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Latest update on uterine transplantation

It used to be that women without a uterus, or with a greatly damaged uterus, stood no chance of pregnancy. The medical term for this condition is AUFI (Absolute Uterine Factor Infertility). It is relatively rare but can be from birth or acquired e.g. damage from radiation.

Then five years ago, in Sweden, something amazing happened!  A 35-year-old woman whose uterus was absent at birth underwent a uterus transplantation at Sahlgrenska University Hospital.

The uterus donor was a living, post-menopausal 61-year-old woman. The recipient and her partner had undergone IVF treatment before the procedure in order to create 11 healthy embryos.

Incredibly, the recipients first menstruation occurred 43 days after transplantation! She continued to menstruate at regular intervals, on average once a month thereafter.

After a year, the recipient underwent her first single embryo transfer, which resulted in pregnancy. 32 weeks later she gave birth via caesarean section to a healthy baby boy.

Voila!

The medical team demonstrated two incredible things:

  1. The proof that uterine transplantation works
  2. That it is possible to use post-menopausal uteruses for this purpose.

This was great news for women for whom the absence of a uterus or severe abnormalities prevents pregnancy. The fact that post-menopausal uteruses could be used also meant that there was no shortage of potential donors.

However, the road to this success was fraught with problems, which had to be overcome:

  • The problem of rejection of the uterus: With any transplantation procedure there are risks of rejection of the donor tissue by the recipient. This is overcome with powerful drugs that blunt the immune system of the recipient. In this case the mother had three episodes of mild rejection. One occurred during pregnancy and all of them required immediate treatment
  • The mothers was admitted to hospital at 32 weeks with pre-eclampsia. This condition sees a dangerous rise in blood pressure, which also needed emergency treatment
  • The baby was delivered by caesarean section after scans of the baby showed abnormal heart readings

So, there were challenges. Nevertheless, the promise of uterine transplant remains. This year saw further success with a live birth following a uterus transplant from a posthumous donor.

So where are we 5 years later?

Since that pioneering result, uterine transplant programs have been established in multiple countries. A recent report details the first 45 cases of uterus transplantation.

As with all nearly all cases of pioneering medicine, it has been a somewhat rocky road! But here is the good news:

  • 45 uterus transplantations, including the first transplant from a posthumous donor
  • 18 new babies in the world that wouldn’t be here without this incredible work. This number may increase as 25 women of the 45 still have functioning uteruses
  • All the babies did well and no birth defects were seen
  • The average birth rate was 2.5kg (5.5 lbs)

The bad news is as expected, with similar issues to the first case.

  • 30% failure of the transplantation (13 cases)
  • 11% suffered severe complications and 28% suffered minor complications such as anaemia and constipation.

The authors of the report concluded, “Uterine transplant offers an alternative method to establish a family in women with AUFI. The procedure is associated with significant risks, however, as almost half of the patients experienced minor or more severe complications.”

So uterine transplantation offers AUFI an option to start a family. The procedure is complex, however, and carries associated risk. Also, before transplantation, a recipient must undergo IVF to create and preserve embryos for later transfer.

With that in mind medical professionals agree that the ideal candidate would be a young woman in good health. Most transplant programs of the type covered in the report have age restrictions. They also require a certain number of embryos before they will consider a patient’s suitability for a transplant.

Is it all worth it?

18 babies and their mums shout a resounding ‘Yes!’ And as techniques improve in both pregnancy management and transplantation medicine, things can only get better.