Womb transplants should soon be possible for trans women, allowing them to carry a pregnancy.
- After a first successful uterus transplant in France in March 2019 on a patient who is now expecting her second child, a second operation was successfully completed a few months ago in France.
- The uterine transplant lasted nearly 18 hours and took place at the Foch hospital in Suresnes in the Hauts-de-Seine.
“The first uterus transplant in a transgender woman in the 21st century should take place within the next few years, if not soonerexplains Dr. Rebecca Flyck, one of the authors of a study published in the journal Fertility and Sterility and who affirms that thanks to a transplant of uterus, a transsexual woman will soon be able to become pregnant. As there are growing studies of high levels of depression, suicide among trans women, and the emotional impact of being unable to have children, we must consider the potential benefits of uterus transplant for trans women.”
Several steps before the uterus transplant
For a trans woman to have a uterus transplant, scientists have detailed the procedure. They believe that the first step will certainly be vaginoplasty, that is to say a surgical procedure to construct female genitalia – an artificial vagina – as natural looking as possible, without creating a vaginal cavity. For this, surgeons usually use tissue from other organs in the body. At the same time, it would certainly be necessary to remove the testicles to stop the production of male hormones.
Then, after a period of convalescence, the trans woman could do a uterus transplant. But, as with other transplants, a uterus donor who has the same blood type must be found. Then the uterus would be surgically inserted into the trans woman. According to the authors, the procedure could last more than 11 hours and would proceed almost in the same way as that carried out for a biological woman.
Differences between biological and trans women
Nevertheless, since there are differences between biological and trans women, surgeons will have to be careful about different things. First, the external iliac arteries, which supply the lower limbs and part of the anterior abdominal wall, are about 1.6 millimeters wider in biological women. There would be a risk of blood clot according to the authors, which can be avoided by adjusting the size of the arteries.
In addition, there is a difference between the vagina of a biological woman and the artificial vagina of a trans woman in terms of the quantity and distribution of blood vessels. Thus, the success rate of a transplant of a uterus would not be 100%, there would be risks of failure.
If the operation is successful, to have a child, the trans woman will have to undergo in vitro fertilization (IVF). Indeed, a uterus transplant does not include the ovaries or fallopian tubes which store and transport the eggs: a natural pregnancy is therefore impossible. The trans woman will also have to take artificial hormones to mimic those that the female body generates during a normal pregnancy.
Scientists are advocating for clinical trials of womb transplants in trans women. Nevertheless, they recognize that there is still “several important unknownson the safety of this intervention.