banner by Bridget Moyer
Uterine Transplants: A New Path to Children
by Zahava Rubin
Desperation is being replaced with hope, loneliness is being replaced with life, and women who are not able to conceive are getting a chance to experience giving birth. All around the world, particularly in Sweden, researchers and surgeons are teaming up to establish a concrete foundation for uterine transplants to give women, who are unable to conceive a chance to have children of their own. Mayer-Rokitansky-Küster-Hauser syndrome, known as MRKH, is a disorder that causes the vagina and uterus to be underdeveloped or absent in females. The condition is relatively common, with a rate of diagnosis at about one in every 4,500 girls and one of the major side effects being infertility.
Uterus transplants are the first available treatment for absolute uterine infertility, which makes these scientific advancements so critical. Although this procedure is still in the preliminary stages of research, many wonderful achievements have been made in the last two years. Twelve women have undergone uterine transplants: nine in Sweden, one in Saudi Arabia, one in Turkey, and one in the United States. Though two of the transplants were unsuccessful, resulting in emergency hysterectomies, removal of the uterus, for the safety of the mother, Sweden has had at least five live babies born from successful transplants.
In February of 2016, the Cleveland Clinic, in Cleveland, Ohio, announced its goal to complete 10 uterus transplants using uteruses from live donors. On Feb. 24, 2016, the clinic announced that its first successful uterus transplant. It is important to note that the transplant procedure is a long and tedious one; it takes around 11 hours to remove the uterus from the donor and stabilize it in the receiver. Unfortunately, three days later, the 26-year old recipient underwent an emergency hysterectomy due to an infection, but the Cleveland team continued to persevere. The nine remaining trials are now scheduled with modified protocols to ensure better results and diminish the chances of infection.
Woman who receive the transplant will not be able to become pregnant through normal intercourse. Rather they will need to undergo in vitro fertilization, in which eggs are removed from their ovaries, and fertilized and implanted back into the uterus. If all goes well and the woman becomes pregnant, a Cesarean section will have to be performed, so that the transplanted uterus will not have to go through the trauma of labor. With every surgery comes risk, but do the positives aspects outweigh the negative aspects?
Due to the lack of previous research since it is such a new phenomenon – the first procedure was performed in 2014 – there are many pros and cons to this procedure. The major positive aspect is giving women a chance to have children. However, the negative aspects are still significant, the first being the long-term effects of the anti-rejection medication prescribed to the mother in efforts to prevent the body from rejecting the donated uterus. Furthermore, there are also questions on the effects of being born in a transplanted womb that could have on the child.
Stable graft function is dependent on prevention of rejection, which is currently accomplished by using immunosuppressant medications, to which the fetus is exposed in utero. Although the effects are not clear, these drugs have side effects, including increased risk of infection, which may increase the risk of preterm delivery. Additionally, the suggested guidelines are that the woman retains the uterus for a maximum of two pregnancies, meaning that after two pregnancies, whether or not babies are birthed, the uterus must be removed for the safety of the mother. This poses the question if this temporary procedure is worth the pain and money.
Although this surgery may not save lives, it falls under the category of life enhancing. There are numerous benefits for those involved and for the future of medicine. This procedure could dramatically improve a woman’s quality of life. Uterine transplants are not just a step for women--it is a step forward for science and medicine as a whole.