Uterine transplantation: a survey of physicians perceptions and attitudes

Abstract

To determine whether reproductive endocrinologists and gynecologic surgeons support uterine transplantation (UT) as an ethical treatment option for patients with uterine factor infertility. A 28-item cross-sectional web-based questionnaire was distributed to physician members of the American Society of Reproductive Medicine (ASRM) and the American Association of Gynecologic Laparoscopists (AAGL) between January and February 2017. Individual responses denoting support for or opposition to various aspects of UT were analyzed using log-binomial regression and Chi-squared tests. A total of 414 physicians (ASRM 49.5% & AAGL 50.5%) responded to the web-based survey; 43.7% were female, 52.4% were between the ages of 45-65, and 73.4% were white. In total, 71% of respondents felt that carrying a biological child is a reproductive right while 78.7% felt a woman should be allowed to donate or receive a transplanted uterus. When donating a uterus, 54.4% believe that UT carries an acceptable risk for donors. Furthermore, 28% felt the risk of UT to be acceptable for the recipient, 9% for the donor and only 21% felt the risk acceptable for the resulting infant. Forty-three percent agreed that UT should be considered a therapeutic option for women with severe uterine factory infertility, but only 19.6% felt it should be covered by health insurance. When taking ethical considerations into account, 28% of respondents felt UT to be unethical, even in situations where gestational surrogacy is illegal. Physician members of the ASRM were more likely than AAGL members to support UT in countries or states were gestational surrogacy is illegal (76.6 vs. 65.5%, p=0.01). The most common ethical concerns regarding UT were related to medical or surgical complications to the recipient (48.8%) followed by fetal outcomes (26.3%). Lastly, 19% reported being asked about UT as a treatment option by patients, but only 10.9% stated that they were likely to recommend it as a therapeutic option. The majority of gynecologists surveyed find uterine transplantation to be an acceptable and ethical option for patients with uterine factor infertility. However, there are significant concerns regarding risk to donors, recipients, and resulting infants, all contributing to only a minority recommending it as a therapeutic option. Successful replication of the Swedish experience with UT is likely to contribute to greater clinical acceptance.