Reported in the Lancet, on October 5th 2014, was the world’s first birth of a baby following a uterus transplant. The woman was a participant in a clinical trial, the first of its kind, transplanting uteri from live donors.
Women with absolute uterine factor infertility, caused by congenital absence of a uterus or due to hysterectomy, are not able to carry and give birth to their own children. The only way in which these women are able to become mothers is via adoption, or surrogacy.
In 1999, a group of researchers who have spent over ten years studying uterus transplantation in animal models, including rodents and non-human primates, began their first clinical trial in humans, conducted at the Sahlgrenska University Hospital, Gothenburg, Sweden. Nine women with absolute uterine factor infertility were enrolled in the trial. These nine women were transplanted with uteri derived from live donors (usually family members). While two of the nine women subsequently had their uterus removed due to complications, seven of the women had successful transplantations. These seven women began menstruating regularly within 2-3 months post-transplantation.
One woman involved in the study had a uterus transplant in 2013. She was 35 years old, and the donor was a 61 year old woman who was approximately 7 years post-menopausal, and had previously had two successful pregnancies. In addition to full medical work up, the donor had been treated with an oral contraceptive pill to ensure the uterus was able to function normally. The recipient underwent in vitro fertilisation between 18 and 6 months before the transplant surgery, in order to have cryopreserved embryos prepared for implantation following the uterus transplant. The transplant surgery was successful, taking more than 10 hours for the donor surgery, and almost 5 hours for the recipient surgery. Both patients recovered in the hospital for 6 days. The recipient was placed on immunosuppressive drugs both before and after the surgery. Spontaneous menstruation began 43 days after the surgery, and regular menstruation continued after that, ranging from every 26-36 days. Around 12 months after the surgery, an embryo transfer was done, using a single embryo to avoid potential complications due to multiples. Three weeks after the embryo transfer, the patient had a positive pregnancy test, and the fetus was first detected on ultrasound two weeks later. The woman experienced a normal pregnancy until she was 31 weeks and 5 days, at which time she was admitted to the hospital for pre-eclampsia, and the baby was delivered via C-section. The baby boy was born at 1775g, 40cm, and with an APGAR score of 9, 9, 10. Both mother and baby were in good health, the mother discharged 3 days following the C-section, and the baby discharged 16 days after birth.
The recommendation is to remove the uterus after 1 or 2 successful pregnancies, in an effort to reduce the long-term side-effects associated with the immunosuppressive drugs. The concept of a live donor in this clinical trial is important in the fact that it allows for a full medical work up before the transplant, to ensure that there are no risk factors that would compromise either the transplant or subsequent pregnancy.
There are associated risks with uterine transplant, as with any transplant surgery, which could result in removal of the uterus due to transplant rejection, or side effects due to immunosuppressing drugs. However, the successful uterine transplant and subsequent pregnancy and birth, gives hope to women who would not have been able to carry or give birth to their own child.
Clinicaltrials.gov “Uterus Transplantation From Live Donor (utx)” Available from: http://www.clinicaltrials.gov/ct2/show/NCT01844362?term=NCT01844362&rank=1 Last Accessed: Oct 7, 2014.
Mats Brännström, Liza Johannesson, Hans Bokström, NiclasKvarnström, Johan Mölne, PernillaDahm-Kähler, Anders Enskog, Milan Milenkovic , Jana Ekberg, Cesar Diaz-Garcia, Markus Gäbel, Ash Hanafy, Henrik Hagberg, Michael Olausson, Lars Nilsson“Livebirth after uterus transplantation” Lancet, Published online October 5, 2014. http://dx.doi.org/10.1016/S0140-6736(14)61728-1
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Written by Deborah Tallarigo, PhD