Let's Talk About Womb Transplants

In the first major project of its kind, nine women have received womb transplants from family donors, according to an AP story this morning, and the experimental surgery touches on some controversial issues.

In a world where mixing up babies in test tubes now seems pretty old hat, picking and choosing your offspring's genes is getting closer, and even 3D-printed organs aren't that surprising, the idea of the transplant seems oddly old-fashioned, but it's a potential answer to a problem we still haven't solved. While there may be ever-more-efficient ways of combining eggs and sperm around various fertility problems, there's nothing to be done for women who don't have a womb—either because they're born without one (a condition known as MRKH) or because they've had it removed, for instance due to cervical cancer.

The nine women in this new initiative, who all had the wombs transplanted in Sweden, won't be able to get pregnant in the conventional way, as the transplanted uteruses aren't connected to their fallopian tubes. But the hope is they could conceive via IVF and carry their own biological child.

According to a report by the University of Gothenburg, which conducted the transplants, the women will have to wait at least a year after the transplant before pregnancy is on the agenda, and the rest of the world will have to wait until then before we get an idea of how successful the new procedure really is. Earlier this year, a Turkish woman who successfully received one of the few previous transplanted wombs in 2012 got pregnant but lost the baby.

Meanwhile, the whole concept of womb transplants raises questions about the ethics of non-vital medical procedures, fertility techniques, and the importance of carrying your own children.

Straight off, I'm more than supportive of more options for women when it comes to fertility and childbirth (I wouldn't exist without IVF), but I also think it's important to consider the relative benefits and risks of any new medical procedure.

First up, there's no doubt that, while this kind of surgery could bring hope to many infertile women desperate to have children, it's not exactly vital. You can't live without a heart or a liver, but you can get on all right (albeit childless) without a womb.

That argument falls a little flat, however, when you look at recent progress in medicine. After all, there are plenty of other medical procedures that aren't exactly life-saving, including many other transplants. In a talk on the planned womb transplants last year, Mats Brannstrom, who is leading this new Swedish initiative, pointed to transplants of hands, legs, and faces as examples of other procedures that were intended "not to save lives but to increase the quality of life or otherwise restore bodily function."

However, one of the stickiest points in this particular study is the element of risk undertaken by the donors, and not just the receivers, of the transplant uteruses. Because more blood vessels have to be taken from around the womb for it to have a better chance of functioning well, it's a riskier operation than a regular hysterectomy. The question then, is whether it's fair to let healthy people risk such medical complications for the non-life-saving benefit of someone else?

The UK doesn't think so, but there is a way around this. In a similar project planned for the end of 2014, doctors in Britain will instead use wombs from brain-dead donors whose hearts are still beating for transplants in five women. That's more comparable to what usually happens in organ donation situations, and is a lot less controversial than asking a healthy person to go through the donation procedure.

Ultimately, however, all the risks for both parties—donor and recipient—must be weighed against the benefit of having a womb in the first place. Because the womb transplant won't allow the women to have children the conventional way, and only through IVF, the only real advantage it offers is the chance to carry biological pregnancies. While that might seem a pretty slim benefit in itself, the problem is that right now, that's pretty pivotal to having children at all. We're not yet growing babies in Matrix-like pods.

Sure, there's adoption—but our widespread acceptance of IVF suggests we understand the desire to have our own biological children, so should women without a womb not also be given the same opportunity, if it's at all possible?

The only real alternative is surrogacy. That seems like the obvious solution for would-be mothers without a womb; find another woman willing to "lend" theirs (surely less invasive than undergoing major surgery to donate it full-time). But legal issues make this difficult. In the UK, for instance, a surrogate mother is considered the legal mother of a baby she has carried until the genetic mother adopts it. In some countries, surrogacy isn't even legal.

There's surely a question to be asked here about the various merits of surrogacy and womb transplants. Is the transplant option really more ethical, as some doctors who back the procedure claim? And if not, shouldn't we consider making surrogacy a more available option, rather than perhaps "replacing" it with a method that's much riskier for a woman's health—or indeed for both women's health, if healthy donors are used?

Of course, the real merits of the procedure will depend largely on the results, and until then we can't come to any conclusions. One thing's for sure: The scientists and women involved in this latest study are helping to break new medical ground in a field that's of great importance to many people. As Brannstrom told the AP, "It could lead to [the women] having a child, but there are no guarantees … what is certain is that they are making a contribution to science."