Lindsey McFarland was born without a uterus. So she and her husband, Blake, created their family by adopting three boys. But they always dreamed that she could somehow become pregnant and give birth to a baby.
"We just wanted that experience," Lindsey says. "We wanted that connection."
She longed to feel a baby kick and develop inside her. She wanted the thrill of discovering the sex of the fetus during a routine sonogram. She even wanted to go through morning sickness and labor.
"All of that," says the 26-year-old from Lubbock, Texas. "I wanted to experience all of that."
So, when the Cleveland Clinic announced plans to launch the first U.S. study to evaluate womb transplants for women who were born without a uterus or lost theirs to disease, the McFarlands decided Lindsey should volunteer.
She underwent a 10-hour operation in February to become the first — and so far only — woman to get a uterine transplant in the United States.
Everything went so well that McFarland and her doctors held a news conference about a week later to celebrate.
"We were very much thinking to the future," she says.
But hours after the news conference ended, Lindsey started bleeding. Doctors discovered she had developed a severe yeast infection that had destroyed the transplanted uterus.
Doctors rushed her into surgery to remove the uterus. Surgeons then had to perform a third major operation when the infection threatened one of her legs.
"We both just cried," McFarland says. "Some days are harder than others."
Despite that experience, doctors at the clinic remain optimistic. They plan to try the procedure at least nine more times.
"Obviously this is incredibly disappointing," says Dr. Rebecca Flyckt, an obstetrician-gynecologist at the clinic. "But we're very happy Lindsey came through safely. And I think our team can look at this as an example to learn from as we move forward."
Flyckt says the clinic now plans to give medication to all women undergoing the procedure to minimize their risk of developing yeast infections.
But the procedure remains highly controversial. Critics worry about the risks it poses to women who are desperate to have children.
"I don't think you can find people more vulnerable than those who wish to become parents and can't," says Michele Goodwin, director of the Center for Biotechnology and Global Health Policy at the University of California, Irvine.
In addition to possible complications from undergoing major surgery, women and any babies they carry face risks from powerful drugs the women must take to prevent their bodies from rejecting the transplanted uterus.
"There are many, many risks, and they concern me greatly," says Dr. Wendy Chavkin, an emeritus professor of public health and obstetrics and gynecology at Columbia University. She notes that, unlike the transplant of a liver or heart, a uterine transplant is not a life-saving procedure.
Others worry that the procedure perpetuates social stereotypes.
"It further reinforces this idea that to be a 'real woman' you need to have a genetically related child that you gestate yourself," says Lisa Campo-Engelstein, a bioethicist at Albany Medical College.
The critics note that women without a uterus have other options — such as adopting, or enlisting the help of a surrogate mother.
At least three other U.S. hospitals are also considering attempting uterine transplants. They are the Brigham and Women's Hospital in Boston, the Nebraska Medical Center in Omaha and the Baylor University Medical Center in Dallas.
While the Cleveland Clinic is using wombs from deceased donors, doctors in Sweden who pioneered the procedure relied on living donors. The transplant team at Baylor says it, too, will get the organs from living donors (as well as deceased); critics say that raises questions about the risks to the donors, as well as to the recipients.
But the doctors conducting these studies defend what they're doing. The Cleveland Clinic only started its program after the doctors in Sweden showed the transplants can work and produce healthy babies, Flyckt says.
A successful transplant, of course, is only a first step; embryos that have been created beforehand through in vitro fertilization (IVF) must also be implanted in the uterus, and carried to term to produce a healthy baby.
Physicians at the University of Gothenburg in Sweden have performed at least nine uterine transplants, so far, resulting in at least five babies.
"I think there will be a small group of women who are interested in doing this procedure despite the fact that we know that there are some risks," Flyckt says. "And I think, with enough counseling, we can ensure they are making a pretty informed choice about this."
To try to minimize risks to the recipient, the transplanted uterus would only remain in her body until she has tried to have a baby once or twice. It would then be removed so she can stop taking anti-rejection drugs.
Lindsey McFarland says she has no regrets about attempting the procedure.
