The Next Frontier of Fertility

November 12, 2015 3:13 PM

Uterus Transplants May Soon Help Some Infertile Women in the U.S. Become Pregnant (SLNYT)
posted by ThePinkSuperhero (50 comments total)

They've already been trying them in Sweden: The Swedish team used live donors, and showed that a uterus from a woman past menopause, transplanted into a young recipient, can still carry a pregnancy. In five cases, the donor was the recipient’s mother, which raised the dizzying possibility of a woman giving birth from the same womb that produced her.

Incredible! The future is here, people.
posted by ThePinkSuperhero at 3:14 PM on November 12, 2015 [19 favorites]

In five cases, the donor was the recipient’s mother, which raised the dizzying possibility of a woman giving birth from the same womb that produced her.

Motherhood & moms: the gift that keeps on giving.
posted by Fizz at 3:16 PM on November 12, 2015 [3 favorites]

A family heirwomb.
posted by sevenofspades at 3:20 PM on November 12, 2015 [91 favorites]

Excellent. All those male forced-birth advocates can now put their money where their mouth is. I eagerly anticipate that they'll be stepping forward to take sole responsibility for the zygotes and fetuses they wish to "save".
posted by five fresh fish at 3:22 PM on November 12, 2015 [8 favorites]

Dude that is going to be the greatest Human Centipede sequel ever.
posted by 7segment at 3:24 PM on November 12, 2015

I would think you need considerably more than just the uterus to allow a male to give birth.
posted by smidgen at 3:25 PM on November 12, 2015 [4 favorites]

they can squeeze that baby out their butthole as the good lord of fanfic intended.
posted by poffin boffin at 3:28 PM on November 12, 2015 [58 favorites]

I was going to keep my mouth shut about women being pressured into doing this for the wrong reasons (because that's really none of my business), and then I got to this

The 26-year-old candidate said that finding out she had no uterus had made her wonder if anyone would ever want to marry her.

Sigh.

This is a boon for women who want to have children, but can't.

For women who are being pressured into having children by stigma, societal pressures, or religion? Maybe it's not such a great thing? I'm torn on the ethical implications for the sorts of patriarchal behavior that this could enable... but maybe that's none of my business? I really don't know.

I will say that I am somewhat surprised that the ethics board was okay with this, given this particular patient's stated motives...
posted by schmod at 3:28 PM on November 12, 2015 [8 favorites]

I should add that I am very okay with people being able to do whatever they want to do to make them comfortable with themselves, even if the underlying causes/pressures are not-so-great. We live in an imperfect world, and sometimes we need to make the best of what we have to make ourselves comfortable.
posted by schmod at 3:31 PM on November 12, 2015 [3 favorites]

Fascinating. Does this mean men could get a uterus for carrying a child? Probably not, but if you want to talk dizzying possibilities, there you go!
posted by Brandon Blatcher at 3:51 PM on November 12, 2015

My first thought was about graft vs. host syndrome, but the article addresses it early on:

The transplants will be temporary: each uterus will be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs.

These immunosuppressant drugs are no joke, so recipients will need to be fully prepared for the side-effects.
posted by Existential Dread at 3:58 PM on November 12, 2015 [3 favorites]

Wouldn't developing fetuses be harmed by powerful immunosuppressant drugs?
posted by five fresh fish at 4:05 PM on November 12, 2015 [1 favorite]

To be eligible, candidates must be in a stable relationship, because they will need help and support

Wondering who gets to define "stable" and also who determines that you only get help and support from a partner, rather than friends and family. And would same sex relationships qualify? It's an incredible step but disappointing that only the "right" women (including well-off ones) will qualify. The more things change...
posted by billiebee at 4:06 PM on November 12, 2015 [12 favorites]

i feel like in an ideal world anyone could have one for use as long as they needed it and then it would go back to the uterus library for someone else to check out. and if you never needed or wanted one that would be fine and great and okay.
posted by poffin boffin at 4:10 PM on November 12, 2015 [29 favorites]

Ugh, can I opt out of donating this particular organ as an organ donor? I do not want my uterus contributing to overpopulation. There are enough humans already
posted by a strong female character at 4:19 PM on November 12, 2015 [11 favorites]

Eponysterical.
posted by acb at 4:22 PM on November 12, 2015 [5 favorites]

then it would go back to the uterus library for someone else to check out

Imagine the overdue fines!
posted by GenjiandProust at 4:23 PM on November 12, 2015 [6 favorites]

Fascinating. Does this mean men could get a uterus for carrying a child?

