Uterus Transplant, Latest Fertility Feat, Raises Ethical Questions

Sept. 19, 2012— -- It seems science has a solution for every reproductive woe.

Swedish doctors have successfully transplanted a uterus from mother to daughter, raising hope for women without wombs who want to carry their own babies.

The pioneering procedure is the latest in a string of fertility feats that sound more like science fiction.

"It's hard to know where all this is headed," said Dr. James Goldfarb, director of the University Hospitals Fertility Center in Cleveland and past president of the Society for Assisted Reproductive Technologies. "But I've been around long enough to see some stuff we never imagined become sort of standard."

Goldfarb, who in 1986 was the first to put an embryo in the womb of a gestational carrier, said uterine transplants could sidestep some of the downsides of surrogacy, which is illegal in some states and frowned upon in some cultures.

"It's also stressful for the biological parents to have someone else carrying their baby," he added. "I think that would be the advantage to the procedure. But clearly there are disadvantages, too."

Disadvantages include surgery for the uterus donor and recipient, and a lifetime of anti-rejection drugs. It's also unclear whether the transplanted uterus will be receptive to embryos. But if it is, the procedure would mean any woman of any age could get pregnant – in theory, anyway.

"Today, the one woman who can't get pregnant is the woman with no functioning ovary and no uterus. But if this technique works, that woman could get pregnant with a transplanted uterus and egg donation," Goldfarb said.

While the procedure gives hope to some women who lost their fertility to diseases or cancer treatments, it also raises ethical questions, according to Art Caplan, a bioethicist at NYU Langone Medical Center.

"There's a lot going on in reproductive technology, but very little attention being paid by policy makers. Questions about who can use these techniques, who can donate a uterus, are all pretty much left to the marketplace," Caplan said.

The U.S. has little in the way of legislation when it comes to assisted reproduction. Caplan believes that this is because the country is being "paralyzed by the abortion debate."

"No politician wants to go near reproductive technology," he said. "You're sidling up to the abortion debate when you talk about embryos."

Countries like England, on the other hand, are carefully weighing the ethics of the latest advances, including the possibility of engineering embryos from three parents to foil genetic disease.

The procedure, called mitochondrial replacement, swaps parts of one woman's egg with those from a donor egg, thwarting diseases caused by defects in the cell's power supplier, the mitochondria.

"We find ourselves in unchartered [sic] territory, balancing the desire to help families have healthy children with the possible impact on the children themselves and wider society," Lisa Jardine, chair of the UK's Human Fertilization and Embryology Authority, said in a statement.

While mitochondrial replacement could curb some devastating diseases, Caplan said it "crosses the line from infertility treatments to designer babies."

"It's controversial because it doesn't involve changing genes in your own body, but the genes passed onto the next generation," said Caplan, explaining how the process "opens the door" to eugenics. "At this point it's purely to prevent disease, but it's a baby step in that direction."

More women giving birth to biological babies could also shrink the pool of adoptive parents, according to Caplan.

"Some people think spending large sums of money to perfect reproductive technology makes little sense when you have so many children that can't find a home," he said. "People bring a lot of fantasy to the idea of a genetic connection, but that biology doesn't always bear out… It's who raises the child that matters."