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Uterine Transplantation
January 13, 2014 12:36 PM   Subscribe

Nine women in Sweden have successfully received transplanted wombs donated from relatives and will soon try to become pregnant. Many of the women, who were either born without uteruses or who had them removed for medical reasons, have already begun to menstruate. Some doctors question whether uterine transplantation is worth the risk to the patient, but many women say that they would be willing to accept the risks in exchange for being able to bear their own children.

The Swedish experiment is by no means the first attempt at transplanting a uterus into a human. The first attempt, in 1931, resulted in the death of Lili Elbe, one of the first people to undergo gender reassignment surgery. Techniques gradually improved, and most recently, in 2011, 22-year-old Derya Sert made history as the first human to successfully become pregnant with a transplanted uterus. However, the pregnancy was terminated after eight weeks, since the fetus lacked a heartbeat and the pregnancy was nonviable.

Uterine transplantation is of great interest to medical ethicists, and a preliminary set of stadards was outlined in the 2012 Montreal Criteria for the Ethical Feasibility of Uterine
Transplantation
[PDF].

The science behind uterus retrieval and transplantation is more advanced in animal models than in humans- live births have been recorded from transplanted uteruses in mice, dogs, and sheep, and successful transplants have been recorded in other animals, including non-human primates.
posted by showbiz_liz (43 comments total) 17 users marked this as a favorite

 
It's worth noting that in Sweden surrogacy is illegal commercially and unclearly regulated if arranged in another way (friend or family, for example). There is also a lot of interest in the UK, where surrogacy is completely illegal.

I admit sometimes the ethical issues of surrogacy give me pause, but it seems a lot safer for the mother and child than this.
posted by melissam at 12:46 PM on January 13 [8 favorites]


wow, i had never heard Lili Elbe. what a fascinating/sad story.

sounds like she had a pretty full life tho.

also, had no idea surrogacy was something that would be outlawed. interesting.
posted by sio42 at 12:51 PM on January 13


"UK, where surrogacy is completely illegal" - This isn't true. There are organisations that exist to support surrogacy in the UK. You're not allowed to charge fees to act as a broker/introduction agency and you're not allowed to advertise for or as a surrogate. But you are allowed to pay a surrogate for reasonable costs associated with the pregnancy, as long as it isn't a for-profit arrangement.

I would agree it is uncommon and difficult in the UK. You lack a lot of legal framework and aren't allowed to enforce most contractual arrangements you might expect to put in place, but it's not illegal.
posted by samworm at 1:00 PM on January 13 [4 favorites]


The UK also seem to make it difficult to enforce surrogacy contracts.
posted by melissam at 1:04 PM on January 13


I'd like to begin with the caveat that I am speaking as someone for whom this is not a direct personal issue and I am happy to be corrected if I am making any mistakes or am unintentionally insensitive.

This seems really exciting for trans women who are interested in this! I know that not everyone will be (which is totally cool too) but wow, if this is indeed a priority for any women, cis or trans, who have personally struggled then I am so so so happy and excited for them!

I do get that the medical ethics are super tricky and that it's more complicated than just "yay" but any time people have additional options for making their bodies work for them it seems really exciting, as long as women (of any kind) are actually able to use this as a means of controlling their own bodies which, unfortunately, can be a big "if".

That said, if it gives women who want to have biological children that option when previously they didn't have it, I'm (cautiously) pretty happy about that.
posted by Mrs. Pterodactyl at 1:09 PM on January 13 [5 favorites]


Before shaking off the Mondays, read the FPP as "Nice women..." and wondered, does this procedure not work for mean women? Can really, really nice women produce twins and triplets?
posted by riverlife at 1:13 PM on January 13


I'm a transwoman with no interest in raising kids, and I think it's pretty exciting.
posted by egypturnash at 1:16 PM on January 13 [1 favorite]


Where do I sign up to donate this bleeding hellpit of mine.
posted by elizardbits at 1:23 PM on January 13 [70 favorites]


Wow! Will be interested to see the Christian ethicists' take on this. For example, Catholics have a pretty simple, yet developed, set of ethical principles relating to human reproduction. All things being equal with regard to those principles, this procedure would seem to resolve a number of difficulties for *first-world* Catholics faced with insuperable reproductive problems.
posted by resurrexit at 1:45 PM on January 13 [1 favorite]


I admit sometimes the ethical issues of surrogacy give me pause, but it seems a lot safer for the mother and child than this.

