Uterus transplant for MtF transsexuals (born male)
Not just "pregnant men" (trans FtM, born women) as per the cover of Espresso: the bioethical criteria for uterus transplants have recently been reread. Which can also be received by trans MtF, i.e. biologically males. For a complete transition

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The cover of the latest issue of the Express it probably appears to most as a provocation. Those who follow certain scientific literature, however, know well that what was designed is already reality, and has been for a while. Pregnancies in women who identify as men - FtM, the acronym (Female to Male) - like the one drawn on the cover of the weekly magazine - are certainly nothing new: just search in the sector databases (Scopus or WOS or Pubmed, to be clear, recognized for scientific publications evaluated for university competitions) and consult the vast literature that emerges.

Purely by way of example, in 2014 the magazine Obstetrics & Gynecology  (of the American College of Obstetricians and Gynecologists) published an article titled Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transition, related to a study approved by the University of California, San Francisco Committee on Human Research. Twenty-five FtMs used testosterone before pregnancy and only for six of them it had not been planned; the majority had their child with their partner, five had recourse to anonymous donors or sperm banks, three from known donors, 21 with their own oocytes. And the publication of some scholars of the is recent Rutger Robert Wood Johnson Medical School, New Brunswick, in the USA, sui obstetric treatments for "transgender men with advanced paternal age", that is, FtMs over 35 years of age, whose advanced age is defined “paternal” but at the same time we talk about labor, birth etc. We don't know how many have been born from FtM so far, but according to experts these are increasing numbers.

On the other hand, for some time in the scientific literature there has been ample space for "transgender health", the health of transgender people, which includes fertility preservation treatments, that is, the possibility of conserving oocytes for FtM and spermatozoa for MtF (Male to Female), collecting the gametes before the transition, and the purpose is clear: to be able to be, in the future, genetic mothers (and also gestational, if one does not undergo to hysterectomy) and biological fathers being, respectively, social and often also registered fathers and mothers. It should be remembered that the possibility of these treatments is also offered to adolescents, including those who are given puberty blockers, provided, of course, that sufficient sexual maturity has been reached: It remains a mystery how a thirteen-year-old could be aware of all this, when he expresses his informed consent in this regard, just as doubts remain very strong about the real freedom of consent of parents, who are called upon to give legal approval to these paths.

However, it is still at the level of academic discussion possibility of uterus transplantation for “transgender individuals”: the magazine Bioethics recently published an article whose lead author is Jacques Balayla, a gynecologist at McGill University, in Montreal, Canada. It is one of the three signatories of the “Montreal criteria”, i.e. the international ethical reference criteria for uterus transplants. It must be said that the text was updated by the same authors in 2013, a year after publication, with some ethical openings to uterus transplantation in men or trans, but confirming its exclusion from a clinical point of view. In the article published this year, the ethical reasoning is resumed by rereading the first of the required criteria - The recipient is a genetic female of reproductive age with no medical contraindications to the transplant - because “the condition that the patient is a genetic female intrinsically disqualifies transgender, certain non-binary, gender diverse and cis-gender women who have a non-XX karyotype (“transgender UTx”)”, where UTx stands for “uterus transplant ”.  

The authors declare that so far there have been no uterus transplants on “UTx transgenders”, but in the article they develop a series of arguments to show theethical acceptability, in reference to the well-known bioethical principles of autonomy, non-maleficence, beneficence and justice. The Montreal Charter is then reread with comments such as “If a cis-gender person who identifies as female but lacks a uterus can ethically have one, then the principle of justice indicates that this opportunity should be offered to all such people, regardless of the circumstances of their birth.". And if the purpose of the uterus transplant according to the Montreal Charter is to procure a pregnancy, invoking the principle of beneficence one can think of "make uterus transplant available to those suffering from gender dysphoria”, provided that clinical safety criteria are respected. UTx could become “part of gender reassignment surgery,” therefore, as also supported in previous works by a team of English surgeons, cited in the article.

Finally, some considerations on the construction of any vaginal access to the uterine cavity: the authors however felt the need to specify, to avoid any misunderstanding, that this is a treatment applicable only to trans-females and not for cis-males, the latter were called into question if they were hypothetically interested in carrying on a pregnancy without carrying out the gender transition. In short and without particular emphasis, here's in black and white where you want to go.

(for the unbelievers, in the original text: As we mentioned previously, though UTx may well be transitory to void the need for lifelong immune-suppression, the gender re-assignment surgery and orchiectomy needed to ensure the success of UTx are permanent – a consideration that would not apply to cis-males who would seek to carry pregnancy without transitioning. Indeed the ready convenience of access to the uterine cavity both for embryo transfer and biopsy via the cervix prefers that a transgender patient seeking to become pregnant through UTx should have previously undergone surgical construction of a neo-vagina that may be connected to the transplanted canal and cervix. Such a reality would only apply to trans-females and not cis-males).

Assuntina Morresi

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