According to Penn Medicine, over 70 uterine transplants have been performed globally, providing new hope for women with Uterine Factor Infertility (UFI). Since 2017, institutions like the Penn Transplant Institute and Baylor University Medical Center have pioneered this procedure to provide women struggling with infertility a chance to have biological children.
Penn Medicine describes UFI as a condition for being born without a uterus, not having a functioning uterus, or having had their uterus removed. According to the NHS, a hysterectomy or the removal of a uterus is often considered for those with heavy periods, endometriosis, pelvic inflammatory disease (PID) or cancer of the uterus or ovaries. Baylor Scott & White Health, outlines that candidates for the transplant must have UFI, be a non-smoker, non-diabetic, cancer-free for at least five years, negative for HIV and hepatitis, and be within child-bearing age, 21-40. The donor – either living or deceased – must be HIV, STD free, be aged 30-50 of a healthy weight, cancer-free for at least five years and have no history of diabetes.
Penn Medicine describes a uterine transplant as a lengthy procedure which begins with in vitro fertilization (IVF) treatments to harvest and fertilize the patient’s eggs. The uterus is then transplanted and the patient begins to take immunosuppressants, followed by an embryo transfer, and eventually a hysterectomy to remove the transplanted uterus. The entire process takes between two to five years, and women can have up to two children under clinical trials.
UFI affects 5% of all women worldwide. Addressing it is a monumental step towards providing women with more opportunities to have biological children, according to Baylor Scott & White Health. In addition to cis-gendered women, future uterine transplants may provided more reproductive freedom for transgender women who have undergone gender confirmation surgery, according to a recent 2019 study in the U.K. published by the JAMA Network.
In the same 2019 study surveying transgender women in transgender support groups, over 90% indicated that a uteran transplant would increase their happiness, feelings of femininity, and address gender dysphoria. Access to new technologies for non cis-gendered individuals can break down barriers in healthcare that traditionally cater to cis-gendered people. Transgender individuals are often deprived of fertility preservation counseling and limited in their access to IVF – leaving countless uninformed about assisted reproductive technologies.
Not surprisingly, social issues come into play. Although the movement towards more innovative technologies improves the wellbeing of those who are non cis-gendered or those who may be infertile, uterine transplants highlight existing societal and racial inequalies.
As a white woman, I have an inherent bias towards favoring uterine transplants in those who share both my race and socioeconomic status. Therefore, it is important that I take ample time to realize how reproductive technology may disproportionately impact certain women of color.
The highest rates of U.S. poverty are experienced by African American, Native American, Alaska Native and Latina women, according to the Center for American Progress. The wealth gap that places women of color in lower socioeconomic environments, prevents access to quality education, healthcare and job opportunities. This often prevents them from accessing invasive, expensive, and new technologies that expand their reproductive choices.
On average, IVF costs between $8,000 to $13,000 per round without medication– effectively limiting low income women from accessing reproductive technologies, according to the Pacific Fertility Center in Los Angeles. Additionally, the use of immunosuppressants – which according to the Cancer Research Institute, causes nausea, increased risk of infection, loss of appetite, vomiting, etc. – may deter women who work full time, work multiple jobs, or have limited opportunities for leave from participating. During the recent pandemic, the increased risk for infection and potential for dangerous exposure to COVID-19 may be a risk many working women of color facing poverty are unwilling to take.
In her novel Intimate Justice: The Black Female Body and the Body Politic, Shatema Threadcraft discusses how women of color have often historically been targeted by coerced sterilization, encouraged to take birth control to reduce their fertility, and have deemed ‘welfare queens’ who through motherhood take advantage of welfare programs. This has culminated in an ingrained pattern in American healthcare to effectively maintain white reproduction. New expensive procedures like uterine transplants are institutionally marketed towards upper-middle class white families which in turn prevents reproduction for women of color who struggle with infertility.
The inaccessibility of many treatments can also raise the question of if uterine transplants should be covered by subsidized healthcare. For example, in states like California, Medicaid explicitly covers transgender services, which according to the State of California Health and Human Services Agency includes, “psychotherapy, continuous hormonal therapy, labratory testing to monitor hormone therapy and gender reassignment surgery that is not cosmetic in nature.” Within this definition, uterine transplants to aid gender dysphoria should be made more accessible through government-funded programs like Medicaid in states like Colorado, California, Connecticut, Delaware etc. If these services are not provided through federal funding, this highlights the broader issue of a lack of bodily autonomy for people of color, those below the poverty line, and LGBTQ+ members.
Overall, uterine transplants present unmatched opportunity for transgender or infertile women to participate in expansive fertility options. However, the inaccessibility of these technologies consistently put women of color or those in poverty at a disadvantage when taking control of their reproductive autonomy. Uterine transplants are just one example of modern biomedicine highlighting social inequity. This can beg the question if novel assistive technologies perpetuate modern day eugenics by encouraging white reproductive choice, whilst alienating the conception of Black, LatinX or Native children.
References
Healthcare Laws and Policies: Medicaid Coverage for Transition-Related Care. 10 Dec. 2021, https://www.lgbtmap.org/img/maps/citations-medicaid.pdf.
Hysterectomy - Why it’s necessary - NHS. (2019, February 9). NHS. https://www.nhs.uk/conditions/hysterectomy/why-its-done/
Immunotherapy Side Effects - Cancer Research Institute (CRI). (n.d.). Cancer Research Institute. Retrieved March 13, 2022, from https://www.cancerresearch.org/en-us/immunotherapy-side-effects
Penn Uterus Transplant Program. (n.d.). Penn Medicine. Retrieved March 13, 2022, from https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/penn-fertility-care/uterus-transplant
Perceptions and Motivations for Uterus Transplant in Transgender Women | Pediatrics | JAMA Network Open | JAMA Network. (2021, January 20). JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association; JAMA Network. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775302
Ross, L., & Solinger, R. (2017). Reproductive Justice. Univ of California Press.
Sahakian, V. (n.d.). The Cost of IVF in California. Pacific Fertility Center of Los Angeles | Top-Rated IVF Clinic. Retrieved March 13, 2022, from https://www.pfcla.com/blog/ivf-costs-california
The Basic Facts About Women in Poverty - Center for American Progress. (n.d.). Center for American Progress; https://www.facebook.com/americanprogress. Retrieved March 13, 2022, from https://www.americanprogress.org/article/basic-facts-women-poverty/
Threadcraft, S. (2016). Intimate Justice: The Black Female Body and the Body Politic. Oxford University Press.
Uterus Transplant | Baylor Scott & White Health. (n.d.). Welcome to Baylor Scott & White Health. Retrieved March 13, 2022, from https://www.bswhealth.com/uterus-transplant/