Nine Women Receive Uterus Transplants in Sweden, Raising Ethical Questions


It’s been over 35 years since Louise Brown, the first “test tube” baby, was conceived through in vitro fertilization (IVF), and in the intervening decades there have been numerous reproductive technologies developed to help women facing infertility, as well as same-sex couples who want children, become biological parents. Now, researchers in Sweden are trying what might be considered the most radical idea yet: They have transplanted uteruses into nine infertile women who wish to give birth. 

Many of the women had intact fallopian tubes and ovaries that were able to produce eggs, but were either born without a uterus or had lost their uterus as a result of cervical cancer. (A condition known as MRKH that causes a fetus to develop ovaries but not a uterus is estimated to occur in about 1 in 4,500 newborn girls.) The donors were all living relatives, including mothers, of the women. The uteruses were transplanted into the women beginning in September 2012. Doctors did not attach the recipients’ fallopian tubes to the uterus, so spontaneous pregnancy is not possible. Instead, before the surgery, the doctors harvested the recipients’ own eggs and created embryos that have been frozen.

Within the next few months, doctors hope to implant the embryos and determine whether these women can become pregnant and carry a fetus to term using a donor uterus.

Thus far, according to the medical team, there have been signs of success, with few complications. Many of the women got their periods within six weeks of the surgery. One women had an infection in her new uterus, but it was cleared up easily, and others had “minor rejection episodes.” None of the women needed intensive care or further surgeries.

They do, however, have to continue to take anti-rejection drugs, which can cause high blood pressure, swelling, diabetes, and increase the risk of certain cancers. For this reason, the doctors plan to remove the donor uteruses after a maximum of two pregnancies.

The researchers involved are hailing this as a potential breakthrough for women with no other options, while others worry that this approach is too radical. British fertility expert Richard Smith told The Province that he worries about the risk for the donors. In order to ensure enough blood vessels can be attached when the organ is transplanted, surgeons had to remove even more tissue from the donor than they would in a woman having a radical hysterectomy for medical reasons. Smith questions if this is ethical given that these donors are healthy and their donations, while generous, are not life-saving. He also is concerned that the implanted uteruses will not have enough blood flow to adequately nourish a growing fetus. Still, Smith and his team are attempting to raise money for uterus transplant experiments of their own, but say they will use organs only from dead or dying donors.

Medical teams in other parts of the world have also attempted to transplant uteruses from both living and deceased donors. In 2000, a Saudi Arabian woman received a uterus from a live donor but a blood clot meant doctors had to remove it a few months later. In April 2013, Turkish doctors announced that a 22-year-old woman who had received a cadaver uterus in 2011 was pregnant. A month later she miscarried.

In an editorial for Healthline, Dr. Kenneth Troffater, who has worked with kidney and liver transplant patients, argues that uterine transplants of any kind violate the oath of “first do no harm,” as the risks to the potential mother and child far outweigh the benefits. He writes:

[T]here are risks to the woman of transplant rejection, diabetes as a consequence of the immunosuppressive therapy, preeclampsia, early delivery, and potential risks to the fetus from all of these factors. But, apart from these other risks of organ transplants, we have no idea whether the vascular changes that are required to support a normal pregnant uterus, and the baby inside, can occur with a transplanted uterus, what the risks of transplant rejection of a uterus might be during a pregnancy to the woman, or the consequences of these events on a developing baby. To be the first woman with a transplanted uterus to take this chance on a baby is, in my opinion, a selfish and foolish proposition.

He adds that the physicians involved should “step back, take their egos out of the picture, and think about what they are doing more carefully.”

RH Reality Check spoke to Dr. Alan Kaye, an expert in cervical cancer who had a different opinion. He cautions that this is still in the experimental stages, and we don’t yet know if it will ever be a really viable option for women. He also agrees that the risks to the donors need to be carefully assessed, but, he says, it may someday be a good option.

“The concept appears sound and is not much different in providing a person a transplanted kidney, even though they could live with dialysis,” said Kaye. “If a wholesome natural environment-like womb can be provided, for IVF, it can have a positive loving outcome for the mother and baby. That can be a blessing.”

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  • fiona64

    The moment I read an article about these transplants a few weeks ago, it raised numerous ethical questions in my mind. Glad to see I’m not alone.

  • JamieHaman

    There are so many children who need a home, I can’t see the justification.

  • coolmind

    can’t have kids? Adopt or better yet, rescue a dog.

    • Mandy

      Yeah…I’d love to see these women interviewed and learn some more about them and why they want to physically birth a child so much. Were options such as a surrogate or adoption even considered? Do so many people really feel like they can’t be a “real” mother or something unless they physically are the one to give birth? What is cheaper: transplanted uterues surgery and medication or the fees your go through trying to adopt or surrogacy? Because yeah, there are hundreds of thousands of kids already here waiting to find a family. Is passing along your genes by going through a pregnancy yourself really that important?

      This issues brings up a lot of questions about parenting and motherhood and stigmas surrounding the non-traditional family for me.

      • L-dan

        It does mention that surrogacy isn’t an option there. It’s not legal. And I guess, from an ethical standpoint, this procedure risks the person with that fervent desire for a child of their own genetic material, rather than potentially exploiting someone else via surrogacy*.

        But yeah, I really have trouble seeing the mindset that wants that so much.

        *not that I think all surrogacy is exploitative, but I can see the cautious ethics involved in banning it.

  • Mindy McIndy

    This is weird and all, but a little part of me says “Sign me up to be a uterus donor.” But then that little bit of logic reminds me that I wouldn’t wish my uterus on even my worst enemy.

    • L-dan

      This.

      Also, while I’d be happy to be rid of it, I don’t know that the highly invasive surgery is worth it.

      From the linked article, “The Swedish researchers and others have previously reported successful uterus transplants in animals including mice, sheep and baboons, but no offspring from the primates were produced.”

      That does not say to me that this procedure is ready for testing on humans. If you’re going to risk your health that way, I think it should be with at least a bit more of a chance that you’ll get the intended result out of it.

  • bitchybitchybitchy

    There is something distinctly creepy to me about this story. Women undergoing elective surgery that will leave them taking anti-rejection medication for the rest of their lives for the chance to have a uterus? So that doctors can stroke their egos and be seen as miracle workers? No thanks. And let’s not forget the children already living who need loving, responsible parents….

  • KSB

    I have to say I’m pretty ashamed and shocked at the responses on this website of all places. Not everyone can adopt, if you’re not rich, white, straight, married, and even Christian you may have a very hard time adopting, it may even be impossible.
    This is an amazing opportunity for women and I hope that this technology can be dveloped in a safe and ethical manner. Shame on everyone here who is so selfish as to callously deny any woman the chance to bare a child. Is there something wrong with that desire? Aren’t we all here to uphold the rights of every woman to choose her reproductive destiny?