I don't clearly see a way of preventing either surrogacy or this type of surgery that doesn't also deny women agency over their own bodies.
posted by mhoye at 1:49 PM on January 13 [2 favorites]


You know, if it weren't for the fact that I think it would cause life changing hormonal shifts or possible organ shifting, and maybe nerve damage in extraction, as I increasingly look not to have children and become impatient with my reproductive cycle/contraception, I wish I could donate this uterus.

I don't clearly see a way of preventing either surrogacy

Generally what's prevented is paid surrogacy (and even then there's provisions for giving the woman support during pregnancy) and surrogacy contracts that automatically sign over various custodial rights to the person who got a surrogate.

So it doesn't prevent me, say, getting implanted with someone's kids and handing them off after out of the goodness of my heart, just like I can register in my own country's bone marrow donor bank but I won't get paid, even if I get called up to donate. But, it does mean that anything in my womb cannot be legally enforced to belong to someone else, which closes down a whole avenue of things that could restrict my freedoms, for example the courts interfering if I was 'bad' during pregnancy (a problem) or restricting my freedom of movement if it was suspected I was going to claim the baby I was producing, or taking it from me.

There is the issue of criminalizing body work, but countries with nationalized healthcare seem to frown on all sorts of paid body bits donation- Canadians don't get paid for egg or sperm donation, or blood/plasma donation, for example.
posted by Phalene at 1:58 PM on January 13 [3 favorites]


I am almost certainly too old for this to matter, but 10 years ago I would have spent a large pile of money to receive this gift.

Not every transwoman feels this way, but many do.
posted by andreaazure at 2:04 PM on January 13 [3 favorites]


Here's a whole new collaboration possibility for transmen and transwomen. Can the ovaries be transplanted along with the uterus?

On the other hand, anti-rejection drugs (and their side effects) PLUS cramps? I'm with elizardbits, take mine, please!
posted by Dreidl at 2:10 PM on January 13


Why limit it to women? I can think of LOTS of men that would benefit from the experience of having their own uterus. We could start with the ones who think it's their business to regulate the reproductive rights of women: "So, you don't trust us to do a proper job with this thing? Well, then - here you go!"
posted by Mary Ellen Carter at 2:11 PM on January 13 [37 favorites]


I really wish we, in both the public/national sense and in the species sense, weren't putting more money into the ability of people to make more people.
posted by Slackermagee at 2:26 PM on January 13 [5 favorites]


Whoa holy shit.
posted by turbid dahlia at 2:28 PM on January 13


> Where do I sign up to donate this bleeding hellpit of mine

It's such an inefficient system. I've wanted it exactly twice in my life, but I have to carry it around 24/7.
posted by The corpse in the library at 2:35 PM on January 13 [7 favorites]


I also hear that apparently post-hysterectomy life isn't all that great, because shit up in there is all connected to other shit up in there. Which sounds really horrible. I truly wish we were all intelligent reptiles instead of being mammals, because uteruses are totally for the birds.
posted by asperity at 2:46 PM on January 13 [2 favorites]


I also hear that apparently post-hysterectomy life isn't all that great

I think this varies wildly. I know some women who would never go back to having a uterus and some are close enough to me to tell me if they had even minor health problems due to the hysterectomy.
posted by soelo at 2:50 PM on January 13 [1 favorite]


I think this varies wildly.

Glad to hear it. Still, I think I'd make an awesome crocodile.
posted by asperity at 2:59 PM on January 13


I really wish we, in both the public/national sense and in the species sense, weren't putting more money into the ability of people to make more people.

It's about giving people choices. Particularly, giving women more choices with regards to their fertility. I think that's an amazing thing and I'm happy to be living in a society where it's even a possibility. And world-wide, birth rates actually appear to be falling, so it's not going to be the development that tips us over the edge.

Also I realise I've been lucky, as its never been any trouble, but I'm very attached to my uterus, so I feel the need to stick up for the wombs in the room. They're fairly incredible things. I'm glad there's now an option for people who want one being able to get them.
posted by billiebee at 3:03 PM on January 13 [7 favorites]


I also hear that apparently post-hysterectomy life isn't all that great

Let me tell you, I could get a small parade going among women I know to celebrate the wonders of a hyst.

That's one major life decision I will never regret.
posted by BlueHorse at 3:06 PM on January 13 [9 favorites]


This seems really exciting for trans women who are interested in this!

