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Senior Family Law Associate Duncan Ranton on Womb Transplants

Has Surrogacy has its day? I pose the question, on the back of reports about recent transplant surgery performed in Sweden.The Times (amongst others) picked up the story on 19 September. Two Swedish women were transplanted on the weekend with the wombs of their mothers in what is being described as the world’s first mother-to-daughter uterus surgery.  The operations were without apparent complication. However, surgeons involved said they would not consider the transplants a success unless the recipients were able to give birth to healthy Children.Both recipients were in their 30s. One had had her uterus removed many years earlier due to cervical cancer. The other had been born without a uterus. Both were selected for the procedure after a lengthy examination process. The genetic link between the women and the donors was important, as it was hoped to lower the risk of organ rejection. The emotional connection between the mothers and daughters was also important, said one of the surgeons, Michael Olausson.  The women receiving the transplants will wait for at least a year before starting fertility treatment. They will be closely monitored for their responses to anti-rejection drugs, necessary to prevent their immune systems from compromising the donated organs.If the transplants appear stable, the two women will continue IVF treatment started before the transplants, using frozen embryos created using their own eggs fertilised with their partners’ sperm.  After a maximum of two pregnancies, the transplanted wombs will be removed so they can stop taking immunosuppressant medication. That medication can have side effects, such as high blood pressure, swelling, diabetes and an increased risk of some cancers.Commenting on the surgery, Scott Nelson, chair of obstetrics and gynaecology at the University of Glasgow, said: “There’s no doubt this will be a pioneering step if it’s been successful. At present, the only option for these women is to have a surrogacy, i.e. having their embryos implanted into another woman.”  Pregnancy was not without risks, however. Nelson said the greatest concerns were the placentas not developing normally, the baby not growing properly, or being born prematurely. Further, the chances of becoming pregnant may be reduced, as the donated wombs would have fewer blood vessels, possibly compromising a baby’s development.We will need to wait until 2014 to see if the women are able to become pregnant and carry their babies to term. If they can, the procedure will be hugely important. Even now, eight more women are due to undergo transplants in Sweden within the next six months. Women who are able to become pregnant following this surgery will be able to be mothers in both the genetic and physical sense.  Compare this with surrogacy. There are two general models of surrogacy arrangement. The first uses the egg of the surrogate mother and the sperm of the commissioning father (and is sometimes called “traditional”, “partial” or “straight” surrogacy). The second uses the egg of the commissioning mother (or else of a donor) combined with the sperm of the commissioning father (or donor sperm)(sometimes called “gestational”, “full” or “host” surrogacy). So, many women who have a child via surrogacy will not be the child’s genetic mother. Further, they will not have carried their child to term and given birth to him or her.For my part, I’m confident that surrogacy will remain a viable, realistic and increasingly popular option for those who cannot conceive a child conventionally or by assisted fertility treatments. The surgery described above remains relatively untested. The availability of donor organs will necessarily be limited. The nature of the infertility issues that prevent some parents from having children will mean that a uterus transplant will not address the underlying difficulties.But I suggest we watch this space with interest. A decade or so ago, a successful uterus transplant would have been seen as the stuff of science fiction.  Writers of that genre have long explored the social, political, technological, and biological consequences of pregnancy and reproduction. This looks to be yet another area of development where fact is rapidly catching up with fiction. As Family Lawyers, we need to be ready to ensure the rights needs and relationships of children within emerging family models are properly protected. 

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