Is it possible to transplant a uterus

In addition, transplant patients are required to take immunosuppressant medication so they don't reject their new uterus. Short-term use of these medications is less risky; however most centers recommend just one to two pregnancies to limit the time a patient is exposed. Johannesson, who was a part of the team who delivered the first baby from a uterus transplant in Sweden, emphasized that there is still a need for research.

Not research around the safety of the procedure itself, but rather studies around immunology, ideal donors, and the quality of organs used in transplantation. While she said it is positive to see the procedure becoming available at other centers, Johannesson said getting insurance to cover the surgery is an additional obstacle.

Nevertheless, Johannesson hopes that more patients with uterine-factor infertility become aware of this procedure. Edwards acknowledged that uterus transplantation is a major commitment. But she still encourages other women to consider it if they want to experience a pregnancy. The study invitation was distributed through a variety of platforms, including websites, email, Facebook, Twitter, and Reddit.

The only inclusion criterion was being a transgender woman older than 16 years. A consent form and an information leaflet, detailing the study and the proposed process of uterus transplant in the context of transgender women eAppendix 1 in the Supplement , were sent to willing participants. Following receipt of the signed consent form, an electronic questionnaire was sent to all participants.

The questionnaire consisted of 27 items eAppendix 2 in the Supplement and was distributed via email through SurveyMonkey over a 6-month period between May 1 and November 1, Further questions ascertained reproductive aspirations, perceptions of adoption and surrogacy, and opinions on uterus transplant.

All the questions were closed, using tick boxes, with the option to include further comments if further description was warranted. Five-point Likert scales were used in questions related to perceptions.

The data were anonymous. Descriptive statistical analysis was performed. To quantify the Likert scale responses to ascertain what appeared to be the most influential perceived factor, a weighted ranking system was used, assigning a score of 0 not at all to 4 definitely for each answer to the various influencing factors. The demographics of the cohort are summarized in the Table.

Only 1 woman reported having a child since transitioning. The factors perceived to influence their desire for uterus transplant are shown in Figure 1. All those who disagreed elaborated further that their unwillingness would be because of perceived potential worsening of dysphoric symptoms following hysterectomy.

Figure 3 summarizes the reasons this cohort provided for not cryopreserving their sperm. Since storage of the sperm, 1 person returned to use their cryopreserved sperm with their partner, which has resulted in the birth of 2 children. The data presented herein report the views of transgender women on their reproductive aspirations, motivations, and desire to undergo uterus transplant should it eventually be proven feasible.

These findings are comparable with those regarding the perceptions of women categorized as female at birth. This shift of focus to reproduction after rather than before transition highlights the importance of fertility preservation counseling and the offer of sperm cryopreservation before medical or surgical intervention, as recommended by the World Professional Association of Transgender Health and the American Society for Reproductive Medicine.

More than three-quarters of our cohort would, however, preserve sperm if uterus transplant became an option. This finding suggests that respondents to the survey were not overly concerned about inheritance of gender dysphoria in their offspring, despite increasing evidence of a genetic component associated with gender dysphoria. Although adoption or surrogacy may allow a proportion of transgender women to meet their reproductive aspirations, previous research suggests that gestation could play a vital role in conveying and consolidating a female identity 13 and may therefore facilitate the alleviation of gender dysphoria in transgender women.

These results are consistent with those from an earlier survey of transgender women in which many respondents were more interested in the prospect of uterus transplant than sperm cryopreservation, holding pregnancy and childbirth to be superior to genetic relatedness. Our findings also suggest that transgender women may expect the ability to menstruate to enhance satisfaction with their desired gender after uterus transplant and anticipate improvements in perceptions of their femininity.

The potential for having a functional vagina transplanted as part of the graft may also enhance sexual function and quality of life, and further optimize perceptions of femininity. This expectation raises the prospect of transgender women wishing to undergo uterus transplant primarily to relieve their dysphoric symptoms—with the uterus not intended for the sole purpose of childbirth in women categorized as female at birth.

Although essential to prevent rejection when the graft is in situ, the use of immunosuppression is associated with a number of risks, including infection and cancer. If uterus transplant is performed to allow women to experience menstruation and enhance perceptions of femininity, the duration of the graft would likely increase, significantly worsening its risk-benefit profile.

Given that all those who disagreed indicated that hysterectomy would exacerbate their dysphoria symptoms, it is clear that a proportion, after extensive multidisciplinary counseling, could opt to keep their uterus despite the ongoing cumulative risk related to immunosuppression exposure. The possibility of permanent uterus transplant in transgender women raises ethical concerns, as it would in any woman. The production of a favorable risk-benefit ratio is a key component of any justified medical procedure.

The additional risks caused by permanent uterus transplant and life-long immunosuppression would therefore need to be considered and weighed against the likely benefits for the recipient. Thus, it may well be that, despite the additional benefits that permanent uterus transplant could provide to some transgender women, its risks are too great.

Research into this possibility is necessary to further examine risk vs benefit and ensure that decisions about permanent uterus transplant are not clouded by individual or social biases. Providing uterus transplant for transgender women would complicate an already complex procedure. Concerns surrounding the neovaginal anastomosis, differing male vs female pelvic size and shape, and hormonal variation call into question whether the procedure is feasible.

To our knowledge, this is the largest study of its kind to examine the reproductive aspirations of transgender women and assess detailed perceptions and motivations regarding uterus transplant. Our findings suggest that uterus transplant in transgender women could facilitate the achievement of their reproductive aspirations while concomitantly alleviating dysphoric symptoms, enhancing feelings of femininity, and potentially improving happiness and quality of life, despite the significant associated risks involved.

The demonstration of desire and willingness to undergo uterus transplant in this population supports the need for further animal and cadaveric model research to assess the feasibility of performing uterus transplant in transgender women.

The study has limitations. Participants were self-selected, predominantly recruited via support groups and social media, meaning that the results are not extrapolatable to all transgender women. Because the questionnaire was advertised through various platforms, including websites and social media, it is not possible to know how many people were exposed to the offer of participation overall.

Because the denominator is unknown, it is not possible to calculate the overall response rate. In addition, the exclusive use of self-reported data introduces the potential for bias. A further limitation is that, although the immunosuppression-related risk of cancer following uterus transplant was described in the patient information leaflet, the risks were not described in detail and were not robustly characterized.

In this study, transgender women reported a desire to have physiologic experiences unique to cisgender women, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. Our findings suggest that some transgender women may believe the potential benefits of uterus transplant outweigh the significant risks with which it is associated and may improve quality of life, happiness, and dysphoric symptoms while enhancing feelings of femininity.

As such, just as the desire to experience gestation and psychological sequelae spurred uterus transplant research in women categorized as female at birth with AUFI, uterus transplant in transgender women could be considered in the same light, and research should be undertaken regarding its feasibility. Published: January 20, Corresponding Author: Benjamin P. Author Contributions: Mr Jones and Ms Rajamanoharan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. The mother, who is in her mids, is part of a groundbreaking research trial involving 10 women with uterine factor infertility. The study is testing whether receiving a uterus transplant from a deceased donor could allow these women to become pregnant via in-vitro fertilization and carry and deliver a baby.

Balayla, Y. Gil, etc. Enter your keywords. Published: 19 Mar Facebook LinkedIn Tweet Widget. Medicine Research Faculty of Medicine News releases.