Womb transplant for MTF transgender
persons and infertile cisgender women:
The vast majority of humans are "cisgender." They are identified as either female or male at birth, are raised as that gender, and identify as having that gender throughout their life. However, about 0.6% of people regard themselves as transgender. They identify their gender later in life as being different from their birth-identified sex. Most transgender persons identify as having the opposite gender to their birth-identified sex. Some identify as having switching between genders from time to time. Some don't identify as being either female or male.
MTF transgender individuals are persons who were identified as male at birth, who remain biological males throughout life, -- typically with XY sex chromosomes throughout their body. However, unlike 99.4% of biological males, they identify as having a female gender later in life. Sometimes this happens as young as three years of age. They obviously cannot conceive and bear children because they were born without a womb/uterus.
The Daily Mail, a UK newspaper, published an article on 2017-JUL-02 with a very long title:
"Wombs for men: Astonishing prospect as fertility doctors back operations on NHS so transgender women born as boys and not equipped with a uterus can receive a uterus and have babies." 1
Dr. Amel Alghrani, of Liverpool University, is a medical ethics lawyer who is promoting womb transplants on MTF transgender individuals, -- persons who are biological males who now identify as female and wish to bear children. Such transplants might even be performed on cisgender males -- adults who are biological males. currently identify as male, and who want to become pregnant and give birth.
Some successful womb transplants have been made on infertile biological women. Between 2014 and mid-2017, doctors at Gothenburg University in Sweden have performed such transplants. At least five successful pregnancies have resulted. Since early 2016, doctors in the U.S. have also performed transplants, with a lower success rate.
Some British doctors hope to create a non-profit program to fund womb transplant operations for at least three cisgender women in the UK who are currently infertile. These were identified as female at birth, are biological females, do not have a uterus and identify as females today.
Sanchez Manning & Stephen Adams, writing for the Daily Mail, discussed the possibility of performing transplants on MTF transgender women. He said:
"... gynecologists are increasingly convinced that implanting a donor womb into a person born with male organs is possible, with one top doctor saying it is just a decade away. They believe the recent success of ‘uterine transplantation’ in [cisgender] women born without wombs has drawn it a step closer." 1
The Daily Mail article also discusses Hayden Cross, who is described as a "British female-to-male transsexual" He was identified as female at birth, is a biological female, and now identifies as male. He decided to delay his planned sex-change operation so that he could first give become pregnant and give birth. His story is unrelated to the topic of the article, since a transplant is not involved. He was apparently included as an illustration of a man who wants to give birth.
Two debates have emerged in the UK concerning such transplants on MTF transgender women:
Whether such transplants are ethical, and
Whether they should be financially covered by the National Health Service (NHS). That is the public health program established in the mid-20th century. It:
"... provides a comprehensive range of health services, the vast majority of which are free for [all] people ordinarily resident in the United Kingdom. 2
Since the UK NHS system was mentioned above, it might be worthwhile comparing the costs of health care systems in the UK, U.S., and other countries. In the UK, Canada, Australia, New Zealand, and most other developed countries, the government supplies an economic universal health care program for all citizens. In comparison, in the U.S., many citizens are without a health care program:
The NHS in the UK is 98.8% funded from general taxation. Its current budget is approximately £1,980 per year for every man, woman and child in the UK. This equates to about US $2,600 per year per person at the exchange rate in early 2017-NOV. It is a universal plan, so that all residents are covered.
During 2014, The U.S. health care systems averaged U.S. $8,745 per person each year, and plans only covered some residents.
Life expectancy in the U.S. is only 79 years. In comparison, in countries with universal health plans, it is 82 years in Canada, 81 years in the UK and 84 years in Japan. 3
Perhaps it is time for a change. Converting the U.S. system to Canada's might increase the life expectancy of the next generation of Americans by a total of one billion person-years!
Opposition and support in the UK to womb transplants for transgender females:
Laura Perrins, who was described on the Daily Mail article as a "women’s campaigner," said:
"Most [UK] taxpayers will not think this is a good use of resources. It raises profound ethical and moral issues that will have an impact on women’s rights. It will impinge on the meaning of motherhood and womanhood." 4
Julie Bindel, described as a "feminist campaigner," said:
"... those born male who are dosed with female hormones and undergo cosmetic surgery in order to present as female will never be women. Trans-women pushing for womb transplants on the NHS are driven by a desire to experience childbirth, because it is considered to be an authentic female experience. But this is not about transgender rights -- it’s about a twisted notion as to what constitutes a ‘real woman’. ... Let’s be clear: this is a lifestyle choice, not a health issue. And quite frankly, I’m not sure if men will make good mothers." 1
Consultant gynecologist Dr Arianna D’Angelo, of the NHS’s Wales Fertility Institute, disagreed. She said it was correct from an:
"... ethical point of view. ... We already have fertility preservation for transgender people, to give them the possibility to have their own genetic child. So I don’t see much of a difference between that and actually delivering their own child."
