It was a first in the United States. A woman, only identified as Lindsey, received a uterus from a deceased woman. Lindsey was born without a uterus, and she was hoping this transplant would enable her to get pregnant. At a press conference at the end of February, Cleveland doctors announced it was the first successful uterus transplant in the United States. Only days later, Lindsey suffered complications and had to undergo another surgery to remove the organ.
The Cleveland team of doctors has been given permission to experiment with uterus transplants in nine other women, and a few other clinics will also attempt the procedure.
In Sweden, doctors have performed nine uterus-transplant surgeries on women who were missing wombs, and these have resulted in four births. All of these organs came from live donors. All of the children were premature and were delivered by cesarean section.
In every case, whether successful or not, uterus transplants are only temporary. The women have to take immuno-suppressive drugs to prevent the body from rejecting the transplant. The plan is to only allow one or two pregnancies before the women undergo a final surgery to remove the organ. This is to minimize their exposure to the immune-suppressing drugs.
Also, in all of the uterus transplants to date, the Fallopian tubes are not connected. This means that conception cannot take place naturally; in vitro fertilization (IVF), with the transfer of embryos to the transplanted uterus, is required. The women can use their own eggs or use donated eggs from another woman to create embryos.
Many Catholics are wondering if uterus transplants are ethical. As they stand right now, the answer is: No, simply because IVF is required to create embryos, and the Catholic Church teaches it is morally unacceptable to separate procreation from the marital act. But what if the uterus transplant can be modified to link the Fallopian tubes to the ovaries, allowing natural conception to take place?
At initial glance, uterus transplants where conception can take place naturally would be good for women who are unable to have children due to a missing or defective uterus. The Church has not denounced uterus transplants, and some Catholic theologians are cautiously optimistic about the procedure, if the IVF component can be eliminated.
But beyond the procedure itself, the ethics of uterus transplants are complex. Many people liken the operation to a kidney or heart transplant, but it is fundamentally different.
A uterus is not an organ required for life. A uterus transplant is an elective procedure that is incredibly invasive and carries a multitude of risks for the live donor, the recipient and for the children gestated in these experimental wombs.
Harvesting a uterus from a live donor goes well beyond a simple hysterectomy. The procedure in Sweden took 10 to 12 hours of surgery and required the extraction of much more tissue than just the uterus. British doctors who are also planning on conducting their own transplants will be using deceased donors because they deem it unethical to put the life and health of a live donor in danger for a non-lifesaving procedure.
In addition, the woman who receives the uterus will undergo a minimum of three surgeries: one for the transplant, which is highly invasive, one to deliver the baby and one to remove the organ. Then there is the fact that the pregnancy itself will be very high-risk, not for the sake of saving a woman’s life or improving her health, but to allow the experience of gestating a child and giving birth.
One woman screened for the Cleveland clinic told The New York Times, “I crave that experience … I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I’ve wanted for as long as I can remember.” I want. I crave. Not: I need it to live.
Finally, and most often overlooked, there is the health of the child to consider.
It is a stark reality that every child gestated in a transplanted uterus will have to survive the most critical part of human development in a womb her mother’s body wants to reject. In the first pregnancy for the Swedish team, the doctors reported that the mother began to reject the organ at week 18. They were able to control the rejection with more immune-suppressing medication, and the baby was delivered premature at 31 weeks because of pre-eclampsia. As with all medications during pregnancy, there are potential risks to the baby.
There is also significant concern that the baby will not get enough nourishment from the placenta or that the blood flow will not be good enough to support the growing fetus. Derya Sert, a 22-year-old Turkish woman, became pregnant after a uterus transplant in 2013. Sadly, Sert miscarried. Whether or not that was due to the transplanted uterus may never be known.
Mats Brännström, the head of the Swedish team, admits that a uterus transplant is not really “successful” unless a baby is delivered. In other words, the child is the experiment.
The reality is that uterus transplants put the life of mother, child, and, in some cases, donor at significant risk for a non-life-threatening condition: the desire to experience pregnancy. One has to ask if this is good medicine.
