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?!?
Irony Anyone?!?
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
I want to become a uterus donor. If anyone knows whom to contact to make this happen, it’d be greatly appreciated.
As far as I know (and I don’t know a lot about this), there are only a couple of medical centers in the US working on transplanting uteri and their protocol uses uteri from cadavers.
Thanks for that perspective Dawn.
I think it should remain legal – I also am not a fan of using legislation to address decisions that I think should be between a doctor and patient. I also agree that it needs to be proven safe for the mother and child – and I simply don’t know enough about anti-rejection meds to know the impact on offspring. But that is a risk/benefit analsysis that should be between the patient and doctor. I just don’t feel that it is my right to tell someone else whether it would be worth it to her or not. And that is a completely different conversation than discussing whether our society puts too much pressure on women to give birth themselves.
As you mentioned in the article, there are many other types of transplants that are not life-saving (hands, face, etc.) and yet, I don’t think there is much societal or media pressure on those people to defend their right to a transplant. The fact that it is related to reproductive rights makes it a hot topic because there is so much focus on all aspects of reproductive rights these days.
I did want to mention something I found interesting – it appears that the article title has changed from when it was first published. I believe that the original article title was “Giving Birth with a Borrowed womb does not make you a mother” and the title currently appearing is “Giving Birth with a borrowed womb is not what makes you a mother” semantics, but those read very differently to me and the initial title was the trigger for me because it seemed to suggest just one more way to “disqualify” a woman from the mother title – although the article did go on to sort of suggest otherwise. Did you notice that change in the title?
Sue, no I did not notice the change in the title, and now I completely get why folks were offended by the first title. It is a huge difference in meaning to me as well. The article clearly suggests that Belkin’s intent was that you didn’t have to give birth to by a mom.
Ultimately, I agree that only the patient and her doctor can make this risk/benefit analysis, but I would want her to be fully apprised of the risks to both herself, her donor, and her unborn child. Anon’s analogy to IVF has given me pause, because she is right that in the beginning when IVF was new for humans, there were very similar arguments being made. Maybe this is just the nature of acceptance in developments in infertility treatment. As you can tell, I’m still processing.
I think the IVF thing still isn’t really settled… the oldest IVF babies are now in mid-30s, enough to establish that they are themselves fertile, but not really enough to say that issues with epigenetic changes as a result of spending 3-5 days in very early development in artificial culture media don’t cause increased risks of cancer or past-middle-age or beyond related changes.
So, I think in many ways, this is less daunting step forward from current practice than IVF was — it’s still a uterus! The concern about the anti-rejection drugs would be my biggest, but I certainly wouldn’t tell someone with a life-sustaining organ transplant they couldn’t get pregnant. As for surgeries – people undergo them for much more frivolous reasons all the time (e.g. cosmetic surgery). I think the individual people are the best served to weigh the risks and benefits, along with a medical care team to outlay what exactly the risks are, and then decide whether this is really a better plan than surrogacy.
So, would I do it? No, but I also have a same-sex spouse who would happily carry in my place, so I’d have pretty much the easiest surrogacy plan in the world in place. But I don’t think it’s my business if someone else decides that this is better for their situation than surrogacy would be, provided that they foot the bill of the many medical procedures this involves.
Philyre, you raise a good point about cosmetic surgery. Each person (and their wallet) get to decide if the risk of cosmetic surgery is worth the reward.
Thank you btw for this great piece! it has already served as fodder for some of the greatest discussions of my week. 🙂
And thank you for providing such good fodder for thought. Yesterday at one of my kids tennis matches, I brought up this subject with a friend. She immediately said she didn’t see any ethical issues at all, which launched me into a discussion of possible issues. She and I continued to talk about it while all the nearby kids gradually moved slowly away. I think they started moving at the first mention of “uterus”.
Yes it is interesting. So far, two doctor friends I have spoken with and also a friend who is an organ donor recipient (not a womb) have all said they do not know but suspect the meds in quesion would not necessarily be harmful to an unborn child. Are other organ donor recipients advised against having children? I am not sure. of course the immune suppressant drugs are but one in a myriad of issues…
This procedure also brings up the possibility that m-f transgendered individuals may, at some point, be able to become pregnant.
The implications for how we understand gender are huge.
My concern with the teratogenic effects of these meds, is that they are largely unknown. Just the fact that children born from organ transplant mothers are alive with 10 fingers and toes, does not at all mean that the drugs have not affected the children in some way that may not be determined for another 30 years. These more subtle affects won’t be known for many years and may well never be known because the numbers of women who take these drugs in pregnancy are relatively few. (And, as far as I know there is no long term study of their children.) The general rule of thumb is to avoid all medications in pregnancy. In this case, the women are going in to the pregnancy with the plan of taking the meds. Of course, the same could be said for many medications, not the least of which are anti-depressants, and I’m certainly not saying woman who need antidepressants should not get pregnant, so in some ways I see that I’m being hypocritical. {sigh} And I continue to go round and round in my head, although this discussion here has given me so much to think about.
What if you could combine this procedure with the organ-growing tech also being developed? http://abcnews.go.com/Health/lab-grown-custom-organs-future-medicine/story?id=16631764# A long way off still, but say the immunosupressants and the donor surgery were out of the picture, would that ease your concerns?
Major surgery (which I know is a mushy phrase) is already a part of the reproductive health and fertility toolbox. I came close to it for endometriosis but luckily had docs who chose to push their laparoscopy skills to their limits to prevent a laparotomy. A family member, on the other hand, had to have a full hysterectomy for her treatment. Doing that with a laparoscopy was not considered possible when she had her surgery. Though we’re not “there” yet with the transplants, I think this work–especially if pregnancy is successful–demonstrates a proof of concept for one more treatment option for infertility that could become viable in the future. I think anon’s comparison to IVF is spot on.
anon WP, yes, I think that would ease my concerns. It’s one thing to decide the risks are worth it when the risks fall on us; it’s another thing when the risks fall on someone else. I too think that anon’s comparison to IVF is uncomfortably spot on, and I know it has given me a great deal to think about. I’ve had to ask myself if I would have written a similar blog way back when Louise Brown was first born through IVF. I squirm when I think about it, but the truth is that many of my arguments against the uterus transplant could apply to IVF when it was first introduced. No, the woman wouldn’t be taking the IVF drugs during the pregnancy, but she would have taken them right before the pregnancy, and thus, they could still potentially be in her system when first pregnant. And way back then, I might well have argued that the very act of in vitro fertilization and growing an embryo outside the human body could affect the unborn child for life, just as the anti-rejection drugs might. Boy, a lot to process. I LOVE this community for being able to have a thoughtful, deep, and respectful discussion about this complex issue.
Great discussion. I agree that we should make our decisions based on what’s best for the child. But absent any real data that presents a smoking gun on the ill effects of this procedure on babies grown this way, I still stop short of saying we should outlaw this altogether. IVF was groundbreaking and controversial and scary when it first emerged, and now thousands of babies are created this way.
anon, I have very mixed emotions about prohibiting through legislation. And your analogy to IVF is certainly a valid one. But I still feel like the risks outweigh the benefits.