It's called a 'broterus'
posted by prize bull octorok at 4:25 PM on November 12, 2015 [15 favorites]

I wonder why you would do this? Surely, getting someone to be a surrogate would be cheaper, easier on your body, and less dangerous as a procedure. Also, you wouldn't have to wait for someone with a working uterus to die in a sudden and unnatural manner.
posted by ethidda at 4:25 PM on November 12, 2015

and if you obtain one by unethical means, it's a murdterus
posted by prize bull octorok at 4:26 PM on November 12, 2015

I wonder why you would do this?

Because for some people the whole shebang of being pregnant and giving birth is really important to them? I personally find the entire process distasteful and inhumane and the end result frankly unspeakable but I'm not ridiculous enough to expect to impose my reasoning on the rest of the world.
posted by poffin boffin at 4:29 PM on November 12, 2015 [24 favorites]

Well, I would think donors would not have to be dead. Like liver and kidney and bone marrow donors. But I'm not a doctor, so.
posted by crush-onastick at 4:30 PM on November 12, 2015 [1 favorite]

i would totally donate my uterus, especially if we worked out intersex or trans women recipients.
posted by nadawi at 4:34 PM on November 12, 2015 [11 favorites]

I'm surprised this passed the ethics board. Immunosuppressive drugs are a pretty big deal, as is organ rejection (and the surgery isn't totally safe either). There's a lot of risk to the recipient here. There's probably also a non-trivial risk to any pregnancy carried, either; there's the immunosuppressive drugs, which are probably not fully tested in pregnant women (as almost no drugs are), there's being carried in a uterus which might fall under immune attack at any point, and then there's being carried by an immunosuppressed mother. You might not care about risks to the fetus, depending on your stance on such things, but it feels likely there's a very good chance of having a pretty messed up kid.
posted by Mitrovarr at 4:36 PM on November 12, 2015

I thought the idea of live donors sounded pretty good until I read the part of the article which mentions that part of the vagina is transplanted along with the uterus. I guess it makes sense--the cervix is a pretty important bit of the uterus, after all. But that sure makes it a big ask for live donors, post-menopausal or not.

Also noticed that this team is requiring transplantees to have ovaries, which default excludes intersex and trans candidates before the question can even be asked. I think that's a shame--and why require ovaries, since all pregnancies will be IVF pregnancies, anyway? I wonder what the logic behind that requirement is, and hope it isn't specifically designed to limit the procedure to cis and non-intersex women.
posted by snorkmaiden at 4:47 PM on November 12, 2015 [3 favorites]

Also noticed that this team is requiring transplantees to have ovaries

There are a lot of hormonal contributions to the phenomenon of pregnancy. It's kind of amazing that it works with all the immunosuppressives they have to use. And there are other factors, such as the fact that if you were born male you don't have a female pelvis even if you've done the rest of the transition.
posted by Bringer Tom at 4:55 PM on November 12, 2015 [11 favorites]

Pregnancy is not advisable for at least a year after transplant for other organs as that is the time when the risk of rejection is highest. A 2007 review article including 80 studies on the topic indicates that "successful pregnancy outcomes are possible in female organ transplant recipients, although sporadic adverse outcomes have been reported after immunosuppressant use in pregnancy." A few other items of note from this review:

