Let’s Talk About Uterine Transplants

by Kallie Fell, Executive Director on January 28, 2020

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When I enrolled in nursing school, I knew that I wanted to work for women. Nearing graduation, I hoped for a job as a labor and delivery nurse, but ever the realist, I understood that the opportunities in labor and delivery for brand new nurses were few. I was open to the many options that the field of nursing offers and found myself considering a position in a transplant unit. This particular position interested me because the hospital offering the job was about to embark on the first uterine transplant trial in North America. This sounded amazing. I would be involved in cutting-edge research AND helping women. After dozens of interviews and countless conversations with the mentors in my life, I accepted a wonderful position as a labor and delivery nurse. 

Fast forward four years. I am still a labor and delivery nurse, I am still passionate about women’s health, and uterine transplantation is a “new frontier in reproductive medicine.” So let’s talk about it. 

Here is a brief history of the procedure:

  • The first reported uterine transplant was performed in Saudi Arabia in 2000; it was unsuccessful, and the uterus was removed after three months.
  • Sweden was the first country to have a ‘successful’ uterine transplant. A live baby was born, but two months premature.
  • The first U.S. uterine transplant was performed in 2016, but the recipient had life-threatening complications, and the uterus was removed less than two weeks after the transplant. 
  • In 2017, the world’s first known woman to receive a uterus from a deceased donor gave birth to a six-pound girl in Brazil. 
  • To date, there have been about 70 uterine transplants around the globe. Most of the transplants have been from live women. 
  • Unlike other organ transplants, this one is temporary. After the recipient is done having (usually one or two) children the uterus is removed. 

Some physicians believe that uterine transplant surgery is the way to help women who have uterine factor infertility (UFI) become pregnant. UFI is a broad term given to women who are either born without a uterus, had their uterus removed, or had uterine damage. Understandably, these women have a hard time getting pregnant.  About 5 percent of reproductive-age women worldwide are affected, according to Penn Medicine. 

However, some medical experts, including the high-risk obstetricians at UT Southwestern Medical Center “do not recommend uterine transplantation.” Dr. Horsager-Boehrer states, “We strongly believe that women can become mothers in a variety of ways, and uterine transplantation is not worth the risks.”

Uterine transplantation is major surgery for the recipient. If the donor is alive, it’s major surgery for her, too. Any surgery has physical risk. Transplant surgery has increased risk because the recipient has to take immunosuppressant medications so that her body doesn’t reject the foreign uterus. Combined, this makes uterine transplant very risky for an elective procedure that will only have to be reversed in the next few years (remember, that uterus has to come out). If the transplant is successful, these pregnancies are high-risk and carry risks to both the mother and unborn child. Immunosuppressant drugs do pass through the placenta and pose risks to the baby, including low birth weight and preterm birth (both of which increase infant morbidity and mortality). The baby must also be delivered via c-section (another surgery with risks to both mother and baby). 

Not only are there physical risks, but there are emotional and moral considerations as well. Currently, the only way to be considered for a uterine transplant is to enroll in a clinical trial. If uterine transplantation becomes part of medical practice, it is forecasted to be very expensive (hundreds of thousands of dollars). I can’t help but roll my eyes at yet another fertility procedure that only the wealthy can afford. Most likely, women considering uterine transplantation have already exhausted other fertility treatments and might already have suffered emotional, physical, and financial trauma. 

I have so many more questions concerning the ethics of uterine transplantation. Is this just another way for women to succumb to the social pressures of creating genetic offspring? Will women continually subject themselves to physical, emotional, and financial stress so they can achieve pregnancy and birth? Is this another example of women being used as guinea pigs in medical research?  Will uterine transplantation become available for trans women? If so, how does this affect women, or does it? Perhaps we should think about these together.

Please send your thoughts, comments and questions to Kallie.fell@cbc-network.org

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