Vox reporter, Julia Belluz, asked various medical ethicists and doctors, including one of the authors of the ethical guidelines for uterine transplants, for their opinion on the procedure. She writes, “They all pointed out that the uterine transplant is a supremely risky operation — but agreed that doctors and willing patients should continue experimenting with them anyway.”
And there is the rub. These uterine transplants are not being performed in a vacuum. From the very beginning, the fertility industry’s mantra has always been to try it first and see how the kids, and moms, turn out later.
Over the last four decades, IVF practitioners have tried all kinds of new techniques on the next generation, testing to see what worked and what didn’t. The children are the data. There is intra-cytoplasmic sperm injection (ICSI), where sperm is injected directly into the egg, and pre-implantation genetic diagnosis (PGD), where a single cell is removed from the embryo after he or she is only days old, in order to be tested for everything from genetic disease to gender.
For a short time, there was “cytoplasmic transfer,” where cytoplasm from a donor egg was injected before fertilization, resulting in children with the genetic material from three parents; and now there is mitochondrial replacement (MR), where the egg is completely torn apart and then pieced back together before fertilization.
Doctors and scientists have been very busy tinkering with human life at the earliest stages. We won’t know the full ramification of the risks of these invasive procedures on the children they produce for many more years to come.
At the same time, as a necessity, the fertility industry turned women’s bodies into commodities to provide raw materials for the ever-increasing demand. The fertility machine is in constant need of young eggs. We have all heard and seen the ads calling for 20-something cash-strapped women to “give the gift of life” to an infertile couple. These young, often unsuspecting, women get paid to undergo a painful and dangerous egg-retrieval procedure. The long-term health of egg donors is not monitored, and these procedures have left some women infertile and others dead.
Beyond eggs, the industry needs wombs — surrogates willing to rent out their uteruses for money. Surrogacy is rapidly growing, and the cheaper the better. It is becoming popular in states like Idaho, where surrogates cost half of what they do on the East Coast. Surrogacy has also been exploding in countries like India and Thailand, where many women live in poverty.
Some surrogates pay the ultimate price for providing an “oven” to infertile couples. Most recently, Brooke Brown, a surrogate in Idaho, died from complications of her pregnancy. The twins she was carrying also passed away. She leaves a husband and three sons behind.
With the booming surrogacy industry, there is a real fear that if uterus transplants become more mainstream, poor women will become victims of a red market in wombs, giving up their reproductive capacities for life-changing money.
The fact is the fertility industry in the United States is largely unregulated, and the juggernaut has been experimenting on women and children with some serious consequences. It seems society is happy to turn a blind eye because no one is raising red flags.
Well, almost no one. In a review of artificial reproductive technologies in the journal Reproductive Biomedicine, two fertility industry professionals point out that, often, techniques are implemented before they are thoroughly studied. Some are “not confirmed to be safe,” and yet they are still offered.
Rachel Brown and Joyce Harper expose that, in the fertility industry, “new technology has rarely been robustly validated before clinical use, and developing scientific understanding of the available techniques has done little to alter their use.” The authors conclude that discussions about the safety of such techniques “are urgently needed.”
It is hard to trust practitioners that deem an elective procedure “supremely risky” and then recommend continuation of experimentation anyway. Do they not realize the subjects of the experiments are women and children and not rats?
Would it be nice to be able to perfect the uterus transplant so every woman could experience pregnancy if she so desired? Absolutely. But is it something we can accomplish without treating human test subjects, namely real women and children, unethically?
Unfortunately, children-as-experiments and women-as-parts-factories have been the modus operandi of the fertility industry since the onset. It is into this culture that the uterus transplant has emerged. The history of the industry does not inspire confidence.
Uterus transplants may become one more way women and children are marginalized by ever more radical experimental procedures.
Rebecca Taylor is a clinical laboratory specialist
in molecular biology.
She writes about bioethics
on her blog, Mary Meets Dolly.