Concepts in Conception: Uterine Transplants

With increasing numbers of people seeking infertility treatment, it is not surprising that the medical community has begun investigating new and more effective ways to help these couples get pregnant.

Within this context is an up-and-coming procedure designed specifically for women unable to achieve pregnancy due to uterine abnormalities, such as an enlarged or prolapsed uterus, or lack of a uterus altogether. The procedure is called a uterine transplant, and although it is not yet being offered, researchers are predicting it could become available within the next five years. The surgery, however, is not without it's share of controversy, as ethicists debate its moral rationale.

 

What is a Uterine Transplant?

A uterine, or uterus, transplant would function in much the same way as a kidney, heart, or liver transplant; a donor would offer her uterus to be transplanted into a woman who is looking to conceive. However, the procedure would be considerably more invasive, and would involve a lengthy, and potentially risky (not to mention costly), surgery.

The first step for any patient being considered for the surgery would be to undergo in vitro fertilization (IVF), so that doctors would have a ready supply of frozen embryos available for implantation after the transplant. This is done because intercourse is generally prohibited after surgery; it is also a way for doctors to confirm that there are no other fertility problems inhibiting the woman from getting pregnant.

The surgery itself involves a vertical incision in the abdomen of the recipient. The donated uterus would be attached to the recipient's vagina by the cervix, and the uterus would be connected to four blood vessels-- two on each side. As is the case for every transplant surgery, immunosuppressive medication (typically steroids) would be offered afterwards to prevent organ rejection. Women would be encouraged to use donor sources from immediate family members (i.e. mother or sister) to avoid the risk of rejection.

The frozen embryos would then be implanted, once the woman is in stable condition. It is important to note, however, that this does not always result in pregnancy. If pregnancy is achieved, delivery would have to take place via cesarean section. Afterwards, a hysterectomy would be performed to prevent any additional complications.

 

Risks of a Uterine Transplant

Any woman becoming pregnant via a uterine transplant would be considered high-risk, and therefore would be closely monitored for the duration of her pregnancy. There would also be a considerable number of risks associated with the surgery, including:

 

  • The immunosuppressive drugs administered after the transplant could be toxic for a fetus
  • Infection
  • Blood clotting
  • Organ rejection
  • Pre-term birth
  • Low birth weight babies
  • High blood pressure
  • Preeclampsia

In addition, there is the risk that the transplanted uterus would not be well adapted to pregnancy. It is also unknown what potential risks the surgery could pose to the baby, as rates of birth defects and other complications are not well documented.

For these reasons, medical experts are recommending the procedure be sufficiently tested on other primates before moving to humans.

 

The Controversy

Although some women have already expressed an interest in having a uterine transplant, there are members of the medical community who are concerned about the ethical implications of performing the surgery.

Indeed, some doctors have expressed the concern that the procedure's considerable risks do not outweigh the benefits. Since infertility is not a life-threatening condition-- unlike heart or liver failure-- they argue that undergoing such an invasive surgery simply does not make sense. They emphasize that experiencing pregnancy is not the definition of parenthood; raising your children is. Therefore, they feel that women should not be so focused on becoming pregnant, but rather, on becoming a parent in whatever way possible, such as through surrogacy or adoption.

Some, however, disagree, stating that it shouldn't be the job of the medical community to make such a personal decision, and that for some women, becoming pregnant is paramount to the experience of motherhood itself.

To further complicate the issue, some are even saying that if and when the surgery was perfected, it could eventually lead to men being able to become pregnant-- although that procedure is purely conceptual at this point. For now at least, doctors are sticking with primates.

 

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