A Woman Born Without a Vagina Is Trying to Have Biological Children

Devan Merck, 23, of Fort Benning, Ga., is just one of millions of women dealing with infertility, and she is hoping to be able to utilize in vitro fertilization (IVF) to grow her family.

Merck was diagnosed at the age of 13 with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a congenital disorder that effects the reproductive tract. For Merck, this means she was born without a vaginal canal or cervix and with an abnormally formed uterus.

“Trent and I have been married for 5 years and have wanted so badly to start our family. As many of you may already know, at the age of 13 I was diagnosed with a condition called Mayer-Rokitansky-Küster-Hauser, or MRKH,” Merck writes on the fundraising page she has launched to help pay for the fertility treatments she needs to have a biological child.

Reconstructive surgery created a vaginal opening for Merck, thus allowing her to experience vaginal intercourse, and the innovations in the world of fertility science make her an excellent candidate to have a biological child of her own through the use of IVF and a gestational carrier (surrogate), a process for which Merck and her husband have started a GoFundMe page to raise money to cover these costs.

“MRKH is the underdevelopment or absence of the vaginal canal, cervix, and uterus,” Merck explains on the GoFundMe site, “So unfortunately I cannot carry my own babies.”

As Sue Ellen Carpenter, MD, a fertility specialist with the Atlanta Center for Reproductive Medicine explains to Yahoo Beauty, the uterus forms in a fetus as small muscle bundles adjacent to the kidneys at 6 to 9 weeks gestational age in utero. These muscle bundles then are thought to migrate toward the pelvis to stimulate the development, or canalization, of the vagina. If the uterus does not form for some reason, Carpenter says, the vagina does not cannulate — which is how a woman with the condition, like Merck, can be born without a vaginal canal.

Women with MRKH often have “a small dimple on the perineum, between the urethra and the anus,” says Carpenter, “usually with a normal hymen, but no vagina.”

She explains that while science hasn’t identified just what causes the uterus not to develop in some women, as there is no genetic basis for it, there is an association with an absent kidney or occult spina bifida in MRKH, so there is a theory that a “vascular accident ‘knocks out’ the formation [of the uterus] in whole or in part.”

Carpenter notes that women with MRKH often aren’t diagnosed with the condition until puberty, since while the development of their ovaries is entirely separate from that of the vagina, their secondary sexual development is completely normal, except for the absence of periods.

Which is why Carpenter makes a point of noting that girls diagnosed with MRKH during puberty — and the adult women they grow up to be — “are normal with an isolated anatomic issue,” adding that frequently, just like with Merck’s case, a partial-thickness skin graft can be used to create a vagina for women with MRKH. Other options, such as dilation of the vaginal space without surgery — which she says is most common — or techniques involving laparoscopic and vaginal surgery to use the peritoneum to create vaginal lining, also exist for women born with the condition, thus allowing them to effectively have a vagina.

And because the ovaries tend to develop completely normally in women with MRKH, these women are typically excellent candidates for IVF.

Carpenter says that in a woman with MRKH, “we expect normal ovarian reserves” measurements and that “ovulation induction and egg retrieval would be normal for [a woman’s age at the time of the procedure],” allowing biological embryos to be created using the woman’s eggs and her partner’s sperm. These embryos can then be transferred to a gestational carrier, thus allowing women like Merck to pursue biological motherhood.

Merck’s fertility story takes on an added layer of nuance given the upcoming administration, with Vice President-elect Mike Pence and secretary of Health and Human Services nominee Tom Price’s shared belief in personhood — the idea that life begins at fertilization, and thus from that moment a fertilized egg, embryo, or fetus should be afforded the full rights of a living person under the law. Both Pence and Price have tried to pass federal personhood legislation that has the potential to effectively criminalize IVF and other forms of fertility treatment (as well as ban certain forms of contraception and abortion).

Resolve, the National Infertility Association, notes that “if microscopic fertilized eggs [and] embryos are full humans, anything that puts an embryo at risk could be a criminal violation, even if its goal is the undeniable social good of helping someone have a baby.” And IVF and other forms of assisted reproductive technologies (ART) could thus be at risk should Pence and Price push for a federal personhood measure, as the failure of any embryos to develop normally in an IVF cycle either in the lab or after transfer could be seen as a potentially criminal act, putting the physicians and lab scientists at fertility practices — and their patients — at risk for prosecution.

Other concerns raised by personhood that could affect IVF and ART include whether non-IVF treatments such as simple inseminations could be threatened because they carry a high miscarriage rate (thus, again, potentially putting doctors and patients alike at risk for criminal liability); whether embryos that are not used in a cycle and frozen and stored for potential future cycles and fail to thaw successfully could put fertility practices at risk for prosecution; who will have legal responsibility for frozen embryos if these embryos are to be thought of as people; and will women undergoing IVF be forced to have a potentially dangerous number of embryos transferred to their uteri should the freezing of embryos become illegal, thus putting their health and lives at risk.

As a result, Resolve has taken the position that personhood legislation would threaten “a medical treatment [IVF] that has, since being pioneered in 1978, brought some 4 million babies to loving infertile couples around the world” and that the “consequences of personhood legislation represent such an obstacle to the practice of reproductive endocrinology that valuable and effective infertility treatment such as in vitro fertilization might no longer be available,” leading the organization to oppose all personhood legislation.

Or as Kaylie Hanson Long, the national press secretary for NARAL Pro-Choice America, tells Yahoo Beauty, “Donald Trump has made it clear that he has no plan to help women access reproductive health care or grow our families on our own terms. He’s bad enough for women on his own, but now he’s building a team of people to lead health care policy who have tried to dismantle reproductive rights at every turn. Tom Price, his selection for secretary of Health and Human Services, actually cosponsored legislation that would, if it went into effect, ban some of the most common forms of contraception, stem-cell research, and in vitro fertilization. With a record like that, we can only imagine just how dangerous he’ll be for women and families in a Trump administration.”

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