I was recently asked by a good friend and well known, respected national columnist to explain what would happen if men could really get pregnant. He wanted a real medical explanation. When I started thinking about it more, I was reminded of the 1994 movie with Arnold Schwarzenegger and Danny DeVito called “Junior.”
In this film, Arnold plays an Austrian-American scientist who invents a new fertility drug called “Expectane.” In the movie, the drug is not approved by the FDA, and the long and short of it, Arnold decides to be a human guinea pig. He is impregnated with an ovum donated by another scientist (Emma Thompson). Dr Danny Devito plays the OB who delivers “Junior” by Cesarean section. So now we have proof that a man can actually get pregnant and give birth, at least in Hollywood.
My friend is not the first person to ask this question, and Hollywood is not the first to offer up a dubious answer.
Aimee Arrambide, executive director of AVOW (an abortion activist group in Texas that says the “patriarchy and white supremacy” are behind the pro-life policies there) recently testified before congress. She was asked by a congressman “Do you believe that men can become pregnant and have abortions?” Her answer was “ Yes.”
I am going to stay far away from any political commentary. My role is as a physician and as tempting as it is, I will try to stay in my lane throughout this article.
So, let’s delve into this. The very simple answer is that no biological male can ever get pregnant on their own. It is scientifically impossible. Just as no biological female can naturally impregnate someone else.
Let’s take that a step further. Can an embryo be implanted into a male. The answer is technically yes, but it is catastrophic to both the male and the embryo.
So what is a normal impregnation?
A normal pregnancy starts with fertilization when sperm meets egg in the fallopian tube. This is the part of a woman’s anatomy that connects the uterus, or womb, to the outer area around the ovary.
The flowered end of this fallopian tube hangs over the ovary. When a woman ovulates, this ovum (egg) hopefully enters the flowered end of the fallopian tube and travels down the tube. This is where it meets a sperm (which came through the uterus by way of the vagina) halfway and is fertilized. Once fertilized, this new “zygote” then travels deeper down the fallopian tube and enters back into the uterus where it hopefully implants and develops into a fetus and a baby.
That’s the normal process.
When the zygote implants and grows in other parts of the body, such as in the ovary, fallopian tube, or even the bowel, it is called an ectopic (abnormal place or position) pregnancy.
Ectopic pregnancies are emergencies and can be life threatening if not recognized and treated. This multiplying, living embryo out grows the abnormal site it implants on and starts to bleed profusely, hence the medical emergency. I have seen well over a liter of blood (a normal person has close to six liters in their entire body) in the belly from a ruptured ectopic pregnancy.
Here comes the biggest and most obvious problem for a “man” to become pregnant. Men do not have a uterus, so there is no way for them to safely carry a pregnancy, any other location would be a disaster.
Can that be remedied and is this good medicine or just scientific manipulation? Just because something can be done, does not mean it should be. What happened to the credo, “above all physician, do no harm”?
Uterine transplantation has been done in women who have AUFI (absolute uterine factor infertility). One can also ask if this is good medicine, since we now have in vitro fertilization, which can bypass the impregnation factors and may even involve a surrogate. That’s another question for another article.
There have been successful uterine transplantations resulting in live births. More than 42 uterine transplantations have been done worldwide, resulting in twelve live births, according to a review published in Current Opinion in Organ Transplantation in 2018. We are only talking about biological women in these cases.
Can a uterus be transplanted into a male, or a transgender female (male to female)? Technically yes, and again, just because you can do something, does not mean it’s a good idea? Am I staying in my lane?
The male pelvis is so different from that of a female that it can be differentiated easily at autopsy. There are vascular differences, plus the need for a complete neovagina created for a “natal male” recipient to connect to the new transplanted uterus and cervix.
This includes removing all male organs.
This new “connection” is not “ normal,” the biologic female vagina has a completely different skin epithelium (for a reason too long to explain) and this neovagina can not mimic it. This can lead to numerous problems.
The only solution would be to also transplant a biological women’s vagina at the same time as the uterine transplant. I haven’t even touched on transplant rejection medications that will need to be taken for life as well as the support structures needed for the new uterus, which a biological male does not have.
In an article in the British Journal of Obstetrics and Gynaecology, a collection of academics, researchers and gynecologists argue in support of uterine transplants for transgender women, even with all the risks involved.
This is where politics comes before good medicine, or even bad medicine. Going back to answer the question brought up in the title of this article, the only way a man can naturally get pregnant is if we change the definition of man, and that’s what is being done.
Straight, gay, transgender, lesbian, religious, atheist, liberal, conservative, I have all of them as patients, and all are treated the same. As a physician I have no problem with anyone’s beliefs as long as I am not asked to do harm.
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