With the First Uterus Transplant in the US, are we Making Women Obsolete?

Feb 26, 2016

Welcome to the “Brave New World” of procreation

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Procreation is entering in the territory of “Brave New World” faster than we think. In this famed novel, Aldous Huxley envisioned a future where children were not born but “decanted,” and the very thought of “viviparous birth” was met with disgust at the barbarism of flesh-pregnancy. That future is today, for patients can receive a temporary uterus capable of gestating a fetus until the point of live birth, and then jettison the transplanted organ. In 2014, nine women in Sweden received uterus transplants. Yesterday, doctors at the Cleveland Clinic announced that they’d successfully performed the surgery on a patient in the United States.

On its face, this announcement seems a triumph of modern science. Soon anybody, regardless of age, sex, or gender, will be able to experience the condition called pregnancy. The next logical step is to make that host body irrelevant. This too is happening, via an experimental process called “extra-uterine gestation.” Once that is fully achieved in humans, decanted infants are not only possible, they’re inevitable.

In an age when the sex organs are decoupled from gender identity, we no longer understand “woman” as a biological entity but a point marking the intersection of various cultural continuums: legal, economic, religious, social, political. Arguably, the biological definitions have changed the most rapidly, rendering Simone de Beauvoir’s framing of the question, “What is a woman?” scientifically obsolete. Today, science accommodates conditions called “intersex,” which refers to individuals possessing the sexual organs of both males and females even as they frequently adhere to neither gender. That condition is rare, but chimerism is surprisingly common. It refers to the state of having chromosomes from more than one being, including the DNA of the opposite sex. One of the more unusual cases involved a wife who become pregnant via old-fashioned sex with her husband. She gave birth—but her child wasn’t hers, at least not in the way she’d expected, because her ovaries belonged to a fraternal twin she’d absorbed when both were blastocysts in their mother’s womb. Her husband’s sperm fertilized her brother’s eggs.

From the biological standpoint, the unborn brother is her child’s mother. Is her brother a woman? Given that the wife’s body carries male DNA and has no ovaries, is she?

There is no essentialist definition of biological being, meaning that we’re always working at ever more finely-honed approximations. This is a paradoxical exercise akin to attempting to reach zero by halves, leading down the rabbit hole to maddening exasperation. Consider that Beauvoir argued that pregnancy bound females to the “animal” condition, thwarting her freedom to be a fully autonomous being. Shouldn’t the artificial womb then be the pinnacle of feminist liberation? Finally, the fertile body will be unbound from its biological imperative, even as healthy broods emerge from eggs implanted in an eternally receptive womb-machine. Thus the female fulfills her reproductive mandate to pass along her genes, even as her nulliparous flesh remains perpetually committed to the lure of the erotic. So why does the uterus transplant seem…wrong?

Certainly, there’s the overweening aspect of what Donna Haraway, feminist author of the Cyborg Manifesto, calls “nationalist natalism,” where the rich make demands on the poor by exploiting vulnerable bodies in the name of science. We owe the concept of “companion species” to Haraway, whose rallying cry is “Make Kin Not Babies,” as a holistic response to the cries of our struggling planet. The intense concentration of medical resources on a slight handful of patients hoping to experience pregnancy (as opposed to motherhood, given that there is a surfeit of children needing to be adopted) is a snapshot into global asymmetries of power, and a reflection of cultural narcissism that is ultimately dis-empowering women.

Bioethicist Elizabeth Yuko wrote a brief history of the surgery as well as an overview of the ethical challenges it presents. But the subject lends itself to fictionalization precisely because there are no clear answers. Novelist Marie Myung-Ok Lee is taking on this challenge in her unnamed forthcoming novel.

To dig deeper into the issues, I asked Susan Merill Squier, Professor of English and Brill Professor of Women’s, Gender, and Sexuality Studies at the Pennsylvania State University; and Einstein Visiting Professor at the Free University of Berlin, Germany. Her current research focuses on the feminist implications of the “epigenetic landscape,” and she teaches a graduate seminar on gender, science, and reproduction.

The most straightforward challenge to this procedure argues that this surgery is not only risky but expensive, and transplanting a uterus is qualitatively different from transplanting a heart or a liver because a womb is neither essential to individual survival nor, currently, to the survival of the species.

In “Liminal Lives” I make the distinction between replacement medicine and regenerative medicine (think of it as the difference between transplantation and stem cell culture). Transplant medicine is so the past, and yet yes, you can always produce a new procedure that you can guilt mothers into taking. It is obscenely iatrogenic. The key distinction here is between organs seen as carriers of identity (that is, organs that preserve a person’s life) and organs that preserve what we could think of more as a lifestyle. Not survival, but quality of life, that is. In 2003, the Swedish researcher who first did the uterine transplants in mice said that he expected there would be debate about whether it would be ethically acceptable do to this in people, since it wouldn’t have been done to cure a life-threatening illness. The needle seems to be moving on this issue, though, since we have now seen hand transplants which are, given prosthetics, unnecessary, and so on.

Q: The transplant model seems so Cartesian. Treating the body as if it was a literal machine even as the “me” of the mind ironically invokes the terms of essentialist being denied to the embodied condition. We denigrate and fetishize the mortal body, whereas the soul is perfect, pure. It’s as if medical practice hasn’t caught up with phenomenology. The transplanted uterus also strikes me as facilitating the social obsolescence of women because the next step is a fully autonomous womb. At which point, the sole biological utility of the female is as a fresh egg donor, and childcare will be carried out by beta men. Or by robots, which are already becoming popular for sex.

