As part of a clinical trial that began in the fall of 2015, the successful transplant gives hope to women unable to conceive or carry a full-term pregnancy due to uterine related infertility. Uterine Factor Infertility (UFI) can be the result of an abnormality in the uterus, including genetic malformations, scar tissue, fibroids or an under-developed uterus (2).
According to the Cleveland Clinic website, some UFI patients aren’t born with a uterus while others may have suffered damage from a “serious pelvic infection, or abdominal or pelvic surgery”. Other possible candidates include women who’ve undergone a hysterectomy.
If the trial is successful, then other women suffering from UFI may also be eligible for a uterus transplant. There’s no exact data on how many women in the US are afflicted with UFI, but it’s estimated to be thousands. A uterus transplant is the only hope for UFI patients to bear their own children.
Discussing the undertaking of the study in 2015, Cleveland Clinic Women’s Health Institute chairman and obstetrician-gynecologist Dr. Tommaso Falcone said, “Women who are coping with UFI have few existing options.”
He went on to state that alternatives, such as “adoption and surrogacy provide opportunities for parenthood, both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.” For some women, surrogacy isn’t an option in their country since it is illegal.
10 women are participating in the uterus transplant study and hoping their transplants will be viable. If the surgeries are successful, then the women should be able to conceive, carry the fetus full term and give birth.
Doctors Oversee Transplant, Embryo Implantation and Birthing
The 10 women participating in the clinical trial will have the advantage of a team of highly qualified doctors along each step of the way. As each woman was approved to participate in the trial, she underwent a process to ensure her success in conceiving and giving birth to a healthy baby.
The eggs of each woman are harvested and then go through in vitro fertilization (IVF). Afterwards the embryos are frozen until time for implantation.
The next step is taken by Lifebanc, an organ procurement agency. Lifebanc begins its search for a compatible donor.
Once a donor is procured, the uterus is “transplanted within six to eight hours into the patient’s pelvis” (3).
The uterus is allowed to completely heal over a period of 12 months. The next step is to thaw the embryos and implant into the patient. The embryos are implanted “one at a time” until the patient becomes pregnant.
All through the pregnancy, the patient is monitored for organ rejection. She also continues to take anti-rejection drugs to ensure her body doesn’t reject the uterus.
When the pregnancy has reached full term, “the baby is delivered by cesarean section.”
Even though the uterus transplant is a temporary organ, most women can expect to have two births before the uterus is surgically removed. The uterus is removed to spare the woman a lifetime of anti-rejection drugs.
First Birth to Uterus Transplant Patient
In October 2014, the BBC reported that the first baby had been born to a womb-transplant patient. The baby boy was born to a 36-year old woman. The woman was born without a uterus but had functioning ovaries (4).
The 61-year-old woman who donated her uterus to the younger woman was a live donor. A year later, the doctors successfully transplanted one of the patient’s frozen embryos. The mother “developed pre-eclampsia and the baby’s heart rate became abnormal.”
The baby had to be delivered earlier than anticipated. Although the baby was born at 32 weeks, it was healthy. Swedish doctors performed nine uterus transplants. Out of those, five resulted in pregnancies with four births.
In 1931, one of the first uterus transplants was undertaken in Germany but three months later, the patient died (5).
When in vitro fertilization became a reality in 1978, uterine transplantation research was abandoned. However, in 2000, renewed interest in uterus transplant research was undertaken by Dr. Wafa Fagee in Saudi Arabia. The transplant failed after 99 days and the uterus was successfully removed from the patient.
On 2011, a team of doctors at Akdeniz University Hospital in Turkey perform the first uterus transplant from a deceased donor. Although the patient got pregnant, her pregnancy failed.
Live Versus Deceased Donors
The biggest difference between the US transplants and the Swedish uterus transplants is the donors.
The Swedish transplants were made from living donors, whereas the US transplants and future transplants will be from deceased donors.
According to ABC News, the Swedish donors underwent major surgery that Dr. James Goldfarb of University Hospitals Case Medical Center in Cleveland (division chief of reproductive endocrinology and infertility) described as, “much more surgery than someone who is donating a kidney” (6).
If the first uterus transplant and the subsequent nine others in the clinical trial are successful, then thousands of woman will have new hope of having their own children in the near future.
References & Image Credits:
(1) Cleveland Clinic
(2) Cleveland Clinic Clinical Trial
(3) TSW: US Military Looking to Create Organ Banks
(5) Wikipedia: Uterus Transplantation
(6) ABC News
(7) Diagram of Uterus