It would seem logical that, if a woman’s uterus has been removed, she is no longer able to have children. And while that’s technically true, from a purely physical perspective, women who have had a hysterectomy are often capable of having children, even genetically – it just requires some extra help.
A hysterectomy is the surgical removal of the uterus. The decision to have the procedure is never an easy one – and sometimes it’s not a choice at all. Whether it’s due to severe pain or a cancer diagnosis, this major surgery is likely to be thoroughly researched before a final call is made.
Sometimes, in the case of a severe infection or excessive bleeding after childbirth – for example, if the uterus won’t contract and the mother could die from the blood loss – an emergency hysterectomy may be performed. Typically, women with severe uterine fibroids, endometriosis (where the tissue that normally lines the uterus grows outside on the ovaries) or adenomyosis (where the tissue grows inside of the uterus where it doesn’t belong) are candidates for hysterectomy, as are women who have been diagnosed with cancer of the uterus, ovary, cervix, or endometrium (uterine lining).
There are three main kinds of hysterectomies:
A supracervical or subtotal hysterectomy, where only the upper part of the uterus is removed and the cervix stays in place
A total hysterectomy, where the whole uterus and cervix are removed
A radical hysterectomy, where the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina are removed
As long as the ovaries remain intact, they will continue to function. Depending on your risk, they may be removed during the hysterectomy in a procedure called oophorectomy to lower the risk for ovarian cancer. According to the Office on Women’s Health, however, “recent studies suggest that removing only the fallopian tubes but keeping the ovaries may help lower the risk for the most common type of ovarian cancer, which is believed to start in the fallopian tubes.” The decision to keep your ovaries is a discussion for you and your doctor, but it’s generally recommended unless removal is absolutely necessary.
Yes, it is possible to have an egg retrieval after a hysterectomy. While you would likely not qualify as an egg donor for someone else, your fertility clinic can explore options with you for your own IVF cycle. Your antral follicle count, or ovarian volume, would be checked to judge the likelihood of a successful retrieval. You would have an ovarian ultrasound to determine the condition and location of your ovaries, as they sometimes move after a hysterectomy. Your hormone levels would also be monitored to determine where you are in your cycle so that the egg stimulation and retrieval can be appropriately scheduled.
If it is ultimately decided that your ovaries need to be removed during the hysterectomy, you can explore the option of harvesting your eggs first. It will likely depend on your age – just as you are not able to donate eggs at 40 or later, you’ll want to consider the quality of any eggs retrieved. If they are healthy, they can either be frozen for a later attempt at fertilization, or they can be fertilized right away with your partner or a donor’s sperm. The embryos can then be frozen until you’re ready to attempt IVF with a gestational carrier.
When you decide to build a family, it’s time to team up with an agency to start your surrogacy journey. A gestational carrier will undergo IVF - using either the eggs that you harvested and froze for later fertilization, frozen embryos, or perhaps embryos created with the help of an egg donor. A hysterectomy is a difficult decision and one that may require a great deal of healing, both physically and emotionally. We are here to support you when you’re ready and will walk with you through the process, step by step.