Abstract
Objective:To evaluate the eligibility of female-to-male (FtM) transgender people as donor candidates with regard to histologic, surgical, and social aspects.Materials and Methods:In this prospective cohort study, 31 FtM transgender people underwent standard hysterectomy and bilateral salpingo-oophorectomy for gender reassignment upon their request. The pelvic viscera of the transgender people was intraoperatively observed and the histology of the removed uteri were evaluated for fertility capacity and procurement surgery. A questionnaire was administered to explore their attitude towards uterus donation.Results:The mean ± standard deviation age was 28.5±5 years. The median duration of testosterone supplementation was 2.4 years; therefore, they all had irregular menstrual periods during this therapy. None had any previous abdominal surgery or additional morbidity. The mean uterine volume was 138±48 cm3. No adenomyosis, endometriosis, polyps, adhesions or uterine anomalies were either observed or reported. Endometrial histology was reported as proliferative (58%), atrophic (29%), and secretory (13%) pattern. Of the 31 transgender people, 30 (96.7%) had a positive attitude; only one had no opinion at the beginning. After detailed information about the procedure was given, 26 (84%) still wanted to volunteer for donation, but 4 (12%) changed their opinion to negative (p=0.12, McNemar test).Conclusion:The proposal of the FtM transgender population as uterus donor is a hypothetical model that has not been experienced before. Nevertheless, our experience revealed that the FtM transgender population would be good candidates socially, legally, and biologically.
Highlights
Absolute uterine factor infertility (AUFI) is characterized by any condition that causes congenital/iatrogenic absence or non-function of uterus, such as severe intrauterine adhesions or multiple leiomyoma, which may destroy the complete architecture of the uterus[1,2,3]
A questionnaire was administered to explore their attitude towards uterus donation
In 2009, the International Federation of Obstetrics and Gynecology (FIGO) Committee[5] reported that it was unethical to remove a uterus for transplantation from young women who had not had the desired number of children
Summary
Absolute uterine factor infertility (AUFI) is characterized by any condition that causes congenital/iatrogenic absence or non-function of uterus, such as severe intrauterine adhesions or multiple leiomyoma, which may destroy the complete architecture of the uterus[1,2,3]. Adoption or gestational surrogacy are the currently available options to overcome childlessness in women with AUFI because an artificial uterus to support the embryo and carry the foetus till birth has not yet been invented. Uterus transplantation (UTx), despite it still being at a very experimental stage, is a reasonable option for fertility achievement It differs from other organ transplantations with its temporary feature that has been kept until the recipient has delivered the desired number of children to limit the immunosuppression period. The first human UTx was carried out in 2000 in Saudi Arabia[7], with a uterus from a 46-year-old live donor It was transplanted into a patient who had undergone emergency peripartum hysterectomy during her first childbirth. The aim of this article was to scrutinize FtM transgender people as to whether they could serve as uterus donors, and to explore their attitude towards uterus donation (UD)
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