Is this possible? Forgive my ignorance on the medical specifics of having converted genderbits, but could an MTF trans individual have this procedure in order to carry a child or is a more thoroughly female biology required?
posted by mediocre at 3:26 PM on January 13


I've been counting down for a hysterectomy since I was in my teens.

A note about the biology:

But all who received a womb have their own ovaries and can make eggs. Before the operation, they had some removed to create embryos through in-vitro fertilization. The embryos were then frozen and doctors plan to transfer them into the new wombs, allowing the women to carry their own biological children.

A large part of successful pregnancy is the complicated hormonal cocktail delivered by the ovary. The uterus in itself is not an endocrine organ and does not produce any oestrogen, progesterone etc. The transplantation and native functioning of a donor ovary is another frontier. Speculating, if native male gonads are in situ they will be interfering with the hormonal signalling of the female gonads, and other complications.
posted by chiquitita at 3:33 PM on January 13 [10 favorites]


I really wish we, in both the public/national sense and in the species sense, weren't putting more money into the ability of people to make more people.
This is potentially a really big deal for a lot of trans women, so I would appreciate it if you could can it with the neo-Malthusian snark, just for now.
posted by aw_yiss at 3:43 PM on January 13 [3 favorites]


Yeah I mean... wombs for trans women is a whole other frontier. This is exciting and amazing, but I think it's premature to be excited about applications outside of the still-experimental surgeries the articles talk about.
posted by kavasa at 4:00 PM on January 13 [1 favorite]


Is this possible? Forgive my ignorance on the medical specifics of having converted genderbits, but could an MTF trans individual have this procedure in order to carry a child or is a more thoroughly female biology required?

So, really naively (like--high school biology ten years ago naive), one obvious issue is that I suspect it would be really hard to get the hormones right and I would kind of assume that pregnancy hormones, er, do stuff that's necessary for the fetus. I could be totally wrong, though. (Why precisely they thought it was a good idea to try uterine/ovarian transplantation with Lili Elbe, I'm not sure. Not really knowing what they were doing (did they understand transplant rejection?), I suspect, coupled with some fucked up ideas about gender. AFAIK, that was the one attempt, but I don't know a ton about the early history of surgery for trans women.)
posted by hoyland at 4:25 PM on January 13


Apparently she did it because she was hoping to be able to get pregnant. So not just weird-ass biological essentialism, though that may still have played a role.
posted by this is a thing at 4:44 PM on January 13


Since they haven't yet successfully produced a viable human fetus by this method, I think it's impossible to say whether this would work for trans women- as of today, it doesn't work for cis women! But I imagine there would have to be some sophisticated hormone therapy above and beyond what trans women normally receive, and/or the transplantation of ovaries.

(I didn't know this, but ovarian transplant has been sucessfully achieved and has actually resulted in live births, the first in 2008- although it has only been attempted with the women's own ovaries, frozen before cancer treatments which would have killed them. But still. Wow.)

But, hey- 65 years ago, the idea of any kind of internal organ transplant whatsoever was science fiction, and now we're swapping around hearts and arms and faces like interchangeable USB cables (well, not quite, but kinda). I wouldn't be shocked if it became possible to transplant ovaries into trans women, or other women born without them.
posted by showbiz_liz at 4:44 PM on January 13


(Also, this gives me an idea for a weird near-future sci fi conceit- a wealthy woman dies without heirs, and her ovaries are stolen before burial...)
posted by showbiz_liz at 4:49 PM on January 13 [5 favorites]


I have to consider myself in the 'against' column for now. Anti-rejection drugs are a big deal that should not be undertaken for non-life-threatening reasons. If rejection happens regardless, rejecting an organ that size could kill the patient (that's what killed Lili Elbe). I am also skeptical of the ethics of having a child this way; I think one has a responsibility to any children you deliberately create to take reasonable measures to ensure they are born healthy, and I'm not at all certain children born this way would be healthy. I think there's a very large risk of severe defects, particularly at first, before the technique is perfected.

I would be all for it if it could be done safely for both the mother and prospective children, but organ transplants are pretty risky and would never be done if the alternative wasn't death or severe reduction in quality-of-life. I don't know for sure that this qualifies. I guess it isn't up for me to decide, but if I was a surgeon I wouldn't perform the procedure.
posted by Mitrovarr at 4:59 PM on January 13 [2 favorites]


"I wish I could donate this uterus."