• There's a lack of RCT trials investigating drug safety in pregnancy so the specific influences that immunosuppressive drugs have on the fetus are inconclusive.
• Prednisone and methylprednisolone, common medications used after solid organ transplants, can cause cleft palates in mice and humans as well, although no other congenital issues seem to be caused by these drugs.
• One of the drugs commonly used in solid organ transplants, cellcept (mycophenolate mofetil) causes structural fetal abnormalities, including abnormal ear formation and severe fetal anemia.
• Calcineurin inhibitors, another class of immunosuppressant, causes fetal structural abnormalities about 5% of the time although there is no discernible pattern to these abnormalities. Cyclosporin, a calcineurin inhibitor, is commonly used in pregnant women with transplants.
• There is very little data on one of the most common drugs used in transplant recipients, tacrolimus or prograf, which is a calcineurin inhibitor. The same is true for sirolimus. It is worth noting that these are two of the more recent immunosuppressive drugs that have been developed.
• Infants born to mothers on immunosuppressants may have a suppressed immune response that normalizes within the first year.
• There may be developmental issues for children born to mothers on immunosuppressants, but they are not known because longitudinal studies are uncommon. In one such study, 24% of the 74 enrolled children had developmental delays; their mothers were on cyclosporin during pregnancy.
• 25% of women on cyclosporin develop preeclampsia.
• Infants are much more likely to be born premature or at a low birth weight if their mother is on immunosuppressants: the preterm birth weight is about 60% in cyclosporin and in tacrolimus.
• The metabolism of immunosuppressant drugs is increased during pregnancy, probably due to the increase in blood volume.
• Mothers taking immunosuppressive drugs are advised not to breast feed.

So, yeah. I was very surprised to see this research. It feels very "sexy" or "hot" and very "translational" and personally I think that there is more interesting and more important research to be done in the area of transplantation, but what do I know? I'm just a lady with access to Medline and a cursory understanding of this kind of science.
posted by sockermom at 5:17 PM on November 12, 2015 [6 favorites]

"It's called a 'broterus'"

Duderus, surely.
posted by Eyebrows McGee at 5:37 PM on November 12, 2015 [28 favorites]

“There are women who won’t adopt or have surrogates, for reasons that are personal, cultural or religious.”

How about legal.

Adoption is a mess, costing a lot of money, time, and too often heartache. That's after a person gets beyond not having a biological child and all the issues of there being a biological parent somewhere else in the world (alive or dead). It's a beautiful thing, but it's hard enough to deal with the endemic issues. The layers of bureaucracy on top are in need of serious reform.

Surrogates are a gamble as well. The laws on surrogacy are a patchwork around the U.S., and if you aren't careful, not only can this be expensive, it can be incredibly heartbreaking.

These built-in costs and risks are not a small reason why people go through IVF including donor eggs and sperm. At least you can have some certainty if not as to outcome, as to your rights. I would imagine that this transplant procedure, in addition to everything else, brings some level of the same certainty as well. My baby, my business, so to speak.
posted by Muddler at 6:06 PM on November 12, 2015 [7 favorites]

i feel like in an ideal world anyone could have one for use as long as they needed it and then it would go back to the uterus library for someone else to check out.

My ideal would be an actual baby farm. In addition to not having the overdue fines problem and imo (probably) solving 74% of the patriarchy problem, I like the visuals (pods, lots of pods, in a honeycomb structure. Joking but not really).
posted by cotton dress sock at 7:04 PM on November 12, 2015

Guys, this is just like the dream about Luke and Leia I had last night!
posted by newdaddy at 7:12 PM on November 12, 2015

Fuck yeah, the future! This gives me a lot of hope.
posted by corb at 7:50 PM on November 12, 2015 [1 favorite]

It's called a 'broterus'

A huge uterus with a long tail -- munching on the leaves from the highest trees.
posted by smidgen at 8:23 PM on November 12, 2015 [2 favorites]

really all i can picture is a xenomorph which is highly appropriate because it perfectly embodies my feelings about human reproduction
posted by poffin boffin at 8:26 PM on November 12, 2015 [2 favorites]

Holy shit I've been wondering if I could donate my uterus for a while now. I'm sick of mine (it hates me) and don't want kids. But then what if my donated uterus is used to grow and birth some evil dictator or Dick Cheney like person.
posted by mokeydraws at 8:41 PM on November 12, 2015 [2 favorites]

I volunteer to donate. I'm not using mine, I've always said I wished I could give my perfectly-functioning reproductive system to someone who could actually make use of it.
posted by gloriouslyincandescent at 9:28 PM on November 12, 2015 [3 favorites]

I don't mean to rain on the funeral but there's an awful lot of implicitly expressed existential resentment here that seems to have nothing to do with the news that science is further empowering women to have control over their reproductive decisions.
posted by an animate objects at 1:30 AM on November 13, 2015 [5 favorites]

But then what if my donated uterus is used to grow and birth some evil dictator or Dick Cheney like person.

