Perceptions and Motivations for Uterus Transplant in Transgender Women

Benjamin P Jones,Philip Thomas,Stephen Wilkinson,Nicola J Williams,Abirami Rajamanoharan,Isabel Quiroga,J Richard Smith,Cesar Diaz-Garcia,Saaliha Vali,Meen-Yau Thum,Joseph Yazbek,Srdjan Saso,Sadaf Ghaem-Maghami

doi:10.1001/jamanetworkopen.2020.34561

Abstract

Uterus transplant has been demonstrated to be a viable fertility-restoring treatment for women categorized as female at birth with absolute uterine factor infertility. Recent advancements, as well as considerations of fairness and equality in reproductive care, have now led to the possibility of uterus transplant being undertaken in transgender women. To investigate the reproductive aspirations of transgender women and their perceptions of uterus transplant. This cross-sectional survey study used a 27-item electronic questionnaire to investigate the reproductive aspirations of 182 transgender women older than 16 years, including their perceptions of and motivations for uterus transplant, between May 1 and November 1, 2019. Perceptions of and motivations for uterus transplant, including perceived significance of the ability to gestate, menstruate, and have a physiologically functioning vagina. A total of 182 transgender women completed the questionnaire; most women (109 [60%]) were aged 20 to 29 years. Most did not have children prior to transitioning (167 [92%]) and expressed a desire to have children in the future (171 [94%]). In addition, most respondents agreed or strongly agreed that the ability to gestate and give birth to children (171 [94%]) and menstruate (161 [88%]) would enhance perceptions of their femininity. Similarly, high proportions strongly agreed or agreed that having a transplanted, functioning vagina would improve their sexual experience (163 [90%]), improve their quality of life (163 [90%]), and help them to feel like more of a woman (168 [92%]). Nearly all respondents (180 [99%]) believed that uterus transplant would lead to greater happiness in transgender women. More than three-quarters of the respondents (140 [77%]) strongly agreed or agreed that they would be more inclined to cryopreserve sperm if uterus transplant became a realistic option. This study provides insights into the reproductive aspirations of transgender women and reports on their multifaceted motivation to undergo uterus transplant. The survey responses suggest that transgender women would choose to have female physiologic experiences, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. If proven feasible and safe in this setting, uterus transplant may facilitate the achievement of reproductive aspirations, improve quality of life, and further alleviate dysphoric symptoms in transgender women.

Highlights

Gender dysphoria is defined as a persistent discomfort with one’s gender identity or biological sex
If proven feasible and safe in this setting, uterus transplant may facilitate the achievement of reproductive aspirations, improve quality of life, and further alleviate dysphoric symptoms in transgender women
The results of a questionnaire answered by 60 women with absolute uterine factor infertility (AUFI) in France indicated that 58% would partake in a clinical trial on uterus transplant.[21]

Summary

Introduction

Gender dysphoria is defined as a persistent discomfort with one’s gender identity or biological sex. By cryopreserving sperm, should be offered to those desirous of biologically related offspring after medical or surgical transition,[3] with subsequent use of donor eggs in surrogate individuals or with a future female partner.[3] approximately half of transgender women desire biologically related children in the future,[4] fertility preservation rates remain low, owing to various reasons, such as financial barriers and unwillingness to delay transition.[5,6] While the ability to gestate is not essential for a good quality of life, many transgender women experience significant psychological and social harms as a consequence of an inability to fulfill their own reproductive aspirations These harms are exacerbated by social and cultural attitudes, norms, and expectations, which valorize reproduction, genetic relatedness, and parenthood.[7,8,9] many cisgender women report distress, depression, loss of gender identity, and an enduring sense of incompleteness and grief as a consequence of infertility.[10]

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Results

Discussion

Conclusion