Uterus Transplants: A New Era of Possibilities for Motherhood?

When the first baby was born from a transplanted uterus in the United States, at Dallas’s Baylor University Medical Center in 2018, the news was a ray of light for women who thought they’d never carry a child in their wombs. Such was the case for the 1 in 4,500 women worldwide born without a uterus, who suffer from a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome or for cervical cancer survivors who had to have their uteruses removed. This medical breakthrough finally meant that women like these, or other families with fertility difficulties, could finally fulfill their desire to experience a full pregnancy and have their own child.

In the case of trans men, born female at birth and who therefore still have uteruses, there have already been several cases in which they’ve had successful pregnancies and births in the U.S. without the need for a womb transplant. But now there is also hope for trans women, born as men and without uteruses, to carry a baby of their own in their transplanted wombs in the near future as well.

If you thought you’d never live to see a pregnant man in your lifetime, the future is closer than you think: in 2017 Dr. Richard Paulson, President of the American Society for Reproductive Medicine, said in an interview with The Telegraph, that the science is now available for trans women to receive donated wombs and attempt to begin pregnancy as early as “tomorrow.” Dr. Paulson also noted that trans medicine was now considered “mainstream” and that people who had undergone gender reassignment surgery would inevitably want to take advantage of uterine transplants.

Even for the most open-minded of people the thought of men with baby bellies opens up a Pandora’s Box of ethical questions regarding the once sacred role of women in the realm of reproduction. This would mean creating a newfound privilege for men in our society to not only father, but also carry and give birth to their own children. Is the world ready for this new and bearded face of motherhood?  Are women ready to share this privilege with their male counterparts?

Some feminists argue that men having babies would finally mean the end of female oppression that has come with women being the child bearers and caretakers of our society since the beginning of time. “If pregnancy becomes something that, with an extraordinary amount of heroic medical intervention, can be accomplished by people regardless of gender, then gender will become about as relevant as handedness. The Revolution is upon us,” writes Laurie Essig, a PhD in Social Studies, in Psychology Today. In fact she cites Shulamith Firestone’s 1970 The Dialectic of Sex as having seen this coming all along: 

“So the end goal of feminist revolution must be… not just the elimination of male privilege but of the sex distinction itself: genital differences between human beings would no longer matter culturally. The reproduction of the species by one sex for the benefit of both would be replaced by (at least the option of) artificial reproduction: children would born to both sexes equally, or independently of. Either, however one chooses to look at it; the dependence of the child on the mother (and vice versa) would give way to a greatly shortened dependence on a small group of others in general… The tyranny of the biological family would be broken.”

At the same time, while uterine transplants may seem more ethically sound for conceiving than gestational surrogacies, which are illegal in certain states like Arizona and Michigan in the U.S., experts argue that it is equally as thorny in its legal and societal ramifications.  

Since this is new territory for everyone around the globe, discussions on this topic in our governments and health care systems are still relatively rare. Currently, however, research projects on uterus transplantation and its ethics are underway around the world. And be warned: the research that has been done in Sweden, the country that pioneered the transplants, has already showed that uterus transplantation with living donors is ethically just as problematic as altruistic surrogacy.

“If uterus transplantation is to take the step from trials to becoming a reality in the Swedish healthcare system, there must first be an ethical debate on the procedure. Our study doesn’t arrive at an opinion as to whether uterus transplants should be carried out. But it shows that people must be aware of the parallels with altruistic surrogacy,” said Lisa Guntram, a researcher at Sweden’s Linköping University in an interview with Science Daily in 2018.

A number of arguments against altruistic surrogacy can be applied to uterus transplantation, such as subjecting the donor to pressure, even if they’re a relative donating their womb, like in most of the uterine transplant cases in Sweden. There’s also concern that the demand for such transplants can lead to further exploitation of women’s bodies via secret compensation agreements, so that uteruses become yet another organ on the black market. Ultimately, given the few and relatively new successful transplantation cases, there is very little known about the physical and psychological risks facing the child born from a uterine transplant. Our society’s decision makers are thus left scratching their heads for now.

Uterus transplants are not for everyone given how expensive and risky they still are. How much are they? Time magazine reported an estimate cost of $200,000. And like other infertility treatments, it would be extremely lucky to find an insurance company that would cover the procedure since it is viewed as an elective. For the clinical trials at Dallas´ Baylor University Medical Center the cost of the first 10 uterus transplants were covered by the center.

That same medical team that delivered the first successful uterus transplant in the U.S. is now seeking more funding through donations in order to continue doing transplants. Many more transplants need to be done before this procedure could be provided as a standard treatment.  

It’s not only the cost that will keep people away, it’s also the high risk of infection involved throughout their pregnancies. Once the recipient has received the transplant and only if four to six weeks later her transplant is successful, can she attempt in vitro fertilization (IVF) three to six months after the surgery. The potent drugs women must take on a daily basis to prevent their immune systems from rejecting the new uterus can take a toll on their bodies. In fact, the implanted uterus, the root of all the complications, is removed after the birth to avoid further complications.

But for many women, it seems, the risk is worth it. According to Time, more than 1,000 others have contacted the hospital about becoming a recipient. Other hospitals in the U.S., including the Cleveland Clinic in Ohio, Penn Medicine in Philadelphia and Brigham and Women’s Hospital in Boston are conducting their own trials in uterine transplants with hopes for their first successful cases in the near future.

While biologically women have a huge advantage over men when it comes to receiving and nurturing a transplanted uterus (their vasculature, their hormones and pelvic ligaments) designed to support a uterus and the pregnancy, men have none of those support systems in place.  But none of these listed attributes are impossible to create say medical experts.

“Male and female anatomy is not that different,” said Dr. Karine Chung, director of the fertility preservation program at the University of Southern California’s Keck School of Medicine, in an interview with Yahoo. “Probably at some point, somebody will figure out how to make that work.”

Nevertheless, uterine transplants are still considered an “experimental treatment,” with little medical exploration on how to make it work for a trans woman who wants to carry a child. It will likely take years before it’s possible for trans women to conceive from a transplant.

In a Fertility and Sterility article, Dr. Ariel Lefkowitz, a bioethicist, discussed the ethics of uterine transplants for trans women and defended their natural right as humans to the procedure. “A male or trans patient wishing to gestate a child does not have a lesser claim to that desire than their female counterparts. The principle of autonomy is not sex-specific. This right is not absolute, but it is not the business of medicine to decide what is unreasonable to request for a person of sound mind, except as it relates to medical and surgical risk, as well as to distribution of resources.”

In the years to come, as science perfects the uterine implantation, mountains of legal, ethical, and social issues will continue to arise and have to be grappled with. Might unisex gestation simply be too revolutionary for our innately conservative society? Let’s remember that years back in Greek mythology Zeus managed to rescue a fetal Dionysus and stitch him into his thigh until he was good and ready to be born. Aren’t the genders ready to share pregnancy woes yet? We say, let there be mood swings, sleepless nights, and back pain for everyone.