The American Society for Reproductive Medicine recognizes uterus transplantation as the first successful medical treatment of absolute uterus factor infertility, while cautioning health professionals, patient advocacy groups, and the public about its highly experimental nature.
ReadAmerican Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion on Fertility and Sterility, September 2018.
Can minimally invasive techniques provide a uterus suitable for transplant?
Interest in uterine transplantation for the treatment of uterine factor infertility (UFI) has grown exponentially over the past several years. Following the first birth from this procedure in September 2014, multiple centers worldwide have announced plans to perform clinical trials of uterine transplant. A prominent consideration in creating a protocol is whether to select a living or a nonliving donor model and whether a minimally invasive technique can be successfully used to minimize living donor risk.
Although this study and others will increase optimism for the possibility of a minimally invasive uterus retrieval, no current protocols in humans or animals have yet reported a successful pregnancy using a minimally invasive approach. Although resumption of menstrual function occurred in this case report within two months of transplant, it is unknown whether a uterus drained by the utero-ovarian vessels will be able to support and sustain implantation and ongoing pregnancy in humans.
The future of human uterine transplantation: can minimally invasive techniques provide a uterus suitable for transplant?, American Society for Reproductive Medicine, Volume 108, Issue 2, Pages 243–244, August 2017.
Image of Cleveland Clinic surgeons at work performing the first uterus transplant in the US. credit vox.
The UK Womb Transplant Research team has been granted ethical permission to begin an expanded series of 10 womb transplant operations.
The head of the research team, Mr Richard Smith, a consultant gynaecologist at The Imperial College Healthcare NHS Trust in London, said he was delighted with the news:
“As we have seen from the tremendously successful womb transplant programme being carried out by our colleagues in Sweden, this operation is clearly a viable option for those women who otherwise have absolutely no chance of carrying their own baby.
“Absolute Infertility can bring with it terrible consequences for as many as 50,000 women of childbearing age in the UK who do not have a viable womb. We hope to begin a series of ten operations early in the New Year. However, we still need to raise around half a million pounds so that we can cover the costs of NHS services and complete our programme,” he said.
The womb transplant research programme will be open to women in a long term relationship, who are aged between 25 and 38 and who have normally functioning ovaries and their own eggs. They will be UK resident and will be eligible for NHS care.
The research team have received hundreds of requests from infertile women in recent years and currently has 104 women who meet the basic requirements for potential inclusion on the programme.
To find out more about Uterine Transplantation, please visit our fact sheet by clicking here.
La transplantation utérine ; une alternative aux mères porteuses?
Après avoir fait le récit des événements qui ont précédé la première transplantation utérine ayant abouti à la naissance d’un enfant vivant et bien portant et fait un état des lieux, les auteurs exposent la législation française actuelle sur la greffe d’organes. Puis, ils abordent les aspects cliniques, insistant sur la complexité de l’acte chirurgical, le dilemme du choix entre donneuse en état de mort cérébrale ou décédée et donneuse vivante, et les indications chez la receveuse. Ils décrivent ensuite le traitement immunosuppresseur avant et pendant la grossesse, les complications plus ou moins graves qui peuvent en émailler le cours et la surveillance particulièrement attentive qu’elles nécessitent, mais aussi les doutes sur l’opportunité de l’allaitement maternel. Ils s’interrogent sur l’avenir de l’enfant à moyen et long terme, son développement psychomoteur et celui de son système immunitaire. Ils retracent les nombreuses et délicates questions éthiques que pose la transplantation utérine, qu’il s’agisse des particularités de la greffe d’utérus, qui n’est pas vitale mais permet de donner la vie, du choix entre transplantation avec donneuse en état de mort cérébrale ou donneuse vivante, de la pénurie d’organes à greffer, des risques courus par la receveuse, du devenir physique et psychologique de l’enfant, enfin du choix entre transplantation utérine et gestation pour autrui et de l’éventualité de dérives. En fait, la transplantation utérine est une chirurgie encore au stade expérimental et seuls l’avenir et le recueil exhaustif de toutes les données la concernant permettront de s’assurer de son bien fondé.
Pregnancy after New Womb, the @UniOfGothenburg Live-Donor Uterus Transplant Project, 2014
Nine women in Sweden have received uterus transplants from living relatives in an experimental fertility project. The patients in this trial headed by Mats Brannstrom of the University of Gothenburg are mostly women in their 30s who had lost their uterus to cancer or were born without one. The series of transplants took off in September 2012, with donors including the mothers and relatives of the recipients. These women will soon try to get pregnant, Brannstrom said in a CBS report.
Video by TomoNews US, Published on 13 Feb 2014.
In this procedure, a radical hysterectomy is performed on the donor to remove the uterus, cervix and surrounding blood vessels, which will then be implanted to ensure adequate blood flow needed to sustain the uterus. Since the transplanted womb is not connected to the recipient’s fallopian tubes through which eggs are released, natural fertilisation cannot occur in the uterus. Instead, mature eggs will be extracted from the recipient and implanted to the uterus after performing in vitro fertilisation. When the uterus recipient has carried the fetus to full term, the baby is delivered by Caesarian section. The uterus recipient needs to remain on an extensive anti-rejection drug regimen, and the uterus is expected to be removed after a maximum of two pregnancies so the women can be taken off the anti-rejection drugs.
“Mats has done something amazing and we understand completely why he has taken this route, but we are wary of that approach,” said Dr. Richard Smith, head of the U.K. charity Womb Transplant UK. Smith is trying to raise 500,000 pounds ($823,000) to carry out five operations in Great Britain.
Two uterus transplants in Turkey and Saudi Arabia had failed to produce successful pregnancies. Similar procedures are currently under development in Hungary and the UK..
” Two Swedish women have received new wombs donated by their mothers in the first mother-to-daughter uterine transplants… … So far, the procedures have been a success, but the final proof of success will be the birth of a healthy child”
said Dr. Michael Olausson, Surgeon and Professor.
Read First mother-daughter womb transplants performed in Sweden, CNN, September 20, 2012.