Dr Francoise Shelfield, a clinical lecturer in obstetrics and gynecology at University College, London, said:
"‘If we are saying we should have equality and we have legislation [defending the rights of transgender people], I do not see why not. ... [Their rights to equality were] actually enshrined in legislation." 1
As is obvious from the above comments, people differ on how they define "gender." They use different criteria to decide who is to be considered a woman, and who is male:
Many religious conservatives and others view gender as being defined by a person's birth-identified sex that is registered on their birth certificate:
For the vast majority of newborns, a brief inspection of their anatomy is all that is needed to register their gender.
Among the small percentage of newborns who are intersex and are born with ambiguous genitalia -- formerly called hermaphrodites -- a DNA test to search for a "Y" chromosome in their cells can be used as a guide to understand their biological gender. The presence of a "Y" chromosome normally indicates a male biological sex; its lack indicates female. The levels of hormones are another indicator of sex.
Many religious conservatives feel that one's sex defines one's gender and cannot be changed. For example, they will generally refer to a MTF transgender person -- who now identifies as as male -- as a female. Conservatives use the individual's birth name and male personal pronouns. They often refer to transgender persons as "gender confused," and in need of therapy to resolve their mixup.
Many religious liberals, Agnostics, Atheists, and NOTAs (those NOT Associated with any religion) note than structures have been found inside human brains that typically come in one of two forms: male and female. They differ in size and neuron density. In cisgender individuals, these structures match both their biological sex and their gender identification . In transgender individuals, the structures match the person's gender identification and contrast with their biological sex. They feel that for a transgender persons, their gender is different from their biological sex. For example, they will generally define a MTF transgender person as female and refer to the person by their new chosen name and by using female personal pronouns. They often refer to transgender persons as having a female brain in a male body, or vice versa.
Womb transplants in Sweden:
Womb transplants were first performed during 2012 in Sweden. The first baby was born to a womb recipient in 2014, and was delivered prematurely through Caesarean section. According to the British medical journal The Lancet, the newborn was healthy.
Womb transplants in the U.S.:
At the Cleveland Clinic in Cleveland, OH:
Fiona Ortiz of Scientific American discussed "Lindsey", 26. She was born without a uterus. This is an unusual condition that happens to one woman out of about every 4,500 to 5,000 women (sources differ). 5 It is called: " Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome."
Lindsey, who has adopted three sons, said:
"I was told at 16 I would never have children. From that moment on I prayed that God would allow me the opportunity to experience pregnancy."6
The transplant performed on 2016-FEB-24 was the first in the U.S. Nine more 10 uterine transplants were planned at the clinic.
She received womb transplanted from a deceased woman in her 30's. The operation took nine hours. She expected to take immunosuppression medications to prevent her body from rejecting the womb. Since the transplant did not include fallopian tubes, ova would have to be removed from her ovaries, fertilized with her husband's sperm using in-vitro fertilization (IVF) in a laboratory, and placed in her womb. This was scheduled for one year after the operation.
At some time in the future, after she has one or two babies, the plan was to reverse the transplant operation; the womb would be removed, and she would no longer have to take immunosuppression medications.
Sadly, the transplant failed because of an unspecified complication and had to be removed. The clinic released a statement saying:
"We are saddened to share that our patient, Lindsey, recently experienced a sudden complication that led to the removal of her transplanted uterus." 7
Lindsey issued a statement saying:
"Unfortunately I did lose the uterus to complications. However, I am doing okay and appreciate all of your prayers and good thoughts." 7
At Baylor University Medical Center at Dallas, TX.
During 2016-SEP, four women received uterus transplants at the Center. All of the organs were donated from living donors. Unfortunately, the transplanted wombs had to be removed later from three of the women later after it was determined that they were not receiving adequate blood flow. 8
Alexandria Sifferlin, writing for Time Magazine said:
"Uterus transplants with live donors have a precedent for success. In Sweden, where the surgery was pioneered, five of nine womb transplant recipients have given birth to healthy babies and one woman is pregnant for the second time." 8
Incredibly, the donors are unrelated to the recipients, and do not know each other. About 50 women between the ages of 35 and 60 volunteered to have their wombs removed. Dr. Giuliano Testa, the lead surgeon and surgical chief of abdominal transplantation at Baylor University said:
"If you look at this from the science [perspective], it’s something we’ve learned a lot from, and we have a patient who is doing well. ... This is the beginning of hopefully a great history for medicine. ... You cannot discount the desire of a woman to have a normal pregnancy, bear her own child, and deliver. This is part of human nature. 8
Referring to the four donors who anonymously went through the major surgery, he said:
... I am totally amazed by that. They told us, 'We had our chance to become mothers, and now we have this uterus and it’s not doing anything for us. We can put this uterus to use for people who really need it.' That struck me as a physician. These women are phenomenal." 8
Womb transplant in India:
On 2017-MAY-18, a team of 12 doctors at the Galaxy Care Laparoscopy Institute (GCLI) in Pune, India transferred a womb from a mother to her 21 year-old daughter in Pune, India. Pregnancy via artificial insemination will probably be attempted in late 2018. The mother said:
"What is the use of my uterus if it cannot help my daughter?"
Two other transplants were scheduled for a later date. 9
Some related essays and sections on this web site that may interest you:
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
Sanchez Manning & Stephen Adams, "Wombs for men: Astonishing prospect as fertility doctors back operations on NHS so transgender women born as boys can have babies," Daily Mail, 2017-JUL-02, at: http://www.dailymail.co.uk/