Will men soon be able to give birth?

Bizarre, Healthcare, News

By Jonah Gruber

Last month, the Cleveland Clinic announced that it had become the first clinic in the United States to offer women a uterus transplant. The procedure offers hope to women who’ve lost their uterus to cancer, were born without a uterus, or who suffer from uterine defects that make childbearing impossible.

The news caught the attention of the media, and a persistent question arose: If it is possible to transplant a uterus into a woman, could one be implanted into a man? The general consensus among researchers and surgeons was that the process would be extremely difficult, but was theoretically possible.

It appears now, however, that it’s not a question of if, but when.

Transplanting the uterus

Uterus transplants have been attempted since the 1930s, but it wasn’t until 2014 that one resulted in a successful pregnancy, when a team of Swedish doctors delivered a baby that had been carried in a uterus donated by a healthy, 61-year-old woman.

The primary method of uterus transplantation consists of finding a viable uterus donor, using a process similar to other organ donor programs. When a donor is found, consent forms are signed, then the uterus is transplanted into the patient and given a year to heal. The patient must undergo a strict regimen of hormone and anti-rejection treatments to insure that the transplant is accepted by the new host.

The future of uterus implants, however, reads like something out of science fiction. It utilizes a bioengineered uterus, which will free patients from searching for viable donors. Instead, all they will need are their own stem cells, harvested from bone marrow or blood.

These stem cells will be induced to form uterine tissue, grown on a womb-shaped scaffold in the lab. Alternatively, the procedure could use the patient’s own uterine cells, which will have been converted into a less mature, less specialized stage. The immature uterine cells would then be applied to the scaffold and “grown” into a functioning uterus.

The future of male uteruses

The male uterus transplant will become possible in as little as five years, suggests Karine Chung, director of the fertility preservation program at the University of Southern California’s Keck School of Medicine. That might be overly optimistic, but regardless of whether it’s five years or 50, the idea of male pregnancy raises the debate over the ethical and legal problems around uterus transplants to a whole new level.

Medical guidelines used to direct decisions surrounding uterus transplants were established in the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation in 2012. Currently, the Montreal Criteria prohibit genetically non-female patients from receiving uterus transplants, but this may be changing.

Updated in 2013, the Montreal Criteria has developed an ethical basis for considering uterus transplants for recipients who are not genetically female; i.e., men and transsexual women:

A male or trans patient wishing to gestate a child does not have a lesser claim to that desire [for a uterine transplant] than their female counterparts… A male who identifies as a woman, for example, arguably has [uterine factor infertility], no functionally different than a woman who is born female with UFI.

However, the Montreal Criteria draw the line at men desiring a uterus for purposes other than childbearing. Those who wish to possess a uterus to “feel complete,” as might be the case with an individual suffering from Body Integrity Identity Disorder (BIID), would not be considered appropriate candidates for the operation.

Other ethical conundrums

While the Montreal Criteria can offer guidance and who should be eligible for a uterus transplant, there are a host of other issues. Among these are questions involving insurance—for instance, would medical insurance cover the transplant? And who shoulders the lawsuits if a resulting pregnancy fails?

Then there are societal conundrums to ponder. Consider a couple in which the wife has a uterine problem along with an immunodeficiency that prevents her from undergoing surgery. If the husband receives a uterus transplant and gives birth to a baby conceived with his own sperm, he would be both father and mother of the child in the eyes of the law.

And how would society deal with men who are not transgendered but seek a uterus transplant in order to experience personal or spiritual empowerment through childbirth?

While we may be decades away from having to address such revolutionary problems, by asking these questions now we are forced to confront a future where gender as we know it may no longer exist.

It might not be the singularity we were expecting, but it could be just as impactful to who we are as a species.

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