Around 10 women without a uterus are born each year in Sweden. This brings with it difficulties in what it may mean to have a body that does not follow the norm, and it means, of course, that these women cannot become pregnant.
Swedish researchers have investigated since the end of the 1990s whether uterus transplantation, in combination with IVF, can be a pathway to pregnancy for women without a uterus. The research project has led to nine children being born in Sweden to such women.
However, in order to participate in the research project, it was necessary that the recipient find a donor, preferably a relative, who was willing to donate her uterus. In a new study, Lisa Guntram has investigated how women who have considered – or undergone – uterus transplantation acted in order to acquire the uterus that was required for transplantation.
How do you ask someone to donate their uterus? What challenges does this involve? These are two of the questions that Lisa Guntram poses in the article that has been published in the journal Medical Humanities.
“The study shows that when a woman asks a relative, such as her mother, to donate her uterus, much more than medical aspects are involved. Innovations can stimulate existential questions and challenge relationships. We must remember this, if we are planning to include uterus transplantations in medical practice”, says Lisa Guntram, senior lecturer at Linköping University.
To ask for the uterus you were born from
Lisa Guntram has interviewed ten Swedish women, aged 26-37 years, who discovered in their teenage years that they had been born without a uterus. All of them had considered adoption or arranging for a surrogate mother abroad, but had rejected these pathways for various reasons. A uterus transplantation was a further possibility they considered, and in some cases carried out.
The analysis shows that the issue of receiving someone else’s uterus can create difficulties both on an emotional plane and in the relationship between donor and recipient. This has previously been seen in research into organ donation between relatives. What is special about uterus transplantation is that it raises questions both about the meaning of motherhood and the varying significance of a uterus through the lifetime of a woman.
With respect to motherhood, the women in the study describe how they experienced it as “obvious” that their own mothers should be willing to donate. At the same time, the study illuminates the risks that a refusal may pose to the relationship. When a question about receiving one’s mother’s uterus is made, expectations about motherhood are made evident, and ideas about what a mother “should” be willing to sacrifice for her daughter.
The question also puts the spotlight onto ideas of the aging female body and her uterus. Does an older woman “need” her uterus? Previous research is often based on the premise that it is emotionally easier for women who are ‘done with’ childbearing to donate their uterus than it is to donate other organs. The uterus is considered to have completed its task. Lisa Guntram believes, however, that we need to consider how women feel when faced with the prospect of donating this particular organ.
Effects beyond the donor and recipient
The women in study whose mothers could not, or were unwilling to, donate their uterus were compelled to consider who else they could ask. The study points out that this puts the question of availability onto the agenda. If uterus transplantation is to progress from being a research project to a procedure offered in the healthcare system, the question of availability must be discussed. Those interviewed during the study experienced that the search for a donor brought both stress and a new awareness of the networks around them. It became very clear that the donation of a uterus involves many more people than just the donor and the recipient.
“My study doesn’t say anything about whether uterus transplantation should become a part of routine medical practice. But the results suggest that those who go through this, or consider it, must be given tailored support. And this is needed before, during and after the procedure”, says Lisa Guntram.
The study has received funding from the Swedish Research Council.
May I have your uterus? The contribution of considering complexities preceding live uterus transplantation. Lisa Guntram (2021). Medical Humanities. Published online: 24 February 2021. doi: 10.1136/medhum-2020-011864