A uterus transplant is a promising new procedure that is helping some women overcome uterine factor infertility (UFI) and have a baby.
Uterine transplantation (UTx) is a newly developed experimental procedure for the treatment of absolute uterine factor infertility (AUFI). This type of infertility is attributable either to uterine absence (congenital or surgical) or a uterine abnormality (anatomic or functional), that prevents embryo implantation or completion of a pregnancy to term. AUFI is estimated to affect 1-5% of women who are of child-bearing age. Any woman without a uterus (either born without it or who lost it at a younger age), or presence of a dysfunctional uterus is a potential candidate for uterus transplant.
In uterine transplantation, there is need for a donor as well, as with all transplant procedures. The transplant uterus is almost always taken from a live donor, and ideally it should be premenopausal with proven fertility and no previous uterine surgeries, as that may impact the transplant process. The ideal candidate is someone who has a similar blood type as the recipient and someone who is in relatively good health, especially reproductive health.
Need for UTx
For all the years prior to the development of the UTx method, adoption and gestational surrogacy were the only options available to women with AUFI. While these are good choices for these women who wish to become mothers, they do not restore the anatomical issue underlying the cause of their infertility. Furthermore, adoption and surrogacy do not give the experience of pregnancy, which is of high value for a woman.
How is it done? Pre-UTx
There are some procedures to be carried out in advance of the transplantation. Firstly, the donor is identified and a number of tests are carried out, including screening for various illnesses and ascertaining that the donor uterus is healthy. Donor matching or testing for donor compatibility with the recipient is also carried out. Both the donors and the recipients go through a careful medical evaluation including preimplantation genetic screening before the transplant can take place. Secondly, in vitro fertilisation (IVF) is carried out, during which eggs are harvested and fertilised to create embryos, that are then cryopreserved for transfer into the uterus following transplantation.
After all the preparations are completed, the transplant surgery is initiated. The womb (uterus) and the cervix are surgically removed from the donor and implanted into the recipient. Once that is done, the surgeons work diligently to connect the muscles, cartilage, tendons, arteries, veins, and other blood vessels in order to allow the uterus to function normally. This entire process takes several hours and a large team because the live donor also needs to be operated on, monitored, and rehabilitated after the surgery simultaneously.
After the transplant surgery, the patient will begin a course of immunosuppressant medications, in order to prevent the immune rejection of the foreign uterus. Once she heals, a single embryo will be placed into the uterus. This transfer occurs approximately 6-12 months after the transplant, depending on the medical stability of the patient and the health of the uterus transplanted. If the patient becomes pregnant, she will be monitored closely by a team of obstetricians who specialise in high-risk pregnancies. The baby will be delivered via caesarean section because women with AUFI cannot deliver vaginally. This is done at approximately 35 to 39 weeks, and the premature infants born are cared for in a neonatal intensive care unit for several weeks .
It is important that the recipient and donor both remain in the intensive care unit for several days immediately following the transplant. This will allow for pain management along with medical monitoring to see how the recipient responds to the immunosuppressive medications. If the patient (recipient) does not want more children, the uterus will be removed through hysterectomy and the immunosuppressive medications stopped.
What are the Risks?
Uterine transplantation offers a different option to adoption and surrogacy, but it is also associated with significant risks,
There are risks associated with UTx, and a 30% chance of the transplant being unsuccessful. The entire process can also take about 2-5 years. Besides, UTx like any other assisted reproductive technique is a costly procedure. But, it is a boon for many women who would prefer this method to the others, and the current status of uterine transplants promises an exciting future for women with AUFI.