Pregnancy for Transgender Women: Will it ever be possible?

Transgender and nonbinary communities are resourceful and creative. We’re used to innovating and utilizing every tool available to meet our goals. And when it comes to becoming parents, Assisted Reproductive Technology (ART) can help trans people (and others) expand our families. Medical science continues to advance, making parenthood more and more possible for so many people. What once seemed like science fiction is now science fact.

Which leaves us wondering… will uterine transplants ever be commonplace?

Absolute Uterine Failure Infertility (AUIF) refers to infertility that is attributable to uterine issues that prevent embryo implantation or completion of pregnancy. Whether an individual was born without a uterus or had it removed surgically, there are many reasons a cisgender woman may be diagnosed with AUFI. Currently, one of the suggested treatments for AUIF is a transplant of a uterus, cervix, and-- in some cases-- a vagina. 

Human organ transplants have been performed experimentally for hundreds of years, with successful transplants being performed in the 1950s. Immunosuppressant medications were discovered in the 1980’s and since then, transplants have had even higher success rates. Organ transplants are now common enough that there are lists where people can willingly register themselves as volunteers for their organs to be donated.

One of the earliest and most infamous cases of a uterus transplant is that of Lili Elbe. Lili was a transgender woman who received her transplant 90 years ago in 1931. The procedure, though revolutionary, was not successful. Eventually, she succumbed to infection relating to the uterus transplant and died three months after the procedure. Sadly, death was the common outcome for those practicing with experimental medicine like this at that time. Lili’s attempt to find her personal wholeness is a testiment to how fiercely some transgender women have fought to have families.

Only recently have scientists and doctors begun to transfer uteruses with some success, though all of these cases have been with cisgender (not transgender) women. Through the early 2000s, teams in Saudi Arabia, Turkey, and Sweden have made various attempts at transfers. Each of these transplants had unique factors and outcomes. By 2010’s, some uterine transplants were resulting in successful deliveries, with the first in the United States occurring in 2017. 

That means success is only for years old! So this procedure is still very new, and it may yet be many years (even decades) before it becomes accessible for transgender women. 

When looking at successful uterine transplants, each case is unique. Some procedures used living donor tissue while others used deceased donor tissue. In the cases of using living tissue, there were multiple cases in which a daughter received their mother’s uterus. As of 2019, more than 42 uterine transplant procedures had been performed, with 12 live births resulting from the transplanted uteruses. (Jones)

It is clear that a uterus transplant procedure is still very rare, experimental, and ultimately medically risky for those who have attempted them. Uterus transplants are not standard treatment for AUFI; they are currently being explored as experimental treatment in hopes of creating a standard practice in the future.  

There is currently a code of ethics for uterus transplants called The Montreal Criteria. This criteria was created to maintain ethical practice during the exploration of this new procedure. Regretfully, The Montreal Criteria specifically excludes transgender women from being considered for the procedure. Specifically, the Montreal Criteria claims that the recipient must be a “genetic female.”

Uterine Transplantation in Transgender Women (Jones) contests the claim that transgender women should not be allowed to receive the procedure. The authors cite European law that states that it is illegal to discriminate or deny healthcare treatments to someone based on their sex or gender. They argue that a uterus transplant has been proven to be a feasable treatment for infertility in cisgender women, and should also be explored as a treatment for transgender women, to treat both dysphoria and infertility.

The article explores some of the medical barriers given by other researchers, and provides suggested solutions for those barriers. But much of the discussion about uterine transplants for trans women are still very theoretical. At this time, cisgender women who are the recipients of uterine transplants may be seeing some successful births, but there are also many more instances of multiple miscarriages and unsuccessful pregnancy attempts. An organ transplant is, by its very nature, complicated-- many patients’ bodies reject donor organs, and recipients are required to take immunosuppressant medication throughout the process. For cisgender women, the donated uterus is often surgically removed after successful pregnancies have been achieved.

Living with AUFI or any infertility diagnosis can be difficult. As a transgender woman and nonbinary person, you may experience feelings of grief and loss as you come to accept that your path to parenthood will likely be different from those around you. While the technology around uterus transplants is continuing to develop, and advocates will push for the inclusion of trans voices throughout that process, a uterus transplant will likely not be part of your fertility journey.

Know that however you may welcome children into your life, now or in the future, Trans Fertility Co. will be there to support you and your family. We strive to provide relevant resources and community support for the transgender community at all stages of their journeys to grow their families, including the experiences of dysphoria and the disappointment of infertility. If you ever have questions or would like to speak to a staff member, please reach out to us at adennis@collaborate.consulting.