Uterine Transplantation in Male to Female Transgender Women; A Cross-Sectional Survey Assessing Perceptions, Acceptability and Demand

Abstract

Background: Uterine transplantation (UTx) has been demonstrated to be a viable fertility restoring treatment for women assigned female at birth with absolute uterine factor infertility. Recent advancements, as well as considerations of fairness and equality in reproductive care, have led to the possibility of UTx being undertaken in male to female (M2F) transgender women. Methods: This cross-sectional study utilised an electronic questionnaire to investigate the reproductive aspirations of M2F transgender women, including their perceptions of and motivations toward UTx. Findings: 182 M2F transgender women completed the questionnaire. The vast majority did not have children prior to transitioning (n=167; 92%) and expressed desire to have children in the future (n=171; 95%). The majority ‘agreed’ or ‘strongly agreed’ that the ability to gestate and give birth to their own children (n=171; 94%) and menstruate (n=161; 90%) would enhance perceptions of their femininity. Similarly, high proportions strongly agreed / agreed that having a transplanted, functioning vagina would improve their sex life (n=163; 90%), quality of life (n=163; 90%), and also help them to feel like ‘more of a woman’ (n=168; 93%). Nearly all respondents (n=180; 99%) believed that UTx would lead to greater happiness in M2F transgender women. More than three quarters (n=140; 77%) ‘strongly agreed’ or ‘agreed’ that they would be more inclined to cryopreserve sperm if UTx became a realistic option. Interpretation: This study provides novel insights into the reproductive aspirations of M2F transgender women and demonstrates multifaceted motivation to undergo UTx. There is clear desire to experience physiological experiences unique to women, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. It is foreseen that UTx, if proven feasible and safe in this setting, would facilitate the achievement of reproductive aspirations, improve quality of life and further alleviate dysphoric symptoms in M2F transgender women. Funding Statement: NWs research is funded by a Leverhulme Early Career Research Fellowship: Grant no: ECF-2018-113. SWs research is funded by a Wellcome Trust Senior Investigator Award. Grant no: 097897/Z/11/Z. Declaration of Interests: None of the co-authors have any competing interests. Ethics Approval Statement: Ethical approval to undertake the study was received from Imperial College London on 13th November 2018 (ICREC reference: 18IC4839).