Writer: Nuttawut Kulkaew

Editor: Wittaya Wonglor

Pregnancy isn’t yet a possibility for transwomen. But medical technology and reproductive medicine are moving closer and closer to this goal.

The most common medical procedures to assist in fertility are facilitating sperm and egg fertilization and preparing to send the embryo to grow into the womb in an appropriate condition. Medical science can solve problems such as balancing the body and hormones for pregnancy, sperm donation banks, egg freezing, surrogacy, embryo fertilization procedures, and cesarean sections. But there’s still a problem point. How can someone without a uterus become pregnant?

There are two approaches. Ectogenesis is fertilization and raising the embryo in a lab environment similar to the mother's womb until the child is born, which has ethical and legal limitations. Another approach is giving a person a uterus. It may be obtained from a stem cell transplant to develop into a uterus or using 3D printing technology. The most promising route is to implant someone else's uterus.

The concept creates new possibilities for people born without a uterus to become pregnant, such as women born without a uterus and partial vagina, LGBTQIA+ people, such as transgender women non-binary group, including cis-men who want to conceive.

Uterine implants for pregnancy date back to the late nineteenth century. Yet little has been achieved. The University of Gothenburg in 2014 was able to help a 36-year-old Swedish woman with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) - there is a chance of about one in 5,000 women - to give birth without a uterus through a womb transplant from a 61-year-old friend. The medical team performed in vitro fertilization and then implanted the embryo in the implanted uterus. She gave birth to a son safely in September 2015.

In addition, in 2022, Dr. Narendra Kaushik, a surgeon and administrator of the Olmec Transgender Surgery Institute in New Delhi, India, also disclosed the feasibility of uterine transplantation in transgender women. According to an opinion poll in 2021, 90% of transgender women believe that a uterine transplant will help fulfill their sense of being a woman and enhance their motherhood.

This idea has led to a debate about whether someone born male can get a uterine transplant, conceive, and give birth. It might be possible because men's abdominal areas have enough space to implant a uterus. However, it can be complicated from the steps before, during, and after pregnancy: giving hormones that men do not have for pregnancy, transplanting the uterus, watching out for the possible immune response against the implanted uterus, additional undergoing surgery to add blood vessels to nourish the womb, watching for complications during pregnancy, having to do a cesarean section because the male body is unable to give birth naturally since they have a narrower pelvis than females and do not have a vagina, unclear timeframe of delivery and rehabilitation period after childbirth, including finding the supply of milk for the child, etc.

Implications for the future:

- legalization in issues such as surrogacy, debates about bioethics, and public attitudes will be driving forces in determining the feasibility of commercial uterine transplantation in society.

- Advances in related technologies such as 3D printing of organs, stem cell transplant, and ectogenesis will help determine the options for undergoing uterine transplantation in those who want to have children.

- If uterus implants in people with a gender other than the cis-female are more prevalent, there shall be revised health service system standards, the right to claim insurance, state and employee welfare, to be more inclusive, such as the use of gender-neutral terms, a quota of maternity leave, etc.

- Specialized hospitals and postnatal care centers for males or LGBTQIA+ will become new business opportunities in the healthcare industry.

- Social values ​​will alter if men can conceive and have children, reducing gender disparity.

- If this medical technology is widely used, its use will be hard to predict.

Sources:

- https://thestandard.co/he-expecting-series/

- https://geneticliteracyproject.org/2018/01/05/male-pregnancy-may-closer-think/

- https://themomentum.co/womb-and-ectogenesis/

- https://www.bbc.com/reel/video/p0bmqfk9/what-if-women-never-had-to-give-birth-again-

- https://www.parents.com/pregnancy/my-body/pregnancy-health/trans-and-nonbinary-people-can-be-pregnant-too/

- https://apnews.com/article/ad2fddc7bf1e15fb90747589b8a4ebc8

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