Skip to main content
SpringerLink
Log in

Research on Uterine Transplantation: Ethical Considerations

  • Chapter
  • First Online:
Clinical Research Involving Pregnant Women

Part of the book series: Research Ethics Forum ((REFF,volume 3))

Abstract

Unique ethical challenges arise in the context of research involving assisted reproductive technologies where outcomes must be established for both the woman who participates in the research and any children born as a result of that research. Uterine transplantation, the newest experimental procedure to assist women in their family-building efforts, entails a complex combination of fertility procedures and surgeries with the goal of having the uterine recipient achieve a pregnancy and give birth to a healthy child. Some of those procedures, such as in vitro fertilisation and embryo freezing, are now considered established therapeutic interventions for women outside of the context of uterine transplantation. Other procedures, including the transplantation surgery maintenance of a pregnancy in the transplant recipient, and removal of the uterus after pregnancy are more clearly still in a research phase. While there is data on the use of immunosuppressive drugs in pregnancy for individuals with other solid organ transplants, this data is not in the context of uterine transplantation where a distinct set of anatomical and physiological changes are anticipated as a result of pregnancy. Uterine transplantation research raises important ethical challenges for research involving women to advance the science of fertility medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    At the present time, there is debate about whether a living or deceased donor should be utilised in uterine transplant protocols. Each options presents a different set of risks and benefits, not just to the donor (or donor family in the case of a deceased donor) but also to the recipient.

  2. 2.

    There is debate about the use of donor oocytes, sperm, or embryos if the recipient or her partner are unable to produce usable gametes, or if pre-transplant IVF procedures are unsuccessful.

  3. 3.

    In fairness, prior work in monkeys indicated that they were not an optimal research model for IVF. There were difficulties with in vitro fertilisation of primate oocytes as well as lack of responsiveness in some primate species to standard injected fertility medications.

References

  • Ashcroft, R. 2016. Ethical issues in a trial of maternal gene transfer to improve foetal growth. In Clinical research involving pregnant women, eds. F. Baylis and A. Ballantyne, 247–263. Cham: Springer.

    Google Scholar 

  • Ballantyne, A., and W. Rogers. 2016. Pregnancy, vulnerability, and the risk of exploitation in clinical research. In Clinical research involving pregnant women, eds. F. Baylis and A. Ballantyne, 139–159. Cham: Springer.

    Google Scholar 

  • Biggers, J.D. 2012. IVF and embryo transfer: Historical origin and development. Reproductive Biomedicine Online 25: 118–127.

    Article  PubMed  Google Scholar 

  • Brännström, M., L. Johannesson, P. Dahm-Kähler, A. Enskog, J. Mölne, N. Kvarnström, et al. 2014. The first clinical uterus transplantation trial: A six-month report. Fertility and Sterility 101: 1228–1236.

    Article  PubMed  Google Scholar 

  • Canadian Task Force on the Periodic Health Examination. 1979. The periodic health examination. Canadian Medical Association Journal 121: 1193–1254.

    Google Scholar 

  • Chang, M.C. 1959. Fertilization of rabbit ova in vitro. Nature 184 (Suppl 7/08 August): 466–467.

    Google Scholar 

  • Dokras, A., I.L. Sargent, and D.H. Barlow. 1993. Human blastocyst grading: An indicator of developmental potential? Human Reproduction 8(12): 2119–2127.

    CAS  PubMed  Google Scholar 

  • Emanuel, E.J., D. Wendler, and C. Grady. 2000. What makes clinical research ethical? JAMA 31(283): 2701–2711.

    Article  Google Scholar 

  • Erenus, M., C. Zouves, P. Rajamahendran, S. Leung, M. Fluker, and V. Gomel. 1991. The effect of embryo quality on subsequent pregnancy rates after in vitro fertilization. Fertility and Sterility 56(4): 707–710.

    Article  CAS  PubMed  Google Scholar 

  • ESHRE (European Society of Human Reproduction and Embryology). 2013. ART fact sheet. http://www.eshre.eu/Guidelines-and-Legal/ART-fact-sheet.aspx. Accessed 11 Apr 2016.

  • Fageeh, W., H. Raffa, H. Jabbad, and A. Marzouki. 2002. Transplantation of the human uterus. International Journal of Gynaecology and Obstetrics 76(3): 245–251.

    Article  CAS  PubMed  Google Scholar 

  • Farrell, R.M., and T. Falcone. 2015a. Uterine transplant: New medical and ethical considerations. Lancet 385(9968): 581–582.

    Article  PubMed  Google Scholar 

  • Farrell, R.M., and T. Falcone. 2015b. Jordan M. Philips keynote speaker – Uterine transplantation. Journal of Minimally Invasive Gynecology 22: 311–312.

    Article  PubMed  Google Scholar 

  • Fritz, M., and L. Speroff. 2011. Clinical gynecologic endocrinology and infertility. Philadelphia: Lippincott Williams and Wilkins.

    Google Scholar 

  • Grady, D. 2016. First uterus transplant in U.S. bolsters pregnancy hopes of many. New York Times. http://www.nytimes.com/2016/02/26/health/uterus-transplant-cleveland-clinic.html. Accessed 4 Apr 2016.

  • Healy, D., and D. Mangin. 2016. Does my bias look big in this? In Clinical research involving pregnant women, eds. F. Baylis and A. Ballantyne, 197–208. Cham: Springer.

