In “No Comment,” a short story by Ayşe Devrim found in 2017’s Meanwhile, Elsewhere: Science Fiction and Fantasy from Transgender Writers, a trans woman named Maryam finds herself pregnant following a womb transplant from a cis woman whom nobody realized was with child. The author quickly squashes any fantasy the reader might have of a trans woman clutching her belly like Demi Moore on the cover of Vanity Fair—or like Macy Rodman in last year’s “Greased Up Freak” video—as a fraught tale of bodily autonomy that ends in abortion unfolds.

Though published as part of a sci-fi anthology, Devrim’s subject matter might not be the stuff of science fiction for long. On Thursday, researchers at Philadelphia’s Penn Medicine announced that a cis woman who had received a uterine transplant from a deceased donor gave birth last November—the second such baby to be born in the United States, as The New York Times noted in its coverage of the news.

The Times never delves into the procedure’s implications for trans women’s reproductive health, nor do the researchers at Penn Medicine, who are overseeing the woman’s care as part of a clinical trial of uterine transplants. This could be because Jennifer Gobrecht, the woman in question, was born with a congenital condition called Mayer-Rokitansky-Küster-Hauser syndrome, which, as The New York Times explained in its reporting, means that she was born with ovaries but no uterus, and a trans woman would theoretically need both a uterine transplant and ovarian transplants in order to conceive. But the implications are there, so we might as well name them: If doctors are able to give one kind of woman who was born without a womb the organs she would need to conceive, who’s to say they couldn’t give another kind of woman who was born without a womb the organs she’d need to conceive?

The desire of many trans women to be able to give birth can be traced back over a century in medical literature—if one feels comfortable using the phrase “trans women” to label people who long predate the term’s contemporary usage, which… live a little! In a case study published in Richard von Krafft-Ebing’s Psychopathia Sexualis in 1886, a patient who “feels like a woman in a man’s form” describes feeling phantom pregnancies in their equally phantom womb, sensations that flare every time they have sex with their wife.

Transsexual uterine transplants have their own storied medical history, most notably causing the death of Lili Elbe, the 20th century Danish painter whom Eddie Redmayne portrayed in 2015’s The Danish Girl. Perhaps the procedure would be as commonplace as metoidioplasties and tracheal shaves had Elbe’s doctor, famed German sexologist Magnus Hirschfeld, not been forced to flee Germany in 1930, three years before Nazis burned his pioneering Institute for Sexual Research to the ground along with most of the ground-breaking research contained within.

Could a 21st century surgeon succeed where Hirschfeld failed, transplanting cis women’s reproductive organs into a trans woman who so desires them? It’s certainly on the medical world’s mind, if recent speculation by doctors that a testicular transplant between twin brothers in Serbia could have broader applications for trans men can tell us anything.

Still, possibility does not always mean accessibility. Zil Goldstein, the Associate Director of Medicine at the Callen-Lorde Community Health Center in New York City, told VICE that functional reproductive organ transplants might very well await trans people in the near future. But if trans people in the U.S.—a population that lives in disproportionate poverty relative to the rest of the country—lack the funds or insurance coverage to access those innovations, she continued, they won’t really mean much at all.

“There are all sorts of possibilities in the future for trans health care,” Goldstein said. “The question we have to ask is not whether the technology will exist, but if it will be made available to trans people. Is insurance going to pay for it? Or will it only be functionally available for very rich people?”

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