Squire: Absolutely. And the thing is, it’s also really bad science. I’ve been part of a workshop through the Cambridge University ReproSoc group, where we discussed the ethics of extra-uterine gestation. This thing called “ectogenesis.” Someone actually has accomplished the very first steps of that in mice. But unlike the Cleveland Clinic, which seems to have rushed forward to cash in on this procedure, at Cambridge the research scientist who was involved met with an interdisciplinary group of scholars and scientists so that we could discuss the social implications of such a relocation of pregnancy from the body of the mother (mouse, that is) into a piece of lab technology. Of course that wasn’t the first time the idea of relocating the uterus met with criticism. In “Babies in Bottles,” I wrote about how, in 1923, the physiologist J.B.S. Haldane predicted that babies would be born from artificial uteri, and novelist Vera Brittain responded with a short story, “Halcyon, or the Future of Monogamy.” There, she predicted that gestation in artificial uteri would be abandoned once it became clear that children created that way would fail to thrive.

Q: The family affirms that their newborn is healthy—“normal” — though that’s a loaded term in itself. Still, is it anti-feminist to object? Part of me reacts to the implicit levels of socioeconomic privilege on display here, the willing acceptance of a high risk, debilitating surgery. The emphasis on womanhood being achieved via the gravid uterus also bothers me. It strikes me as ultimately manipulating women, because it places so much emphasis on pregnancy as the definitive purpose and destiny, as it were, of being female. For me, that quote from the anonymous patient born without a uterus and wondering if anyone would marry her—well, that says it all. She’s defining herself according to her desirability to a future husband. Who is she without a husband? To her mind,nobody.

Squire: Damn straight. Not to mention the spurious feminism of saying this is better than surrogacy because that exploits women. Sure, surrogacy (particularly global surrogacy) exploits women. But what about this hospital calling for “volunteers” for an experiment? It really is closer to Independent Women’s Forum style feminism.

Q: There’s something creepy about taking a dead or menopausal woman’s uterus to give temporarily to another so they can experience childbirth. [The patient must take strong immunosuppressant drugs to prevent the organ from being rejected. Once the baby is delivered, the doctors remove the exhausted uterus, with the understanding that keeping it is too dangerous for the host body.] To me, the desire to experience pregnancy irrespective of the horrific costs seems like a variation of “surrogacy tourism” combined with a masochistic need to demonstrate the level of pain one is willing to endure to fulfill the mandate of motherhood. No greater love than a mother willing to die–preferably while young and beautiful–for her children, etc. That affirmation is not only culturally unassailable, it’s become so common in films (“Steel Magnolias”; “Stepmom”) that it even has its own trope: “Death by childbirth.”

Squire: It’s also worth noting that this organ transplantation itself was so disturbing to many of the transplant nurses that they decided to “leave the field” rather than engage with it: because of the horrendous effects of the immunosuppressant drugs. Some quality of life.

Q: I keep on trying to write horror fiction about these themes but every time I think one up, it turns out that it’s actually happening.

Squire: If you want to see something really scary look at the new material about CRISPr, which uses bacterial DNA to make changes in the germline so they are heritable. But I digress. It would be interesting to write it up as a horror tale but you’re right, it’s already been done in a sense. What’s horrible here is the commodification of women fully: not just the monetary exchange of dead Uteri, but the actual corporate entrapment of women to create a money-making enterprise. Not that we don’t already see that in a smaller way with corporate IVF. Aargh.

Q: What say you about the ethics? I’m not a fan of IVF and fertility drugs; I would rather let nature take its course—mitigated by the understanding that we are tinkering with nature on the epigenetic level, so nature is hardly “natural” anymore–because when couples are not successfully reproducing without assistance, I tend to think there is a reason, and that reason ought to be acknowledged instead of overpowered by drugs.

Squire: Right. OK, so from a scientific point of view I take your point re IVF. But the ethical situation here is even worse, because we have a corporate hospital targeting patients for a super-high risk procedure when there is no physical need for it. And that the woman who is the first candidate couldn’t afford surrogacy (!) so she’s “helping” them create a program that, if it were to work, will cost even more . . . sigh.

Q: What about psychological need to become a mother?

Squire: Well, it’s noteworthy that the women are put through the standard psychological tests (they say) to find make sure they will tolerate the transplant well, but no one is putting that team of physicians through tests to find out if they are psychologically balanced. Is no one within the Cleveland Clinic questioning the sanity of this collective endeavor? Where is the hospital ethics committee? Even the wording of the interview with the doctors is diagnostic. “Wow. This is really pushing the envelope.” (Dr. Lichtin) makes it sound more like a moon shot than a pregnancy. Some “envelope.”

Q: It’s a little bit like that experiment that ended up growing an ear on the mouse’s back. Just because you can, doesn’t mean you should.

Squire: Absolutely. Listen, I need to start rereading some essays for a seminar tomorrow with biologist Scott Gilbert. They’re about the microbiome, yet another HUGE issue this cockamamie idea completely ignores: the fact that fetal and newborn development is enabled–even premised–not only on the presence of the uterus but also on the maternal microbiome. Just check out this piece in The Scientist. As biologist Seth Borenstein puts it: “Based on the sum of evidence it is time to overturn the sterile womb paradigm and recognize the unborn child is first colonized in the womb.” In a transplant scenario, the required immunosuppressant drugs don’t bode well for the maternal microbiome.