Transplanted uterus: Complications on fertility shaming are born


A woman in Brazil who received a transplanted uterus in 2016 gave birth to a baby girl using the first ever deceased uterine donor. Although 11 other deliveries have occurred in the world using live donors, this is the first of its kind to utilize the uterus of a woman who was deceased.

The process of transplanting a uterus for these women and utilizing a deceased donor’s uterus offers new options for women like the 32-year-old recipient who had the rare congenital disorder of Mayer-Rokitansky-Kuster-Hauser syndrome, or uterine absence. This disorder affects one in 5,000 women.

Options are growing for women in different social and medical situations. Cryopreservation of oocytes, or egg freezing, is also on the rise and an option for women who may have cancer, do not have a spouse, or are not quite ready to commit to having a baby.

{mosads}Chances for a healthy live birth after the age of 30 decline by 3.5 percent per year; after age 32, a woman’s egg quality and quantity decrease. By the time a woman hits the age of 40, successful pregnancy rates are 5 percent or less and miscarriage rates approach 40 percent to 50 percent.

Age is the number one factor that determines successful conception for a woman.

Popular culture is steeped in the notion of pressure concerning a woman’s biological clock. But what if your biological clock was never set? A small subset of women are born without a uterus, cervix or vagina.

Fertility shaming is receiving more attention thanks to the outspokenness of actresses and political figures, and by physicians such as myself. From women who have chosen to wait to have children, secondary to career aspirations, to women who have had no success secondary to medical conditions, feeling ashamed of your ability to conceive is alive and well.

Former first lady Michelle Obama recently revealed in her book “Becoming” that she had struggled with miscarriage and also opted into fertility treatment through in vitro fertilization (IVF) for her two children, Malia and Sasha, starting at the age of 34.

She writes that she felt like a failure because she did not realize how common miscarriages are.

As a practicing obstetrician-gynecologist, I have held the hands and cried with many patients after a miscarriage. I have, myself, felt the heart-wrenching pain of miscarriage — and I am not speaking of just the bleeding and cramps. I speak of the instant anticipation and bond you feel with your baby the minute you see a positive pregnancy test.

Early pregnancy loss (occurring before 13 weeks gestation) occurs commonly in 10 percent of all clinically recognized pregnancies. Half of all these cases are related to chromosomal abnormalities, which can be a direct result of maternal age. Miscarriages before 20 weeks’ gestation occur in up to 20 percent of all clinically recognized pregnancies.

Michelle Obama, like 9 percent of women age 35-44, utilized assisted reproduction and successfully conceived her girls. It is great that assisted reproductive technology, such as IVF or IUI (intrauterine insemination), gives women options and potential for childbearing.

However, some women, despite being able to utilize and afford IVF, do not have success.

Gabrielle Union, who just had her first baby via surrogacy with her husband, Dwayne Wade, discusses her struggles with fertility and has been an outspoken advocate for women in similar situations.

In her book “We are Going to Need More Wine,” she writes about her struggles with adenomyosis, a condition where cells from the lining of the uterus begin to grow into the muscle layer of the uterus. This results in excessive menstrual pain and longer periods or scarring within the uterus that can preclude successful pregnancies.

Union says she failed eight or nine IVF cycles that resulted in miscarriage, and utilized a surrogate to carry her baby to term. After her years of struggles, she recently revealed that she was given a hard time after birth when she wore a hospital gown in order to allow for skin to skin contact.

Criticism of women and their fertility abounds.

As I blew out my 30th birthday candles on the same day I graduated from a rigorous OB/GYN residency training, all I could hear in the background was the noise of family members, community members and distant friends who had been reminding me of my biological clock all year. As a woman of South Asian descent in medicine, in that community, at 30, I was ancient and past my prime.

Many of my friends and colleagues already had children. Fertility shaming began for me very early on. Compounded by the fact that my last rotation during residency was reproductive endocrinology and infertility, the statistics alarmed me even more.

The news of a successful solution to a live birth through a new route is energizing for many. But the clock has run out on the pervasive fertility shaming underlying our culture.

Sameena Rahman, M.D., is an obstetrician-gynecologist in Chicago, a clinical assistant professor at Northwestern Feinberg School of Medicine and a Public Voices fellow with the Op-Ed Project.

Tags Michelle Obama

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