A new, radical surgery offers hope to women who are missing reproductive organs due to birth defects or disease. But that hope comes at a cost and raises the question: How far should doctors go to give women a chance to have children?
Earlier this week, doctors in Sweden announced they had performed nine successful uterus transplants from live donors to recipients, many of whom have MRKH, a disease in which a woman is born without a uterus, vagina, or both. The Swedish cases represent the most advanced efforts yet at transplanting a womb from a live donor. Previous attempts in Saudi Arabia and Turkey did not result in successful pregnancies for the recipients. A group of doctors in Britain is planning a similar effort with uteruses from dying or dead donors.
In the Swedish cases, doctors implanted the donor uteruses but did not connect them to the recipients' fallopian tubes. The doctors plan to use in vitro fertilization to implant the women's own eggs to achieve pregnancy. So far, doctors have not implanted any embryos, but several women have had their periods, indicating they could be ready for pregnancy.
The transplants are intended to be temporary; surgeons will remove the uteruses after a maximum of two pregnancies, so the women do not have to take anti-rejection drugs for the rest of their lives.
The Swedish cases have raised a host of ethical questions about transplants and reproductive technology. While some physicians have hailed the advance as a way to bring hope to a previously hopeless situation, others say the risk to the uterus donors is not justified by a medical need. During the operation, doctors remove not only a donor's uterus but also many of the surrounding blood vesselsmore than in a radical hysterectomy. The technology also has the potential to create a market for uterus donors and exploit impoverished women.
Some critics of uterus transplants point to surrogacy as a better alternative for a woman without a uterus, but surrogacy is illegal in many countries, including Sweden.
Christian bioethicist Paige Cunningham said the most significant problem with the procedure is its effect on the embryos created in the process. The embryos are transferred into a uterus where their survival is "speculative at best," she said.
"It's all about the parents," said Cunningham, executive director of the Center for Bioethics and Human Dignity. "It's about what they want, their experience, their desires. And I'm not criticizing those desires, but the elephant in the room, the looming question is: What about the children?"
In its commitment to families and children, the church, Cunningham said, can add to the pressure young couples feel to "try whatever is possible" to become pregnant: "We have not as the church really talked about this in ways that are meaningful or protective of young couples."
Widespread availability of uterus transplants to achieve pregnancy remains far away, but use of the technology is already affecting embryos. The women in Sweden had eggs harvested and embryos created for in vitro fertilization prior to their procedures. The embryos are on ice now, waiting for either implantation or eventual disposal.