temperature and volume loss over time after induced failure by removal of insulative vacuum
Authors: Kimball O. Pomeroy, Michael L. Reed, Brian LoManto, Stanley G. Harris, W. Brent Hazelrigg, Dawn A. Kelk
To determine liquid nitrogen evaporation rates of intact liquid nitrogen storage tanks and tanks with their vacuum removed.
Donated storage tank performance (LN2 evaporation) was evaluated before and after induced vacuum failure. Vacuum of each tank was removed by drilling through the vacuum port. Temperature probes were placed 2 in. below the bottom of the styrofoam cap/plug, and tanks were weighed every 3 h. Evaporation rate and time from failure to the critical temperature was determined.
Storage tanks with failed vacuum have a much higher evaporation rate than those with intact vacuum; evaporation rates increased dramatically within 3 to 6 h in the smaller tanks, and time to complete depletion varied according to starting LN2 volume. Tanks with storage racks/specimens may have altered evaporation profiles compared to tanks without. Locating temperature probes 2 in. below the styrofoam cap/plug suggests that for most applications, alarms would sound approximately 1 h prior to reaching the critical warming temperature, approximately − 130 °C. External signs of vacuum loss were dramatic: vapor, frost, and audible movement of air.
For the first time, we have data on how liquid nitrogen storage tanks behave when their vacuum is removed. These findings are conservative; each lab must consider starting volume, tank size/capacity, function (storage or shipping), age, and pre-existing evaporation behavior in order to develop an emergency response to critical tank failure. Times to complete failure/evaporation and critical warming temperature after vacuum loss are different; these data should be considered when evaluating tank alarm systems.
A special thanks to those that donated tanks to this study: The World Egg Bank, Colorado State University’s Animal Reproduction Laboratory, ReproTech, Ltd, Yale Fertility Center, and Kaiser Permanente Center for Reproductive Health.
All authors contributed to the study conception and design and contributed to material preparation and data collection. All authors contributed to data analysis, with final review by KOP. All authors contributed to and had opportunity to comment on the original version of the manuscript.
Compliance with ethical standards Conflict of interest
There were no conflicts of interest reported by the authors, and no compensation was received by the authors for participation in this project. No commercial, State or Federal funding was utilized in this study; materials, monitoring devices, and tanks were available in-house or were donated for the purposes described in this manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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