Medical Contribution by: Robert J. Stillman, M.D.
Typically, if a woman is unable to carry a child to term for medical reasons a couple’s options are to use a gestational carrier—another woman to carry the child—or adopt. Using a gestational carrier has allowed thousands of couples the ability to have a biological child or children when they would otherwise be unable. Now, a new treatment option, uterus transplant, may allow women to carry their own child, even if they were born without a uterus or their uterus is compromised in some way. Last week, Cleveland Clinic transplant and gynecologist surgeons performed the nation’s first ever uterine transplant, a new frontier that aims to give women who lack a womb the chance at pregnancy. The 9 hour surgery was performed on a 26-year-old woman who was using a uterus from a deceased donor.
A New Alternative for Women Worldwide
The Cleveland Clinic transplant team prepared for this surgery for years, announcing last fall they would conduct a clinical trial that would attempt 10 transplants. Other countries have also attempted womb transplants. Sweden was the first to report the first successful birth from a womb transplant in 2014 with a total of five healthy babies born to date. The experimental treatment of a womb transplant might be an alternative for the women who are unable to carry a child because of uterine factor infertility, meaning they were born without a uterus or with uterine abnormalities that prevent pregnancy.
The Benefits and Risks of a Uterine Transplant
It’s been speculated whether such an extreme surgery would be a realistic option for women. There are significant medical risks, including rejection of the transplant with resultant injury or death to the fetus, and having to take potent immune-suppressing drugs that can also affect the child. The main difference between a uterus transplant and other types of transplants like a kidney or heart transplant is that a uterus transplant is not for a life-saving indication and is not intended to last for the duration of the recipient’s life, but will be maintained long enough to have one or perhaps two children.
The Process of Removing and Using a Uterine Transplant
The process of removing a uterus from a deceased donor requires more than a normal hysterectomy, as the major arteries also have to be removed. The womb and blood vessels are sewn inside of a recipient’s pelvis in a long and very challenging transplant surgery. Before the abdomen is closed, surgeons check for a steady blood flow and that the attachment of the ligaments is strong and stable enough to withstand a pregnancy. Then, in the days, weeks, and months after they watch for signs of rejection and may have to remove the uterus if rejection cannot be stopped.
If a woman is approved to become a part of the transplant study, she would first need to have her eggs removed from her ovaries for in vitro fertilization (IVF). After her eggs are retrieved and fertilized, the embryos are then frozen. The embryos cannot be implanted until 12 months after the transplant surgery allowing for an adequate amount of time for healing on the immunosuppressive medications and watch for rejection.
This highly complicated procedure may someday offer another family building option for women born without a uterus or those who’ve had it removed for medical reasons to carry their own child. It may also one day become an option for women who live in jurisdictions where governments will not allow the use of a gestational carrier. There are real medical and ethical concerns that the immense cost; the limited number of uterus’ available for transfer; the limited number of teams of transplant and gynecologic surgeons even capable of attempting such complex surgery; and the real risks involved to prospective mother and the baby, that the initial promise of this new technique will go unfulfilled. For today—and certainly the near future —gestational surrogacy does provide a means for such couples with the severe forms of uterine factor infertility to have their own child
For more information about uterine factor infertility or to schedule an appointment, please speak with one of our New Patient Liaisons at 1-877-971-7755 or click to schedule an appointment.