    Google Scholar 

  • Hulley, S., S. Cummings, W. Browner, D.G. Grady, and T.B. Newman. 2013. Designing clinical research, 4th ed. Philadelphia: Wolters Kluwer.

    Google Scholar 

  • Johannesson, L., and A. Enskog. 2014. Experimental uterus transplantation. Best Practice & Research. Clinical Obstetrics & Gynaecology 28(8): 1198–2210.

    Article  Google Scholar 

  • Johannesson, L., N. Kvarnström, J. Mölne, P. Dahm-Kähler, A. Enskog, C. Diaz-Garcia, et al. 2015. Uterus transplantation trial: 1-year outcome. Fertility and Sterility 103(1): 199–204.

    Article  PubMed  Google Scholar 

  • Johnson, M.H., S.B. Franklin, M. Cottingham, and N. Hopwood. 2010. Why the Medical Research Council refused Robert Edwards and Patrick Steptoe support for research on human conception in 1971. Human Reproduction 25(9): 2157–2174.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klatsky, P.C., S.S. Delaney, A.B. Caughey, N.D. Tran, G.L. Schattman, and Z. Rosenwaks. 2010. The role of embryonic origin in preeclampsia: A comparison of autologous in vitro fertilization and ovum donor pregnancies. Obstetrics and Gynecology 116(6): 1387–1392.

    Article  PubMed  Google Scholar 

  • Kukla, R. 2016. Equipoise, uncertainty, and inductive risk in research involving pregnant women. In Clinical research involving pregnant women, eds. F. Baylis and A. Ballantyne, 179–196. Cham: Springer.

    Google Scholar 

  • Lefkowitz, A., M. Edwards, and J. Balayla. 2013. Ethical considerations in the era of the uterine transplant: An update of the Montreal criteria for the ethical feasibility of uterine transplantation. Fertility and Sterility 100(4): 924–926.

    Article  PubMed  Google Scholar 

  • Lyerly, A.D., M.O. Little, and R. Faden. 2008. The second wave: Toward responsible inclusion of pregnant women in research. International Journal of Feminist Approaches to Bioethics 1(2): 5–22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lyerly, A.D., M.O. Little, and R.R. Faden. 2011. Reframing the framework: Toward fair inclusion of pregnant women as participants in research. The American Journal of Bioethics 11(5): 50–52.

    Article  PubMed  Google Scholar 

  • Markens, S. 2007. Surrogate motherhood and the politics of reproduction. Berkeley: University of California Press.

    Book  Google Scholar 

  • Milliez, J. 2009. Uterine transplantation. FIGO committee for the ethical aspects of human reproduction and women’s health. International Journal of Gynaecology and Obstetrics 106(3): 270.

    Article  PubMed  Google Scholar 

  • Ouellette, A., M. Achille, and M. Pâquet. 2009. The experience of kidney graft failure: Patients’ perspectives. Qualitative Health Research 19(8): 1131–1138.

    Article  PubMed  Google Scholar 

  • Ozkan, O., M.E. Akar, O. Erdogan, O. Ozkan, and N. Hadimioglu. 2013. Uterus transplantation from a deceased donor. Fertility and Sterility 100(6): e41.

    Article  PubMed  Google Scholar 

  • Pincus, G., and E.V. Enzmann. 1934. Can mammalian eggs undergo normal development in vitro? Proceedings of the National Academy of Sciences of the United States of America 20(2): 121–122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rock, J., and M.F. Menkin. 1944. In vitro fertilization and cleavage of human ovarian eggs. Science 100(2588): 105–107.

    Article  CAS  PubMed  Google Scholar 

  • Shahine, L.K., and R.B. Lathi. 2014. Embryo selection with preimplantation chromosomal screening in patients with recurrent pregnancy loss. Seminars in Reproductive Medicine 32(2): 93–99.

    Article  PubMed  Google Scholar 

  • Steptoe, P.C., and R.G. Edwards. 1978. Birth after the reimplantation of a human embryo. Lancet 2(8085): 366.

    Article  CAS  PubMed  Google Scholar 

  • Thornhill, A.R., C.E. deDie-Smulders, J.P. Geraedts, J.C. Harper, G.L. Harton, S.A. Lavery, et al. 2005. ESHRE PGD consortium: Best practice guidelines for clinical preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Human Reproduction 20(1): 35–48.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Obstetrics and Gynaecology and Bioethics, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Ruth M. Farrell MD, MA

  2. Departments of Obstetrics and Gynaecology, Section of Reproductive Endocrinology and Infertility, Cleveland Clinic, Fertility Preservation and Cancer Program, Women’s Health Institute, Cleveland, OH, USA

    Rebecca Flyckt MD

Authors
  1. Ruth M. Farrell MD, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca Flyckt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruth M. Farrell MD, MA .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Françoise Baylis

  2. University of Otago, Wellington, New Zealand

    Angela Ballantyne

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Farrell, R.M., Flyckt, R. (2016). Research on Uterine Transplantation: Ethical Considerations. In: Baylis, F., Ballantyne, A. (eds) Clinical Research Involving Pregnant Women. Research Ethics Forum, vol 3. Springer, Cham. https://doi.org/10.1007/978-3-319-26512-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26512-4_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26510-0

  • Online ISBN: 978-3-319-26512-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation