Michael Cook*

A well-known British cosmetic surgeon says that transgender women (ie, natal males) should be entitled to womb transplants when the technique becomes safe and feasible. Children have already been born after womb transplants from live and deceased donors.

Dr Christopher Inglefield, founder of the London Transgender Clinic and a specialist in “gender confirmation surgery”, told the Mirror (UK) that it would be possible to perform the procedure on a transgender woman.

“... once the medical community accept this as a treatment for cis-women with uterine infertility, such as congenital absence of a womb, then it would be illegal to deny a trans-female who has completed her transition. There are clearly anatomical boundaries when it comes to trans women but these are problems that I believe can be surmounted and the transplant into a trans-female is essentially identical to that of a cis-female.”

The Human Fertilisation and Embryology Authority (HFEA) has confirmed that there are no legal barriers to allowing a trans woman with a uterus transplant from having IVF treatment.

Dr Inglefield says that the “plumbing” for a transplant is straightforward. “Trans females have a much narrower pelvis than cis-women of the same height, but there would still be room for them to carry a child. Supplemental hormones could be taken to replicate the changes that occur in the body when a woman is pregnant. Meanwhile it’s highly unlikely that a trans female would give birth naturally, but would be delivered via Caesarean section in order to safeguard the child.”

The possibility of womb transplants has been described as a solution for women with Womb Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. They are born without uterus, a condition affecting about 1 in every 4,500 women. Dr Inglefield points out that demand from transgender women would be far greater.

“According to some estimates, the prevalence of transgender females in the UK could be as high as 1,000 per 100,000 persons, around 1 per cent of the population. Just looking at the potential number of trans females who might seek uterine transplantation surgery and it’s abundantly clear it could become a vital medical service.

Writing in the Journal of Medical Ethics, bioethicists from the New York University School of Medicine have backed up Dr Inglefield’s plea for his transgender patients. They argue that womb transplants are indisputably ethical, although they should not be attempted now, as they would be too dangerous.

From a justice perspective, there is a moral imperative to ensure equitable access to UTx [uterine transplants]. In this case, arguments against providing UTx to genetically XY women for reasons unrelated to safety and efficacy should be assessed carefully to address potential discrimination against genetically XY women as a social group.

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