Like a Virgin by Prasad, Aarathi (recommended reading txt) 📕

jaw, flattened mid-faces and nasal bridges, smooth philtrums (the slight groove between the nose and upper lip will be absent), thin upper lips, and ear abnormalities.

Substance misuse is often associated with poverty and other social problems, with far-reaching effects on health. And a majority of drug-using women are in their childbearing years. It follows that drug-using women may well be in poor general health before they become pregnant, making their wombs less conducive to a healthy pregnancy, even before ongoing drug use and other issues are factored in. The alternative – a womb outside of your own body – may just be a more salubrious place in which to start life.

One alternative that is already making headlines is transplantation of a new womb, whether a donated organ or an artificially created womb-like structure, into a woman whose own uterus is damaged or missing. While a womb transplant wouldn’t get around the inherent dangers to the mother of pregnancy and childbirth, or the dangers to the foetus from a mother ingesting alcohol or other drugs, it would probably provide a healthier environment – especially given the limits that would be put on a woman’s behaviour after having undergone transplant surgery to begin with. But although ovaries have successfully been transplanted in humans, womb transplants have only recently been tried in humans, and early operations with dogs in the 1970s proved unsuccessful.

In April 2000, Dr Wafa Fageeh, leading a medical team in Jeddah, Saudi Arabia (where surrogacy is illegal), became the first surgeon to attempt a womb transplant in a human. The recipient was a twenty-six-year-old who had lost her womb six years earlier, after haemorrhaging during childbirth, and the donor was a forty-six-year-old who had been told she must have a hysterectomy because of ovarian cysts. Fageeh’s work was innovative, and the transplant was not rejected by the recipient patient – in fact, she went on to have two natural menstrual cycles. This meant that the graft had been properly done, and had been given a sufficient blood supply. But the transplanted womb had to be removed after ninety-nine days, when a clot developed in a blood vessel that was surgically attached to it. Ultimately, the operation could only be regarded as unsuccessful, since it did not result in a pregnancy.

Within three years, however, scientists began to mark their first triumphs transplanting wombs in mammals. First, mice with donated wombs carried to term and gave birth to normal babies. In 2006, Giuseppe Del Priore, at New York Downtown Hospital, performed a womb transplant on a rhesus monkey; though he was able to establish blood flow between the donor organ and the monkey, the animal was given an incorrect dose of anticoagulants and the experiment had to be terminated within a day. Then, in 2009, a team led by Richard Smith, a consultant gynaecologist at London’s Hammersmith Hospital, managed to transplant not just the womb, but also major blood vessels including the aorta, in rabbits. Once the transplant surgeries were completed, the rabbits were placed on immunosuppressant drugs, which helped to prevent the donated womb from being rejected. Alas, despite being mated, none of the rabbits became pregnant. On this occasion, it seemed that the trouble lay with the Fallopian tube, which became blocked and could not carry the fertilized egg to the womb.

These early successes have led to some speculation about the possibility of implanting an embryo into a man. One possibility, in the near term, would be to insert the embryo in the abdomen, the equivalent of an ectopic pregnancy – when an embryo attaches to tissue outside the womb, yet continues to develop. Ectopic pregnancies are dangerous – they can lead to haemorrhaging and death – but a handful of cases in women have been taken to a healthy, live delivery via laparotomy, a form of Caesarean section. In 2008, for instance, a British woman, Jayne Jones, gave birth to a son at twenty-eight weeks gestation; the pregnancy had not terminated earlier because the embryo had attached to a fatty portion of the mother’s large bowel, ensuring a good source of nutrition, and the foetus was removed as soon as it was discovered to be outside the womb. This was the first successful delivery in the UK of its sort – and thirty-six medical staff attended.

The eminent fertility expert Lord Robert Winston has commented that ‘male pregnancy would certainly be possible, and would be the same as when a woman has an ectopic pregnancy... although to sustain it, you’d have to give the man lots of female hormones’. In such a case, the foetus would be implanted inside a hormone-packed man’s abdomen, with an artificial placenta attached to an internal organ – such as the bowel. But apart from all the hormones the procedure would necessitate, the problems associated with ectopic pregnancy would not make it an attractive prospect to anyone. To prevent haemorrhaging at birth, for instance, the placenta would probably have to stay intact, attached to his insides, after delivery. This would be risky for his health – the tissue would either grow, almost like a tumour, or detach or rupture and become lethal when it haemorrhages. If men were to carry embryos to term in this manner, they would, by definition, be experiencing an ectopic pregnancy – which is known to be dangerous to women, and tends to be terminated as soon as it is discovered.

Womb transplantation would be a different prospect entirely – particularly in women. The womb, of course, is a defined space provided for the foetus; as we’ve seen, it is where the placenta embeds itself, offering a line of communication between the mother and the foetus, not just resource management. And while there are several major hurdles to overcome before the procedure could be considered ready for regular trials in humans, optimism