Doctors pioneering innovative womb transplants are optimistic about the prospect of enabling transgender women to experience childbirth. The University of Alabama, Birmingham (UAB) is one of the few institutions in the US offering this procedure to patients who have undergone hysterectomies or were born without wombs. Now, the medical team believes it is “medically possible” to perform womb transplants in transgender women who were assigned male at birth but have undergone sex change surgery. While it is still too early to provide a timeline for this breakthrough, there are potential risks involved due to hormones and previous gender-affirming surgeries. However, the UAB’s efforts bring hope for transgender women seeking the opportunity to bear their own children.
The procedure itself is highly complex and has only been performed about 100 times worldwide, usually as part of tightly-controlled clinical studies. The UAB’s Uterus Transplant Program is one of four programs in the US that offers this service and is the first to do so outside a clinical trial. In May, the program celebrated the birth of its first baby boy. Although the surgical process typically takes about 18 months to complete, the rewards are immense for those previously unable to experience menstruation or conceive due to a lack of a uterus.
The transplant process involves removing a uterus from a deceased or living donor and successfully connecting it to a recipient via surgery. Surgeons need to ensure compatibility between the blood types of the donor and recipient to minimize the risks associated with organ transplants. Connecting the vaginal tissue of the donor to that of the recipient presents a significant technical challenge, which necessitates proper attachment to the cervix and vagina. Successful surgery generally results in the patient undergoing menstruation for the first time, a vital step toward enabling conception.
Dr. Paige Porrett, a transplant surgeon at UAB, reminds us that the primary criterion for considering uterus transplants in transgender women is absence of the organ due to either birth or surgical factors. Generally, women between the ages of 18 and 40 qualify for this procedure. The UAB doesn’t currently offer such transplants to women over 40 years old due to the increased risks associated with pregnancy complications. Patients must also be in good general health without pre-existing conditions such as diabetes or high blood pressure to minimize the likelihood of complications.
Despite the risks, progress in the field is hopeful, with further developments anticipated in the coming years as medical knowledge advances. The current track record for transplanted uteri indicates a similar miscarriage rate in the first trimester compared to those born with the organ. To sustain the successful transplant, patients must undergo immunosuppressive drug therapy to prevent rejection of the new uterus. In vitro fertilization (IVF) is necessary for conception, as it facilitates fertilization in a lab rather than within the body.
It is worth noting that all babies born from transplanted uteri thus far have been delivered through C-sections. This is because individuals born without uteri may have structural abnormalities in their vaginas that make vaginal birth impractical. The typical lifespan of the transplanted uterus is one or two pregnancies, after which it must be removed to avoid long-term immunosuppressant use. By continuing to break new ground in the field of uterus transplantation, the UAB offers hope to those who have been unable to conceive or carry a pregnancy due to uterine factor infertility.
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