Perceptions and Motivations for Uterus Transplant in Transgender Women

Abstract

IMPORTANCE Uterus transplant has been demonstrated to be a viable fertility-restoring treatment for women categorized as female at birth with absolute uterine factor infertility. Recent advancements, as well as considerations of fairness and equality in reproductive care, have now led to the possibility of uterus transplant being undertaken in transgender women. OBJECTIVE To investigate the reproductive aspirations of transgender women and their perceptions of uterus transplant. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used a 27-item electronic questionnaire to investigate the reproductive aspirations of 182 transgender women older than 16 years, including their perceptions of and motivations for uterus transplant, between May 1 and November 1, 2019. MAIN OUTCOMES AND MEASURES Perceptions of and motivations for uterus transplant, including perceived significance of the ability to gestate, menstruate, and have a physiologically functioning vagina. RESULTS A total of 182 transgender women completed the questionnaire; most women (109 [60%]) were aged 20 to 29 years. Most did not have children prior to transitioning (167 [92%]) and expressed a desire to have children in the future (171 [94%]). In addition, most respondents agreed or strongly agreed that the ability to gestate and give birth to children (171 [94%]) and menstruate ( 161[88%]) would enhance perceptions of their femininity. Similarly, high proportions strongly agreed or agreed that having a transplanted, functioning vagina would improve their sexual experience ( 163[90%]), improve their quality of life (163 [90%]), and help them to feel like more of a woman ( 168[92%]). Nearly all respondents (180 [99%]) believed that uterus transplant would lead to greater happiness in transgender women. More than three-quarters of the respondents (140 [77%]) strongly agreed or agreed that they would be more inclined to cryopreserve sperm if uterus transplant became a realistic option. CONCLUSIONS AND RELEVANCEThis study provides insights into the reproductive aspirations of transgender women and reports on their multifaceted motivation to undergo uterus transplant. The survey responses suggest that transgender women would choose to have female physiologic experiences, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. If proven feasible and safe in this setting, uterus transplant may facilitate the achievement of reproductive aspirations, improve quality of life, and further alleviate dysphoric symptoms in transgender women.

Maternidad transgénera

“…Así, el trasplante les brindaría la oportunidad de concebir, gestar y dar a luz a una descendencia relacionada genéticamente. A enero de este año se reportaron 70 casos en el mundo, 45 detallados, y 9 con nacidos vivos (Jones et. al.…”

“…De hecho, se ha reportado como factor de riesgo de suicidio. Siendo los derechos reproductivos, derechos humanos, las mujeres transgénero tienen derecho a al mismo trato que las mujeres categorizadas como mujeres al nacer (Jones et al 2021) Como se mencionó antes, el trasplante de útero para mujeres trans resulta de mayor complejidad y requiere de investigar cuestiones anatómicas, hormonales, de fertilidad y obstétricas, aunque aún no se encuentran argumentos clínicos abrumadores que contradigan a futuro la viabilidad del trasplante de útero en este modelo. Por tanto, para aliviar el dolor causado por las aspiraciones reproductivas frustradas, hay que considerar su posibilidad, alimentando las insuficientes bases de datos disponibles sobre las percepciones y la demanda potencial de trasplante de útero en mujeres trans, previo a la realización de estudios en animales y cadáveres para establecer la viabilidad del procedimiento en este modelo (Jones et al 2021).…”

Uterine transplantation and donation in transgender individuals; proof of concept

“…Infertility is often a consequence of both GAHT (temporary) and GAS (permanent), and fertility preservation should be discussed prior to medical and/or surgical interventions (Defreyne et al, 2020;Jones et al, 2021). Current fertility preservation options for TGW including sperm cryopreservation, surgical sperm extraction, and surgical biopsy of testicular tissue.…”

“…Studies demonstrate that approximately half of TGW desire biological children (De Sutter et al, 2002). For some TGW, the inability to fulfill their reproductive aspirations may lead to an enduring sense of incompleteness and grief (Jones et al, 2021). Additionally, while current fertility options provide TGW the ability to contribute in production of an embryo with sperm donation, they do not allow for the opportunity to experience pregnancy and/or live birth.…”

“…Our efforts were motivated from overwhelmingly positive feedback from both the cis-and transgender communities. In a recent study, Jones et al (2021) found that more than 90% of TGW who were polled regarding UTx, indicated that an UTx would improve their quality of life, enhance feelings of femininity, and alleviate dysphoric symptoms. Other institutions (Baylor, Cleveland Clinic, and a German UTx group) reported that of interested UTx recipients, 0.5%, 2%, and 1.4% of interested respondents were TGW (Arian et al, 2017;Johannesson et al, 2018;Taran et al, 2019).…”