"For something that was so important to me, I went for it," she says. "I can say I tried. And I think that's so important."
She hopes what doctors learned from her experience will help the next woman who tries.
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Doctors have been transplanting vital organs like livers, kidneys and hearts for decades. And in recent years, they've started transplanting other body parts like faces, legs and hands. And now, at least one hospital in this country has started performing uterus transplants in the hopes of helping women have babies. NPR health correspondent Rob Stein reports.
ROB STEIN, BYLINE: Lindsey McFarland was born without a uterus. And even though she and her husband, Blake, have created a big, happy family by adopting three boys, she always dreamed of being pregnant and giving birth to a baby.
LINDSEY MCFARLAND: Getting to feel the baby move and getting to watch your baby grow through sonograms and finding out the gender and then the birth and everything, you know, morning sickness, all of that. I wanted to experience all of that.
STEIN: So McFarland and her husband were thrilled when the Cleveland Clinic announced plans to try doing womb transplants for women who were born without uteruses or lost theirs to disease. She volunteered right away.
MCFARLAND: We just wanted that experience. We wanted that connection.
STEIN: McFarland, who's 26 and lives in Lubbock, Texas, underwent a 10-hour operation in February to become the first - and so far only - woman to get a womb transplant in the United States. Everything went so well McFarland and her doctors held a news conference about a week later to celebrate.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN: I'd like you to join me in welcoming into the room Lindsey and Blake.
MCFARLAND: We were very much thinking to the future.
STEIN: McFarland planned to use embryos she and her husband had created through IVF before the operation.
MCFARLAND: You start thinking - oh, you know, like, which one of these little embryos would they implant first, you know? And well, which one is actually going to take in a pregnancy? And is it going to be a boy? Is it going to be girl? - and things like that.
STEIN: But just hours after the news conference, McFarland started bleeding. Doctors discovered she had an infection, a bad yeast infection, that had destroyed the transplanted uterus. Doctors rushed her into surgery to remove it and then had to perform a third surgery when the infection threatened one of her legs.
MCFARLAND: We both just cried. And - it's - some days are harder than others.
STEIN: McFarland's experience is the kind of thing that's raising concerns about womb transplants. Michelle Goodwin is a bioethicist at the University of California, Irvine. She questions doing risky operations to transplant something people don't need to survive.
MICHELLE GOODWIN: It's highly risky. And it's a true gamble. And I don't think you can find people more vulnerable than those who wish to become parents and can't.
STEIN: There are risks from the operations and risks from the powerful drugs needed to prevent rejection - and not only for the women getting the transplants.
GOODWIN: We don't know yet what the potential risks of this cocktail of medications will mean for fetal development.
STEIN: And some worry the operations perpetuate stereotypes about motherhood. Lisa Campo-Engelstein is a bioethicist at Albany medical College.
LISA CAMPO-ENGELSTEIN: It further reinforces this idea that to be a, quote, unquote, "real woman" especially that you need to have a genetically related child that you gestate yourself.
STEIN: When there are other options such as adoption or using a surrogate mother, doctors conducting the transplants defend what they're doing. Rebecca Flyckt is an infertility specialist at the Cleveland Clinic. She said surgeons in Sweden showed that transplants can work and be done safely. They've done nine womb transplants for women who have given to birth to at least five babies so far. And they all seem fine so far.
REBECCA FLYCKT: I think that there will be a small group of women who are interested in doing this procedure despite the fact that we know that there are some risks. And I think, with enough counseling, we can ensure that they're making a pretty informed choice about this.
STEIN: The plan is to only keep the uterus in place until the women have tried having babies once or twice then remove it so they can stop taking the anti-rejection drugs. For her part, Lindsey McFarland has no regrets.
MCFARLAND: For something that was so important to me, I went for it. And so I can never say I didn't try. Like, I can say I tried. And I think that's so important.
STEIN: She hopes what doctors learned from her experience will help the next woman who tries. The Cleveland Clinic is planning at least nine more transplants as part of a study. And hospitals in Massachusetts, Texas and Nebraska are planning to try womb transplants, too. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.