37 votes

Womb transplants are now a life-changing reality. Here’s how the extraordinary procedure works.

13 comments

  1. [13]
    TanyaJLaird
    Link
    Interestingly, while it has yet to be attempted, womb transplants should be viable for transgender women as well. With about 90 womb transplants having been performed thus far, and approximately...

    Interestingly, while it has yet to be attempted, womb transplants should be viable for transgender women as well. With about 90 womb transplants having been performed thus far, and approximately 1% of women being transgender, it is likely time to attempt this procedure. And in terms of potential patient population, approximately 1 in 500 cisgender women have absolute uterine factor infertility, the fertility issue this procedure is meant to treat. Meanwhile, approximately 1 in 100 women are transgender. There are likely 2-5 times as many transgender women in need of this procedure than cisgender women, but no hospital has yet attempted such a procedure, though research, such as the paper linked, indicate that it is likely possible. Some would raise ethical concerns about transgender women receiving uterine transplants, but these concerns are in practice no different than the ethical issues surrounding cisgender women receiving uterine transplants.

    20 votes
    1. [6]
      Foreigner
      Link Parent
      I wouldn't be surprised if uterine transplants are possible for trans women, but how viable/easy is it to control hormones throughout the pregnancy? I don't know the details surrounding pregnancy...

      I wouldn't be surprised if uterine transplants are possible for trans women, but how viable/easy is it to control hormones throughout the pregnancy? I don't know the details surrounding pregnancy hormones, but I assume it's going to be a more complicated cocktail than gender reassignment treatment, with the implication that mistakes could lead to loss of the pregnancy or potential malformations in the child. Perhaps this is something doctors already know how to manage in pregnant people with hormone deficiencies, but I'm not at all versed on this topic. Given how this touches on two topics that trigger heated debate (transgender rights and the "pro life" movement), I wouldn't be surprised if it's a looooong time before doctors even think to attempt this with transgender patients.

      12 votes
      1. [5]
        TanyaJLaird
        Link Parent
        It would be more complicated, but it shouldn't be impossible. One thing I wonder is if any uterine transplants have been simultaneously given with ovarian transplants at the same time. If so, the...

        It would be more complicated, but it shouldn't be impossible. One thing I wonder is if any uterine transplants have been simultaneously given with ovarian transplants at the same time. If so, the hormonal differences between a trans woman and a cis woman pregnancy via uterine transplant would be minimal.

        The hormonal regimens would have to be different between regular trans HRT, but it's likely quite manageable. These uterine transplant cases all involve a team of specialist who provide very frequent monitoring of the patient. So exogenous hormones could be added to produce proper levels through the pregnancy.

        There are potential risks of birth defects and such, and those are ethical issues worth considering. However, those seem little different in cisgender or transgender uterine transplants. You can ask if it's ethical to go to all this trouble to allow someone to get pregnant, but again, the same applies to cisgender women. If it's ethical for a cisgender woman to have a uterine transplant, then it's ethical for a transgender woman to have one. At least that is true for any ethical framework that holds the lives and well being of cisgender and transgender women on equal footing.

        But ultimately, as you allude to, it's likely politics that have been the limiting factor. But medicine and medical science shouldn't be dictated by the whims of religious radicals, control freaks, and bigots. Yeah, the bigots will have a problem with it, but they can jump in a lake.

        11 votes
        1. [3]
          TreeFiddyFiddy
          Link Parent
          This brings up a very interesting ethics question for me: would transplanting ovaries from a deceased organ donor be ethical? If the donation were not voluntary you are essentially creating...

          One thing I wonder is if any uterine transplants have been simultaneously given with ovarian transplants at the same time

          This brings up a very interesting ethics question for me: would transplanting ovaries from a deceased organ donor be ethical? If the donation were not voluntary you are essentially creating progeny from someone who did not consent. Other organs seem like a no brainer, they simply restore or give basic biological function to the receiver but in the case of ovaries or testes you are also allowing for the genetic propagation of the donor. I would think that this would be decidedly unethical unless very particular consent were given by the donors

          8 votes
          1. [2]
            Oslypsis
            Link Parent
            Don't you have to opt in to be an organ donor though? Although, donating a heart vs potential eggs is way different. I wonder if there's any way to specify what you're willing to donate.

            Don't you have to opt in to be an organ donor though? Although, donating a heart vs potential eggs is way different. I wonder if there's any way to specify what you're willing to donate.

            2 votes
            1. TanyaJLaird
              Link Parent
              Yeah, and this is likely to be treated very differently from ordinary organ donation. After all, it is currently possible to obtain sperm and egg cells from deceased people. You don't need to...

