Euronews gives an account of the rapid progress of research on the uterus transplantation front, with particular reference to the request of trans MtF people whose bodies remain biologically male, while FtM people, if they retain their female genital apparatus, can undertake a pregnancy like any other woman: the 'pregnant fathers' that the mainstream press likes to report on are none other than women who self-identify as men.
In the article, which we translate here, women are referred to as cis- women, a suffix we have voluntarily omitted. In addition, the desire of trans MtF people - which can be turned into an 'inclusive' right - and the legislative profile of the issue are discussed. What's more: the bioethicists and experts questioned regard a womb transplant and a possible pregnancy that would follow as a kind of therapy for trans MtF people, which would consolidate their self-perception of themselves as women and alleviate the discomfort of their dysphoria.
To these novelties must be added the promising research on gametes - ova and sperm - produced from stem cells, which would make 'donations' superfluous (read here).
Not a word instead about the girls and children who in the not too distant future might be born from these practices -pregnant in male bodies-, about their physical and psychological health, about their right to be preserved from such great stress. Their discomfort does not count. Their lives are not worthy of bioethical reasoning. The fate of humanity and the erasure of the mother are not considered significant issues. Rather, some concern is expressed that a possible donor might express a preference for a woman like herself, 'ruling out' donating her womb to biological males who perceive themselves as women.
Not even mentioned is the fact that the male dream of being able to gestate and give birth without women - womb envy, which reaches its peak in the Freudian reversal into penis envy - constitutes the millenary soul of the patriarchal construction, the cup full of blood transparently represented by the myth of the Grail (here in the image comparable with that of a womb) and still remains the pivot around which much of the research on assisted fertilisation revolves.
A year ago the news that a surgeon from New Delhi would soon attempted uterine transplant in a man who identifies as a transgender woman, operation never before successfully performed on a male body, success that has already been recorded in women with infertility problems attributable to uterine problems.
The first womb transplant delivery took place in Sweden, in 2014. Today they would be 90 uterus transplants performed worldwide from the end of 2021, with the birth of around 50 children.
Mats Brännström, professor of obstetrics and gynaecology and head physician at the University of Gothenburg in Sweden, delivered the first baby born after a uterine transplant and He says he often receives e-mails from people 'assigned as males at birth' (i.e. biological males) asking him about the procedure. "I tell them that we have not done enough research," he explains, "but I think it will be possible in the future. It may take five or ten years, I would say'. He adds: 'If it is an effective and risk-free method, I do not believe that there are ethical limits'.
According to Nicola Williams, lecturer in media bioethics at Lanaster University, "there are definitely reasons based on equality to consider uterus transplants in transgender women. But there are also hormonal and anatomical considerations that mean that it will not be possible to transfer this procedure directly to the transgender population (...) to ensure that the procedure is safe and effective, Many studies on computer models, male animals and male cadavers will be necessary'.
"Ethically, I see no objection in principle to offering this intervention to trans women'. says Stephen Wilkinson, professor of bioethics at the same university: 'There are many positive ethical reasons for doing so. If we treat trans women as women and we accept their gender identity, and treat them equally in law and social practice, their request is as good as anyone else's".
In collaboration with other researchers, Wilkinson and Williams conducted a survey of 182 transgender women (see study here): most agree that the ability to gestate and give birth to children would improve the perception of one's femininity and alleviate the symptoms of dysphoria.
"I firmly believe that uterine transplantation allows for a specific kind of experience," said Chloe Romanis, lecturer in bio-law at the University of Durham and researcher at Harvard University, USA. "Wanting to be a parent is one thing, but wanting to be a gestational parent is another; it is a very unique experience. So I think it's something we have to respect.".
How uterine transplants differ from other transplants?
First, they are designed to be temporary: a woman receives a uterus, an embryo created by in vitro fertilisation (IVF) is implanted into it, she gives birth by caesarean section and finally undergoes a hysterectomy so as not to be forced to take immunosuppressants for longer than necessary, which may increase the risk of developing cancer. Things could become more complicated if the recipient requested a permanent uterus transplant, which could not be understood as a life-saving procedure.
In addition How would one decide who has priority on a possible waiting list? A woman born without a uterus or who has had a hysterectomy after cancer, or a trans woman?
Says Laura O'Donovan, research associate working with Williams. and Wilkinson at Lancaster University. "These transplants are not performed on women born without a uterus to consolidate their female identity and enable them to menstruate; there is a clear reproductive purpose here (...) A womb transplant in transgender women improves the quality of life, it is not life-saving'.
What would happen, for example, if a donor specified that she would only want to donate her womb to a woman and not to a trans woman? And how would it be decided that the need of one recipient is greater than that of another?
"I personally believe that both of these things are important," says Romanis, "and comparing them involves the danger of pitting two groups of women against each other in a way that is... is very dangerous. And it ends up marginalising minority groups'.
In addition to ethical considerations there are legal issues: for example, Would denying such transplants to transgender women violate anti-discrimination laws?
"In the UK, for example, with l'Equality Act would be illegal to discriminate on the basis of someone's gender' says O'Donovan. "Therefore, transgender women cannot be subject to discrimination on the basis of this characteristic, if womb transplants became mainstream, it might be illegal to refuse to perform one on a transgender woman solely because of his gender identity'.
Romanis recalls the debate among British academics on the 2008 National Human Fertilisation and Embryology Act, according to which an embryo must be implanted in a woman: "The position of a trans woman was discussed. Most liberal-minded people have read our equality legislation and said that under the law a trans woman is a woman. So as long as they have gone through the legal process to be recognised as women, must have access to in vitro fertilisation if they have a transplanted uterus'. According to the academic i uterine transplants are only one of the whole spectrum of assisted gestation technologies, a small part of a much broader technological future that also includes things like surrogacy and even artificial placentas or entities that could gestate outside the body. "I think that these technologies have the potential to really change the way we think about assisted gestation," he says. "And I think that could bring real benefits to marginalised groups, as long as they are applied in a certain way'.
introduction and translation by Marina Terragni, article by Euronews here.