Last week, The New York Times reported that within a few months, doctors are planning to conduct the first uterus transplants in the US.
For women who are born without a uterus, have one that is damaged, or have had it removed, implanting a healthy uterus from a dead or living donor offers the tantalising possibility of getting pregnant and giving birth to their own child.
As many as 50,000 women in the United States might be candidates for this surgery.
But this naturally begs the question: Could uterus transplants allow men to get pregnant?
Here’s what Rebecca Flyckt, an obstetrician-gynecologist at the Cleveland Clinic who is part of the team that plans to perform a uterus transplant in the US, told the Times:
Although theoretically this would be possible, it would be a huge surgical and endocrinologic undertaking and involve not just the creation of a vagina but also surgical reconstruction of the whole pelvis by someone skilled in transgender surgery.
After this procedure and the grafting of a donor uterus, a complex hormone regimen would be required to support a pregnancy prior to and after embryo transfer (although this could be done, as we provide similar hormone regimens to menopausal women to support a pregnancy).
Instead of using the patient’s eggs, doctors would use his sperm and a eggs from his partner or a donor, Flyckt continued. He would have to have his sperm frozen before the surgery, but this is pretty routine.
For now, added Flyckt, the procedure will be limited to women without a functioning uterus.
Uterus transplants in women
So far, Sweden is the only country where uterus transplants have been successful. The first birth from a transplanted uterus took place in September 2014, to a 36-year-old woman who was born without a uterus. This is often caused by Mayer-Rokitansky-Küster-Hauser syndrome, a disorder that affects 1 in 4,500 newborn girls.
Nine women in total received transplants, from living donors. Five of the donors were the recipient’s mother, which means any babies would be born from the same womb as their own mum!
There have been two failed transplant attempts in Saudi Arabia in 2000 and Turkey in 2011. Within a few months, Ohio’s Cleveland Clinic aims to become the first US clinic to complete such a tranplant.
Of course, even though the procedure is medically possible, there are a number ethical issues to consider.
First, there’s the issue of whether the donor is living or dead, Art Caplan, head of medical ethics at NYU Langone Medical Center, told Business Insider.
If the donor is dead, she might not have consented to donating her uterus when she became a donor. And if she is a living donor who is related to the recipient, she might feel pressured to donate out of family obligation.
Then there’s the issue that this is an elective surgery, not a life-saving procedure such as a liver or kidney transplant. “We’re going to do two surgeries on you, and one on a living donor, just for the experience of pregnancy? How important is that?” Caplan said.
Of course, there are other ways to have children, such as adoption or surrogacy. But for some women, these are not possible for religious or cultural reasons. For example, some sects of Catholicism and Islam do not allow surrogacy.
How the surgery works
The surgeons remove the uterus and part of the vagina from the donor — preferably one who is deceased, since it is a risky surgery that involves separating uterine blood vessels that are tightly wrapped around the tubes from the bladder.
Next, the uterus is transferred to the living recipient. Surgeons connect an artery and a vein on either side of the uterus to connect it to the recipient’s blood supply. A piece of the donor’s vaginal tissue is attached to the recipient’s vagina, and supporting tissue is attached to the pelvis to secure the organ in place. It’s not necessary to connect any nerves.
After the surgery, the woman will have to take drugs to prevent her immune system from rejecting the new organ. She must wait a year before trying to get pregnant by in vitro fertilization, where an egg is fertilised in a test tube and then implanted in the womb. (She won’t be able to have a natural pregnancy; her ovaries won’t be connected to the uterus.)
The baby will be born by cesarean section, since the transplanted uterus might be too fragile to undergo labour. The mother will be able to keep the uterus for one or two pregnancies, and then doctors will need to remove it so she can stop taking anti-rejection drugs.
But like any surgery, it comes with risks.
Besides the typical risks of an infection, there’s the risk that the anti-rejection drugs the mother would have to take could harm a growing foetus. However, many women taking these drugs for other organ transplants have had healthy babies. But these women have a higher risk of preeclampsia, a condition involving high blood pressure, and their babies tend to be smaller than average.
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