This womb trans­plant break­through could open up preg­nancy to all sexes

The Guardian Australia - - Science - Philip Ball

A year ago, a baby girl was born by cae­sarean sec­tion in a hospi­tal in São Paulo, Brazil, af­ter be­ing con­ceived by IVF. What made the birth unique was that the child had been ges­tated in a womb trans­planted from a 45-year-old woman who had died.

Births re­sult­ing from uterus trans­plants have been hap­pen­ing since 2014, but for all pre­vi­ous chil­dren con­ceived this way, the donor was alive. That, un­der­stand­ably, places se­vere lim­its on the avail­abil­ity of the or­gans. This de­mon­stra­tion, re­ported in the Lancet – that a uterus can be suc­cess­fully pre­served and trans­planted from a de­ceased per­son – could re­lax the sup­ply bot­tle­neck for women oth­er­wise un­able to con­ceive be­cause of uter­ine prob­lems.

The re­cip­i­ent in this case was a 32-year-old born with a con­di­tion called Mayer-Rok­i­tan­sky-Küster-Hauser (MRKH) syn­drome. It af­fects one in 4,500 women and means that the womb fails to de­velop. Be­fore she was given the trans­plant in 2016 it was un­clear if a uterus could re­main ca­pa­ble of ges­tat­ing a baby if it had been de­prived of blood sup­ply for some time af­ter the

death of the donor. The baby weighed 2.5kg at birth on 15 De­cem­ber 2017, and both mother and child re­main healthy. The trans­planted uterus was re­moved from the mother dur­ing the de­liv­ery.

All this sounds like good news for women who, be­cause of in­jury, ill­ness, surgery (hys­terec­tomy) or con­gen­i­tal con­di­tions, would need a trans­plant in or­der to bear a child.

But not ev­ery­one will see it as an un­qual­i­fied good. Since the first uter­ine trans­plants, opin­ion has been split about their mer­its. Some bioethi­cists point to risks of com­pli­ca­tions for the re­cip­i­ent and the foe­tus, as well as the high cost. Some ques­tion whether these draw­backs are out­weighed by the ben­e­fits when the al­ter­na­tive of sur­ro­gacy ex­ists – although that of course has its own prob­lems, and it would be naive to draw an equiv­a­lence be­tween them.

But uterus trans­plants also raise com­pli­cated ques­tions for fem­i­nism. “There is a fem­i­nist po­si­tion that sup­ports the uterus trans­plant, ar­gu­ing that it al­lows women … to be in­cluded in an ex­pe­ri­ence that is, for some, cen­tral to and defin­ing of fe­male­ness,” wrote body the­o­rist Shar­rona Pearl. But, she added, that is part of the prob­lem: “The uterus trans­plant sup­ports the so­cial norm of preg­nancy as fun­da­men­tal to be­ing a woman.” Uterus trans­plants im­ply that the risks of the pro­ce­dure are worth it, says Pearl, “in or­der to ful­fil women’s al­leged bi­o­log­i­cal destiny as car­ri­ers of fu­ture chil­dren”.

This ten­sion is noth­ing new. Ever since the early dis­cus­sions of as­sisted re­pro­duc­tive tech­nolo­gies (ART) such as IVF in the 1920s, they have split opin­ion about the im­pli­ca­tions for gen­der roles and fe­male choices in par­tic­u­lar. The idea pro­moted then by bi­ol­o­gists such as JBS Hal­dane of ges­ta­tion in ar­ti­fi­cial wombs – ec­to­ge­n­e­sis – was wel­comed by pro­gres­sives as an eman­ci­pat­ing tech­nol­ogy that would free women from the du­ties of child­bear­ing and the as­so­ci­ated con­straints on op­por­tu­nity.

In the 1970s, Shu­lamith Fire­stone, au­thor of The Dialec­tic of Sex, was an en­thu­si­as­tic ad­vo­cate of ec­to­ge­n­e­sis for those rea­sons, say­ing that only by be­ing re­lieved of re­spon­si­bil­ity for child­bear­ing could women hope for so­cial equal­ity. To Fire­stone, preg­nancy was “bar­baric” and tyran­ni­cal. Oth­ers feared that an ar­ti­fi­cial womb (which re­mains be­yond the means of to­day’s tech­nol­ogy) would sever the moth­er­child bond and deprive women of their role. “If that last power is taken and con­trolled by men,” wrote so­ci­ol­o­gist Robyn Row­land, “what role is en­vis­aged for women in the new world?”

IVF it­self has elicited sim­i­lar con­cerns. For all that it of­fers some women their only chance of preg­nancy and child­birth, it can seem too much like the com­mod­i­fi­ca­tion of a woman’s body by a male-dom­i­nated techno-elite. In the mid-1980s, the Ger­man rad­i­cal fem­i­nist group Rote Zora bombed IVF clin­ics and stole doc­u­ments, while the fem­i­nist net­work FINRRAGE (Fem­i­nist In­ter­na­tional Net­work of Re­sis­tance to Re­pro­duc­tive and Ge­netic En­gi­neer­ing) has long ex­pressed scep­ti­cism about as­sisted re­pro­duc­tive tech­nol­ogy from fem­i­nist and so­cial­ist per­spec­tives.

There’s a dan­ger, as with ob­jec­tions to uterus trans­plants, that, as so­cial his­to­rian Naomi Pf­ef­fer has charged, the crit­ics con­sult the views of all women ex­cept those who ac­tu­ally suf­fer from in­fer­til­ity. But it’s quite right that ad­vances in ART be in­ter­ro­gated as much more than neu­tral med­i­cal op­tions.

By mak­ing preg­nancy po­ten­tially avail­able to trans women and even to cis men (with hor­mone treat­ments), uterus trans­plants could chal­lenge so­cial norms and pre­con­cep­tions, just as IVF has done by cre­at­ing new fam­ily struc­tures. But equally, by in­sist­ing on a par­tic­u­lar route to moth­er­hood these trans­plants could re­in­force those norms and stereo­types, just as an­thro­pol­o­gist Sarah Franklin has ar­gued that anx­i­eties about IVF have mo­ti­vated so­cial con­form­ity in the way it is pre­sented and prac­ticed.

As a man, I know I will be sen­si­tive to only a frac­tion of these cur­rents. But I hope they can be dis­cussed frankly, tol­er­antly and with com­pas­sion. Few is­sues are more emo­tive than con­cep­tion and child-rear­ing – but that’s pre­cisely be­cause there are no easy an­swers.

• Philip Ball is a science writer

Doc­tors per­form the womb trans­plant on Brazil in 2017. Pho­to­graph: Reuters

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