Then, in the future, people will ask ridiculous thought-experiment questions like "would you go back in time to hijack the uterus transplant truck carrying the womb that will gestate Space Hitler?"
posted by GenjiandProust at 2:04 AM on November 13, 2015 [9 favorites]

And yet people are getting flack for crowdfunding adoption costs?
posted by bitter-girl.com at 5:46 AM on November 13, 2015

“I crave that experience,” she said. “I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”

This quote from the article gives me the heebie-jeebies. I understand it as a valid human desire, but sort of like skydiving, it's something I personally cannot wrap my mind around.

I like the idea of having a kid, but only if I could skip the pregnancy part. I'd be fine adopting, but my husband REALLY wants a kid of his own.

In the end, I'm happy for these women if it works and helps them achieve their dreams. Sure, there are more than enough humans already on the planet (IMHO), but we should be striving towards a goal of maximizing happiness. Which means getting contraception and reproductive medical care to all the women in the world, letting each woman have as many, or as few children as they want.
posted by sharp pointy objects at 6:11 AM on November 13, 2015 [2 favorites]

The comments here are really making me sad. As others have said, here we are talking about a way to give women control over their bodies, yet MetaFilter is more than happy to tell these women that their choices are Wrong and They Should Feel Bad. Infertility seems to be one of the issues that MetaFilter is still happy to tell women how wrong they are about their desires and choices.

There are some real patriarchal issues that could be addressed here. But assuming that every woman who could benefit from this surgery is in some way wrong is weird and gross. I think schmod did a great job of understanding that this can be both good and bad, and it's the context that matters.

Kudos to the researchers who are working on this.
posted by PCup at 6:36 AM on November 13, 2015 [7 favorites]

Hooray! They are welcome to take mine; I am not using the fucking thing anyway.
posted by Kitteh at 6:37 AM on November 13, 2015 [1 favorite]

But assuming that every woman who could benefit from this surgery is in some way wrong is weird and gross.

Aw, sorry - that wasn't my intention. If they want this surgery, they should have it if they can!

(I am serious though in thinking that it really would be great to make whatever kind of parenthood available to anyone who wants it, but not even a question to those who don't, and divorcing reproduction from "femaleness" and the body altogether imo would be most ideal. Personally.)

implicitly expressed existential resentment

Maybe… I'm seeing people expressing complicated feelings about the physicality of reproduction, and maybe resentment about the idea that bearing children (through their bodies) is the default expectation for women, towards their own uteri, which have probably (if I'm not overly projecting here) given them a hard time so far. (Because they often do, for a lot of people, which depending on the amount of pain involved can range from annoying to veering on disability, which is extra annoying if you happen not to want children).

I'm with others in being perplexed by people yearning for the experience of pregnancy per se, tbh, but I don't think it's wrong.
posted by cotton dress sock at 7:41 AM on November 13, 2015 [3 favorites]

the adoption costs thread brings up the horrific emotional costs to birth mothers - that doesn't seem to be the case here.

also i don't really understand the point of view that "the comments here" are saying any one thing. i see some people questioning the science, some questioning the ethics, some discussing what limitations on the transplant receiver's body makes sense, other glad to give theirs up (except maybe not a live donation if part of the vagina goes with it) etc etc. seems to be there's a broad range of opinions being shared and tsk tsking a couple you don't like and suggesting it's the overwhelming response of the thread is a little weird to me...
posted by nadawi at 8:52 AM on November 13, 2015 [8 favorites]

Whether or not someone considers being born as the worst thing that can happen to a person (I mean, I get it, I've been there too,) has no bearing on the challenging complexities of women's various experiences (and lack thereof) of pregnancy -- which is even a stretch for me to assert because I too have no bearing on women's experience of pregnancy or lack thereof.

