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One patient, she says, asked if she should wait to have her sex reassignment surgery until she could have a uterine transplant at the same time.

(Unger’s advice was no.) Marci Bowers, a gynecological surgeon in northern California at Mills–Peninsula Medical Center, says that a handful of her male-to-female patients—“fewer than 5 percent”— ask about transplants.

Bowers, who is transgender herself, says she is concerned about dangers to the fetus from a potentially unstable biological environment and unforeseen risks for the mother-to-be.

“I respect reproduction and I don’t think we will ever see this in my lifetime in a transgender woman,” she says.

Giuliano Testa, a transplant surgeon at Baylor University Medical Center who will soon be directing uterine transplant surgeries among natal women, says the hormones would likely prove the biggest obstacle.

“It would really be a feat of unknown proportions,” Testa says.

When Mats Brännström first dreamed of performing uterus transplants, he envisioned helping women who were born without the organ or had to have hysterectomies. Two years ago, in a medical first, he managed to help a human womb–transplant patient deliver her own baby boy. But his monumental feats have had an unintended effect: igniting hopes among some transwomen (those whose birth certificates read “male” but who identify as female) that they might one day carry their own children.

Just over a dozen uterus transplants have been performed so far—with mixed results. And only the Brännström group’s procedures have led to babies.

“A lot of this work [in women] is intended to go down that road but no one is talking about that,” says Mark Sauer, a professor of obstetrics and gynecology at Columbia University.

Such a future is hard to imagine, at least in the near term.

Separately, surgeons that specialize in working with transwomen also often create neovaginas after castration, using skin from the penis and the scrotum.

Even if the hormonal and anatomical challenges are overcome, for someone who was born producing sperm instead of eggs there would be one more hurdle: Before castration that person’s sperm must be collected and combined with a donor’s or partner’s egg to make an embryo via in vitro fertilization, and that embryo would have to be frozen until the transplant patient is ready.

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Yet with six planned uterine transplant clinical trials among natal female patients across the U. and Europe reproductive researchers are hoping to become more comfortable with the surgery in the coming years.