Transgenders could become pregnant says expert

By Dr. Ananya Mandal, MDNov 5 2017

According to fertility expert Richard Paulson, an obstetrician-gynecologist and the president of the American Society for Reproductive Medicine, transgender women who were anatomically men could actually become pregnant. These men could not have conceived and carried a fetus through pregnancy due to the absence of a womb. Paulson claims that this could happen as early as “tomorrow”.

Paulson was speaking at the society’s annual conference in San Antonio, Texas where he said that there have been several advances in the donated wombs that could help these men carry a live fetus within them through a successful pregnancy. He accepted the fact that there would be challenges to these procedures but still said that there are willing transgender men who have a uterus, would be ready to donate their uteruses to the transgender women.

Transgender men who were anatomically female and still had their uterus have been giving birth to healthy babies since 1999. For transgender women who are anatomically male, the process is difficult. The main problem is because the shape of the pelvis in a man is different from that of a woman. This makes birth and pregnancy a challenge. Paulson says birthing may be done by cesarean section and it is possible.

There are 1.4 million transgender persons in the United States and of these very few “male-to-female” transgenders actually ask for pregnancy options. Apart from the surgical complications, complications related to the uterus transplant and risk of surgery and hormonal balance that needs to be maintained during pregnancy, another challenge is the cost of a uterus transfer and cost of the procedure. According to experts who perform surgeries for sex change, very few people would be able to afford this treatment and only the wealthy transgender women who have been originally males could afford this. Uterus transplant has been performed in rare occasions around the world with only around 10 babies born of a transplanted uterus.

As with any organ transplant, the recipient’s body reacts to the donated organ – uterus and the immune system starts to over fire in order to combat this. This has to be kept down using immunosuppressant drugs that may be necessary for life in the organ recipient. Further the transplant of the uterus itself is tricky procedure because the womb has several large blood vessels near it and connected to it. Going through this surgery followed by immunosupressants, maintaining a carrying a pregnancy would be a huge challenge say experts in the field.

The transplanted uterus, for example, might rupture during the pregnancy leading to serious complications in both the mother and the baby including severe bleeding and even death. It is a technically possible situation but difficult in real life explain the experts including Paulson.

Yet other experts believe that the psychological impact on the child born in this manner also needs to be considered before embarking upon such a procedure. Considering these challenges, it might not be “tomorrow” that a transwoman who was born a man would get pregnant and give birth, but the situation may be possible in the near future say experts.