I've sometimes wished people were like whatnot Muppets, and we could just peel off the parts we don't want and trade them with people who do want them. Still more proof, if any was needed, that Jim Henson was a far more benevolent and sensible creator than the one we all got stuck with.
posted by Ursula Hitler at 5:03 PM on January 13 [18 favorites]


I guess I think of it as being similar to when we first explored space, or Antarctica. Without people fumbling around with imperfect knowledge and risking their lives to gain more, and sometimes dying, we'd never have been able to move past that fumbling stage into landing on the moon/setting up research bases on Antarctica/whatever. And, hell, a lot of people died before a human heart was successfully transplanted, but who would argue that it shouldn't have been tried? If doctors don't try this, it'll never be possible- they can't wait until they know more about it because the only way to become better at it is to do it. If the women involved are fully aware of the risks, I can't see the problem.
posted by showbiz_liz at 5:06 PM on January 13 [5 favorites]


In addition to people who are born without uteruses (including those who are assigned male gender at birth) and people who've had the uterus removed surgically, people whose uterus has been all scarred up by cancer treatment as kids or young adults stand to benefit from this.

I understand the "I really wish we weren't putting more money into the ability of people to make more people" perspective but it's been repeatedly and consistently shown that putting reproductive control into the hands of the people doing the reproducing brings fertility rates down, overall. This is a pretty extreme case, but it's part of the same overall notion that it's a social good for people to be as much in control of their own reproductive lives as they can be.
posted by gingerest at 6:11 PM on January 13 [11 favorites]


I've often wondered why, with all the organs we *can* transplant, why uteruses weren't among them. I similarly wonder about pancreases and why we can shuffle livers and kidneys around in the face of failure, but diabetics don't have the option of "donated pancreas" should their disease progress to the point of organ failure. Anyhow, this is truly fascinating that it's something SCIENCE! is working on.

I've sometimes wished people were like whatnot Muppets, and we could just peel off the parts we don't want and trade them with people who do want them. Still more proof, if any was needed, that Jim Henson was a far more benevolent and sensible creator than the one we all got stuck with.

Word. When I'm done with this pregnancy, I would happily donate my uterus as it would ensure my all time goal of *never* being pregnant again. I feel a bit guilty that I know so, so many people who have had fertility struggles and I've gotten knocked up on the first try... twice. There's no way of donating "fertility" and I wouldn't want more bio spawn of my own, so eggs are a no go - but if my uterus would be of use to someone else, I'd totally be up for giving it to them. (One uterus, bloodtype A+, slightly used.)

(Slightly off topic, but I feel the same way about my boobs. I have G/H cup boobs and will be getting a reduction when I'm done breast feeding and so wish the extra boob could go to someone who wanted it. But that just gets gross since silicone does wonders and who wants used boob?)
posted by sonika at 7:15 PM on January 13 [2 favorites]


Sonika - there are pancreas transplants! There really aren't very many organs available (1,200-1,400 a year versus 35,000 new Type I diabetes cases a year in the US) so most transplant patients are type I diabetics with end-stage renal disease who are having kidney transplants and get the pancreas swap at the same time.
posted by gingerest at 7:41 PM on January 13 [4 favorites]


The More You Know! Neat!
posted by sonika at 8:11 PM on January 13 [1 favorite]


From the first link: "...the donors include mothers and other relatives of the recipients."

That's got to feel funny, knowing you once lived inside your own womb.
posted by Herr Zebrurka at 9:46 PM on January 13 [7 favorites]


Yeah, you could now claim to be your own mother. It's totally something out of Thunder, Perfect Mind.
posted by Joe in Australia at 1:31 AM on January 14 [1 favorite]


Wombs to go?

Sorry.
posted by freecellwizard at 7:19 AM on January 14 [2 favorites]


This is a huge, huge thing for those who need it. I'm so glad that it's happening, and admire the brave women risking the procedure.
posted by corb at 7:27 AM on January 14


Metafilter: One uterus, bloodtype A+, slightly used.

Metafilter: who wants used boob?

I'm sorry, the devil, etc.--you know?
posted by BlueHorse at 10:16 AM on January 14


Herr Zebrurka: "From the first link: "...the donors include mothers and other relatives of the recipients."

That's got to feel funny, knowing you once lived inside your own womb.
"

"QUITCHER KICKING! IT WAS GOOD ENOUGH FOR ME!"
posted by IAmBroom at 12:04 PM on January 14 [2 favorites]


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