Pioneering surgeons have made it possible to transplant a human uterus that can bear children, offering hope to millions of women who never thought they could give birth.
On September 4, 2014, in Gothenburg, Sweden, his 36-year-old expectant mother lay on an operating table, suffering from preeclampsia—a pregnancy complication associated with high blood pressure. The baby’s heartbeat showed signs of stress. Normally the woman’s doctors might have taken a wait-and-see approach, treating her with medication and hoping to give the nearly 32-week-old fetus time to grow to full term of about 40 weeks.
But this was no normal gestation. This was the world’s first human nurtured inside a transplanted uterus. He was the product of more than a decade of research. For years, no one had been sure he could exist in that womb—let alone be born. This was not a wait-and-see situation.
As gynecologist and surgeon Liza Johannesson prepped to deliver the child via cesarean section, she was nervous. Not for the baby—she was used to delivering those—but for the uterus. It was 62 years old. A family friend of the patient, who had been born without her own womb, had donated it. The last time it had sustained a life was nearly three decades earlier. “We didn’t know what to expect,” Johannesson says. “We didn’t know if we were going to see [scar tissue] from the transplant surgery or how the new vessels would look, and how they would be positioned.” But as she cut into the woman’s abdomen, her scalpel revealed a uterus that, she says, “looked like it was 20. It reacted the same way it would if it were super young and super healthy. You couldn’t tell it was an old uterus.”
The baby and the mother too both turned out healthy. It would be a month before the journal article announcing the birth would appear, allowing the Swedish- led medical team to tell the world: Uterus transplants are possible. And they can bear life.
Consider that kidneys, the nation’s most commonly transplanted body part, account for around 19,000 of the procedures each year. Then compare that to what may be as many as 2 million women in the U.S. with what doctors call “absolute uterine factor infertility.” Some have undergone hysterectomies due to cancer, fibroids, excessive bleeding, or uterine prolapse. Some are among the approximately 1 in 5,000 girls born each year without a uterus, a medical condition known as Mayer-Rokitansky- Küster-Hauser syndrome. And there is another category that hasn’t yet been tabulated—but almost certainly will be in the future: the hundreds of thousands of women who represent a portion of America’s 1.4 million transgender people. They too might one day be able to choose to bear children thanks to this new surgery.
Of course, there are caveats that need to be negotiated before the uterine transplant can become an everyday surgery. First, there are ethical concerns. Critics question the necessity of the procedure, given that women have other paths to motherhood, such as surrogacy and adoption. Some wonder if surgeons are undertaking the challenge simply because they can. And then there are the risks. The donor must undergo a medically unnecessary surgery to remove her womb. The recipient must undergo three: one to insert the uterus, another to deliver the baby via C-section, and a third to remove the organ after birth. (Doctors do not want patients to spend a lifetime taking immunosuppressive drugs, which come with risks, to prevent rejection of a part not needed for survival.) Finally, there are the costs, which Testa estimates at around $250,000, putting the operations beyond the reach of any but the most affluent, and perhaps the most desperate.
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