I need your help sorting through a thorny issue that I’ve been going round and round about in my mind lately. News of the first uterus transplant sparked quite a debate over at the Creating a Family Facesbook Support Group. Most folks cringed at the title of the Huffington Post article: Giving Birth With A Borrowed Womb Is Not What Makes You A Mother. Others objected to the judgmental tone that they thought the journalist, Lisa Belkin, took which they felt demeaned the pain of infertility and minimized the desire/want/craving to carry your child through pregnancy. The debate, the article, and the very procedure itself leave me filled with more questions than answers. I’d love to start a discussion here to help me figure out what is troubling me.
Here are the facts: Doctors in Sweden transplanted the uteri from two mothers in their 50s, to their two daughters, both in their 30s. One of the daughters was born without a uterus and one had hers removed as part of treatment for cervical cancer. Both of the younger women did an IVF (in vitro fertilization) cycle prior to the surgery and have embryos frozen. After a year for recuperation, the doctors will attempt an embryo transfer with the hopes of a pregnancy. The uterus will be removed after the woman has one or two children. In the meantime, the women will be on immunosuppressant drugs to keep their bodies from rejecting the uteri.
A successful uterine transplant was performed in Turkey last year, but as of yet, the woman has not become pregnant. At least one medical center in the US is soon to begin their own uterus transplant program using uteri from cadavers. Tens of thousands of women in the US alone would be potential candidates for uterine transplants. They include young women who have had hysterectomies for cancer, endometriosis and uterine trauma, and women born without a uterus.
Contrary to the consensus on the Creating a Family Facebook Support Group, I wasn’t troubled by the title of the Huffington Post article since Belkin was implying that giving birth wasn’t what makes you a mom. As a mom through birth and adoption, I agree wholeheartedly with that assessment. However, her lumping uterus transplant as part of the search for the ideal of motherhood did seem a wee bit judgmental and arrogant.
Carrying a child is uniquely feminine, and for some a defining part of womanhood. I could argue that it isn’t the only uniquely feminine part of being a woman (for example, so is being a mom) and need not define you as a woman, but I would be speaking for myself, not for them. I totally get the desire to be pregnant and give birth to your child.
And yet I remain deeply troubled by the idea of a uterus transplant. Transplants are dangerous surgeries. Immunosuppressant drugs are powerfull, to say the least, and come with significant risk of side effects: increased risk of infections of all sorts, increased risk of some cancers, high blood pressure, and kidney and liver damage.
Life is full of risk/benefit decisions, and undergoing an organ transplant would rank right up there as one of the biggest. When the transplant is needed to save your life, then clearly the risk of the surgery and anti-rejection drugs is worth it. This analysis becomes a lot harder when it is not absolutely necessary to save your life. Medical science has opened this door with hand and face transplants. I suppose on some level, why draw the line at the uterus? At least with a transplanted uterus, the organ will be removed after a number of years, thus reducing the length of time the recipient must be exposed to the risks of the immunosuppressant drugs. And, maybe most important, who am I to weigh the risks and benefits for someone else?
And yet, as I said, I’m troubled. Each uterus transplant involves at least four major surgeries (one for the donor if using a live donor, one for the recipient when receiving the organ, one C-section for each birth, and one to remove the organ when child bearing is complete). And although the exposure to the anti-rejection drugs is not life-long, it would last throughout the time the woman is having children. Some side effects may not show up until years after the medicine is used.
What About the Child?
I think what troubles me most is that with uterus transplants a separate risk/benefit analysis should be done for the woman and for the unborn child, and the outcomes might not be the same. You cannot tell me that a pregnancy in a transplanted uterus is not at high risk for premature delivery, to say nothing about the side effects of the drugs amplifying the risks of a typical pregnancy—infections, high blood pressure, and liver and kidney damage. And then there are the potential long term, perhaps life long, effects of immunosuppressant drugs on a fetus. It is true that woman with other organ transplants have given birth while taking anti-rejection drugs (perhaps as many as 15,000), but have there been any long term follow up studies of how these children fare through adulthood? It is one thing to decide for yourself that being pregnant is worth the risk of multiple surgeries and years of immunosuppressant drugs, but it’s a whole other matter entirely to expose your child to these risks.
You Can Always Just Adopt or Use a Surrogate
Are these risks worth the benefit? Many commentators have said that women without a uterus can always just adopt or use a surrogate. I’ve addressed the “why not just adopt” statement before, so will spare you that rant here. I haven’t addressed the “why not just use a surrogate” argument before, so indulge me. Unless you happen to know someone who is willing and able to carry your child for you, a gestational carrier (a.k.a. a surrogate) could easily cost $60-$80,000, assuming that donor eggs are not required and that the carrier’s medical insurance covers a surrogate pregnancy. You would need to add about another $10K for donor eggs, and all bets are off on how much the total cost would be if the intended parents have to pay for the cost of delivery. This is the cost for one attempt. On what planet could the average person afford surrogacy?!?
Does anyone else see the irony here? The total cost for a child born after a uterus transplant would be astronomical. I hesitate to even guess, but three to four surgeries (the transplant surgery itself took hours and had 10 surgeons in attendance), anti-rejection drugs, close monitoring of the transplanted uterus, IVF, high risk pregnancy…. I would guess somewhere in the vicinity of $1 Million. Right now, I would assume the costs are being covered by the medical centers since it is part of research. However, if it ever becomes standard practice, it might well be covered by health insurance. I can’t help but think there has got to be a better way. Let’s imagine a world where just a fraction of this money could be used to help defray the cost of surrogacy or adoption for those who want to choose these options but need just a little help.
Image credit: Sharyn Morrow