              Yeah, and this is likely to be treated very differently from ordinary organ donation. After all, it is currently possible to obtain sperm and egg cells from deceased people. You don't need to transplant an organ, just extract then with a needle. And yet you never hear about egg or sperm cells being harvested from people who die young as organ donors. Likely donated egg cells wouldn't be do expensive if that were the case.

              In reality, the medical field worries about medical ethics more than any of us. And they recognize the unique ethical issues with donated gametes. If you want to donate your gametes post-mortem, you need to explicitly opt in to that, and not just sign up as a regular organ donor. And the same would apply to donated ovaries.

              4 votes
        2. Foreigner
          Link Parent
          I hadn't considered uterine transplants could mean the ovaries are transplanted too, I assumed it was the uterus only that being transplanted into people with functioning ovaries. If the former is...

          I hadn't considered uterine transplants could mean the ovaries are transplanted too, I assumed it was the uterus only that being transplanted into people with functioning ovaries. If the former is the case, then I assume there wouldn't be much difference indeed. If the pregnancy is no more risky for the child or pregnant person than other "conventional" medically assisted pregnacies, trans or cis-gender, I don't see a reason it can't be done. However, I don't see any doctors bold enough to try this anytime soon, but I'd be happy to be proven wrong.

          3 votes
    2. [6]
      EgoEimi
      Link Parent
      I was wondering where the uteri came from. I'm surprised that there are so many live donors. I imagine that we are on the cusp of a new transhumanist era where transitioning individuals can find a...

      There is now a uterus donor programme, including both living and deceased donors. In fact, live donors now make up 40 per cent of donors in the UK set up by the charity Womb Transplant UK.

      I was wondering where the uteri came from. I'm surprised that there are so many live donors.

      I imagine that we are on the cusp of a new transhumanist era where transitioning individuals can find a corresponding transitioning person to exchange-donate sexual organs. Very neat.

      9 votes
      1. [4]
        CannibalisticApple
        Link Parent
        I'm not too surprised. There are a lot of women who have already given birth, and want to give other women the chance to be mothers. I think the logic behind it would be similar to becoming a...

        I'm not too surprised. There are a lot of women who have already given birth, and want to give other women the chance to be mothers. I think the logic behind it would be similar to becoming a surrogate, though I expect the living donors are usually a close friend or relative. It's still a major operation after all, and ultimately not an essential one, so not sure many would take the risks for a total stranger.

        Also: given how hard it is for women to get doctors to agree to sterilization, it may actually be easier to donate it for a transplant, ridiculous as that sounds.

        8 votes
        1. [3]
          Oslypsis
          Link Parent
          My thoughts also immediately went to how difficult it is for women to get sterilized. It makes me too angry to talk about it for long. I know for a fact I never want kids of my own. I don't need...

          My thoughts also immediately went to how difficult it is for women to get sterilized. It makes me too angry to talk about it for long. I know for a fact I never want kids of my own. I don't need "at least 3 children" and "my husband's/father's consent" to know what I know. Nor should I need those in order to be believed and trusted by a doctor. Glad I'm getting older in age. I'm almost 30. Still got a little ways to go for a free and natural "tube-tying", but I'm patient.

          8 votes
          1. [2]
            CannibalisticApple
            Link Parent
            Yeah. I have no interest in having children but I'm also asexual, so for me sterilization is thankfully a non-issue. It's still frustrating to see how many women struggle to get treated properly...

            Yeah. I have no interest in having children but I'm also asexual, so for me sterilization is thankfully a non-issue. It's still frustrating to see how many women struggle to get treated properly though, even women who DO have 3 children or those who need their uterus removed for emergency medical reasons.

            Reading this article had me thinking. If I had a sister or close friend or cousin who wanted a womb transplant, I wouldn't be adverse to donating. Would need to have a close relationship since it IS a major operation with risks, but... I mean, I'm not using it anyway. And hey, no more periods! Bonus!!

            3 votes
            1. Oslypsis
              Link Parent
              I'k exactly the same! I'm also asexual, so it's not an issue for me either. But I feel majorly for the people who want their tubes tied and can't because of "ethics concerns".

              I'k exactly the same! I'm also asexual, so it's not an issue for me either. But I feel majorly for the people who want their tubes tied and can't because of "ethics concerns".

              3 votes
      2. winnietherpooh
        (edited )
        Link Parent
        I just got a gender-affirming hysterectomy last year and I really wish I'd known about this - I'd have LOVED to donate my yeeterus to someone who actually wanted it. Do you know if there's...

        I just got a gender-affirming hysterectomy last year and I really wish I'd known about this - I'd have LOVED to donate my yeeterus to someone who actually wanted it. Do you know if there's something like this in the States?

        4 votes