The following comes from a June 15 story in Scientific American.
When Mats Brännström first dreamed of performing uterus transplants, he envisioned helping women who were born without the organ or had to have hysterectomies. He wanted to give them a chance at birthing their own children, especially in countries like his native Sweden where surrogacy is illegal.
He auditioned the procedure in female rodents. Then he moved on to sheep and baboons. Two years ago, in a medical first, he managed to help a human womb–transplant patient deliver her own baby boy. In other patients, four more babies followed.
But his monumental feats have had an unintended effect: igniting hopes among some transwomen (those whose birth certificates read “male” but who identify as female) that they might one day carry their own children.
Cecile Unger, a specialist in female pelvic medicine at Cleveland Clinic, says several of the roughly 40 male-to-female transgender patients she saw in the past year have asked her about uterine transplants. One patient, she says, asked if she should wait to have her sex reassignment surgery until she could have a uterine transplant at the same time. (Unger’s advice was no.) Marci Bowers, a gynecological surgeon in northern California at Mills–Peninsula Medical Center, says that a handful of her male-to-female patients—“fewer than 5 percent”— ask about transplants. Boston Medical Center endocrinologist Joshua Safer says he, too, has fielded such requests among a small number of his transgender patients. With each patient, the subsequent conversations were an exercise in tamping down expectations.
To date there are no hard answers about whether such a fantastical-sounding procedure could enable a transwoman to carry a child. The operation has not been explored in animal trials, let alone in humans. Yet with six planned uterine transplant clinical trials among natal female patients across the U.S. and Europe reproductive researchers are hoping to become more comfortable with the surgery in the coming years. A string of successes could set a precedent that—along with patient interest—may crack open the door for other applications, including helping transwomen. “A lot of this work [in women] is intended to go down that road but no one is talking about that,” says Mark Sauer, a professor of obstetrics and gynecology at Columbia University.
Such a future is hard to imagine, at least in the near term. The surgery is still very experimental, even among natal women. Just over a dozen uterus transplants have been performed so far—with mixed results. One day after the first U.S. attempt, for example, the 26-year-old Cleveland Clinic patient had to have the transplanted organ removed due to complications. And only the Brännström group’s procedures have led to babies. More efforts are expected in the United States: Cleveland Clinic, Baylor University Medical Center, Brigham and Women’s Hospital, and the University of Nebraska Medical Center are all registered to perform small pilot trials with female patients who are hoping to carry their own children.
The trouble is that uterine transplants are extremely complex and resource-intensive, requiring dozens of health personnel and careful coordination. First a uterus and its accompanying veins and arteries must be removed from a donor, either a living volunteer or a cadaver. Then the organ must be quickly implanted and must function correctly—ultimately producing menstruation in its recipient. If the patient does not have further complications, a year later a doctor may then implant an embryo created via in vitro fertilization. The resulting baby would have to be born through cesarean section—as a safety precaution to limit stress on the transplanted organ, and because the patient cannot feel labor contractions (nerves are not transplanted with the uterus). Following the transplant and throughout the pregnancy the patient has to take powerful antirejection drugs that come with the risk of problematic side effects.
The dynamic process of pregnancy also requires much more than simply having a womb to host a fetus, so the hurdles would be even greater for a transwoman. To support a fetus through pregnancy a transgender recipient would also need the right hormonal milieu and the vasculature to feed the uterus, along with a vagina. For individuals who are willing to take these extreme steps, reproductive specialists say such a breakthrough could be theoretically possible—just not easy….