With womb transplants a reality, transgender women dare to dream of pregnancies

It would require a grueling series of operations, but transgender women now see hope that they could one day become pregnant — despite having been born biological males — thanks to pioneering uterus transplant surgery.

“I hope it becomes a reality,” said Chastity Bowick, 30, a medical case manager in Worcester, Mass. “I absolutely would be willing to do it.”

Bowick began her gender transition at 19, but she knew she wanted to be a mom long before that. “Ever since I was old enough to understand the concept of parenting, I wanted to be a mother,” she said. “I didn’t know how that would ever happen, but that’s what I wanted.”

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Surgeons at the Cleveland Clinic on Monday introduced the recipient of the nation’s first uterus transplant, performed late last month. The 26-year-old patient, identified only as Lindsey, said she has adopted three boys through foster care but has always dreamed of the opportunity to carry a child. The Cleveland Clinic team plans to do at least nine more transplants as part of a clinical trial.

It is theoretically possible to transplant a uterus into someone who was born male. But the body would need a lot of preparation.

Gender reassignment surgery would be much more involved, for one thing. As with traditional male-to-female surgery, doctors would have to create a vaginal canal. But they would also need to make space for the uterus. That would require widening the pelvic inlet, which is substantially narrower in men.

After all that, the patient would need about a year to heal before undergoing the womb transplant — which in itself is quite an ordeal. The first one performed in the United States took nine hours.

If the transgender woman had stored sperm before transitioning, she could use it to fertilize a donor egg for implantation, so her baby would be genetically related to her. Careful administration of hormones would help the patient sustain her pregnancy, which would require close monitoring.

Any patient with a uterus transplant would also have to take powerful drugs to prevent her body from rejecting the donor organ. (For that reason, the transplants are designed to be temporary; surgeons plan to remove the donated womb after the recipient has carried a pregnancy or two to term.)

The many steps would make an already tough process even more difficult and expensive for transgender women

Bowick is undeterred.

“Being a trans woman is already complicated,” she said.

“And pregnancy would be a beautiful thing — even the morning sickness. I mean, I’m kind of getting that now anyway, from the hormones. And I’m moody,” she laughed. “After all I’ve gone through, I’m up for any challenge.”

That commitment doesn’t surprise psychologist Deborah Simmons, who works with couples on surrogacy and fertility issues from her practice in Minnetonka, Minn.

“If you’re a trans woman, this is a way of completing the dream,” she said. “Looking like a woman, feeling like a woman, and being able to bear a child like a woman. The whole notion of being like anyone else who wants to carry a baby — the opportunity for that is blowing people’s minds, in a good way.”

Bowick said she doesn’t expect bearing a child will make her feel like a more complete woman. “There are biological women who cannot bear children and they’re not lesser women because of it,” she said. She’d already been planning to adopt children and still plans to do so, even if she’s able to bear her own children as well.

Angelica Ross, the chief executive of TransTech Social Enterprises in Chicago, said transgender women may have trouble taking advantage of uterine transplants because many have faced discrimination in the past and, thus, lack the financial resources to pay for multiple surgeries.

“Because of getting fired from job after job, most trans people, especially trans people of color, are barely able to take care of themselves, much less a child,” she said.

Still, Ross said “it’s just an exciting idea” that it’s even theoretically possible now to become pregnant after transitioning to female.

“I love living in an America,” she said, “where someone like me would have a chance to have children.”

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