I just think anything that would count as points for Team Woman's Guilt ("Don't have babies it's morally wrong!") should be politely omitted from this and every other goddamned conversation that will ever be had again.
posted by an animate objects at 10:49 AM on November 13, 2015 [4 favorites]

MetaFilter is more than happy to tell these women that their choices are Wrong and They Should Feel Bad

I can't see that anywhere in this thread.
posted by billiebee at 10:58 AM on November 13, 2015 [2 favorites]

I will back off a bit. I accidentally implied that the whole thread is hating on this research, and that is wrong. I apologize for insinuating that about all comments. There are good comments throughout this thread about the safety and ethics of the research. However, I am surprised by a few instances of hostility towards this research:

Ugh, can I opt out of donating this particular organ as an organ donor? I do not want my uterus contributing to overpopulation. There are enough humans already

The author of this comment is very free to use their body and donate their organs in any way they please. But "there are enough humans already" is a really unkind swipe at everyone who wants to get pregnant in the future, especially those who are having trouble conceiving and are seeking medical help.

I wonder why you would do this? Surely, getting someone to be a surrogate would be cheaper, easier on your body, and less dangerous as a procedure. Also, you wouldn't have to wait for someone with a working uterus to die in a sudden and unnatural manner.

This comment raises a reasonable question about this procedure vs surrogacy. However, it is also suggests that the women involved in this research made a wrong or at least irresponsible decision, rather than trusting them to make decisions about their own bodies. We wouldn't say that someone waiting for a lung transplant is "waiting for someone with a working lung to die in a sudden and unnatural manner" yet when we're discussing a transplant that is specific to women we are more willing to judge.

but it feels likely there's a very good chance of having a pretty messed up kid

This comment raised reasonable questions up until it referred to a child with a birth defect as “a pretty messed up kid.” That’s some pretty awful phrasing.

And yet people are getting flack for crowdfunding adoption costs?

This comment seems to be seeking outrage. Couples trying to adopt are doing it wrong, and women trying to have their own children are doing it wrong. There's no substance here, just hostility and judgement about people making their own decisions.

I just wish we could drop the judgement of the women involved that is dripping from these comments and stick to the more interesting discussion of the possibilities, risks, and ethics. But it seems that we always end up judging women when infertility is discussed.
posted by PCup at 11:23 AM on November 13, 2015 [4 favorites]

And there are other factors, such as the fact that if you were born male you don't have a female pelvis even if you've done the rest of the transition.

Not so true for young transitioners who start HRT early (or at least androgen blockers), and there's a lot of room for individual variation in general.

Also sort of moot, since from the article: "If the procedure is successful, any children would be born by cesarean section and the mother would have the transplanted uterus removed after having one or two babies"
posted by Pryde at 12:44 PM on November 13, 2015 [3 favorites]

schmod: "The 26-year-old candidate said that finding out she had no uterus had made her wonder if anyone would ever want to marry her."

So, I've been thinking a lot about that comment that I made, and I want to backtrack from it slightly:

The more that I think about this, the more that I'm convinced that this sentence was some really shitty paraphrasing done by the NYT. I don't think it was the woman's primary reason for wanting the procedure. Wanting to have children is a totally normal human instinct, and I doubt that even the worst ethics board on the planet would have approved this procedure for the sole purpose of making her more marketable to potential husbands.

That being said, I don't doubt that this was a real sentiment that she felt at some point, and I'm sad that we live in a society that made her feel that way.
posted by schmod at 6:39 PM on November 17, 2015 [2 favorites]

I think it's a shame she thought every man out there demands children, let alone so much so that it would cause them to spurn the woman they've fallen deeply in love with. What a horrible expectation. And so obviously wrong, given the existence of childless and adoptive couples.

I think I'll just assume the NYT is making up misanthropic bullshit and that this does not represent her real sentiment.
posted by five fresh fish at 12:25 AM on November 18, 2015 [1 favorite]