Women who do not have a functioning uterus may one day be able to become pregnant thanks to groundbreaking transplant surgery. Doctors at the Cleveland Clinic expect to become the first team in the United States to transplant a uterus from one woman to another in the near future.
The first clinical trial of this new type of transplant surgery was announced in November, with the first surgery at the Cleveland Clinic expected to take place in the next few months.
Ten women with uterine factor infertility are being selected to participate in the study. UFI is a condition that prevents pregnancy because the woman was born without a uterus, has lost her uterus, or has a uterus that does not function.
Until now, adoption or surrogacy were the only options available for women with UFI to become mothers.
To date, Sweden is the only country where a uterus transplant has been successfully completed. In that country, nine women have received uterus transplants. Four have given birth to healthy children, and a fifth baby is due to be born in January, 2016.
"The exciting work from the investigators in Sweden demonstrated that uterine transplantation can result in the successful delivery of healthy infants," Cleveland Clinic lead investigator Andreas Tzakis, MD, said in an article published in the November 12 issue of the Cleveland Clinic publication Health Essentials.
Like any transplant surgery, the recipient of a transplanted uterus must complete an extensive approval process. Considerations include physical and psychological screenings as well as finances.
Once a woman is approved, she must go through a multi-step process to prepare for the transplant and ensure that she has viable eggs ready once the transplant is accomplished.
This includes taking hormones to stimulate egg production so multiple eggs can be harvested. Ten eggs will be fertilized and the embryos frozen for later implantation.
Once the woman is ready for transplant surgery, the search will begin for a uterus with tissue and blood types that match that of the recipient. Unlike the doctors in Sweden, who transplanted uteri from living donors, the Cleveland Clinic team plans to use uteri from deceased donors. This is a common practice in other types of organ transplants.
The surgery will include transplanting the uterus and part of the vagina from the donor. The recipient’s fallopian tubes will not be attached, which eliminates the option of natural fertilization.
The donor vagina will be attached to the recipient’s vagina, which will provide passage for eggs that are fertilized in vitro to be implanted in the new uterus.
All babies carried in a transplanted uterus will be delivered surgically through cesarean section to avoid trauma to the uterus.
Unlike other organ transplants, uterus transplants are intended to be temporary. A woman receiving a uterus transplant will be able to keep it until she has one or two babies. During that time, she will need to take anti-rejection drugs to prevent her body from rejecting the uterus.
Following surgery to transplant the uterus, the recipient will have to wait one year for the uterus to heal and so her body can adjust to the proper dose of anti-rejection medication before the first embryo can be implanted.
When her pregnancies are complete, the uterus will be removed and she will no longer need to take anti-rejection medications.
Doctors at the Cleveland Clinic intend to perform 10 uterus transplants, then determine whether the program should be continued. Women participating in the study are clearly informed of the potential risks of the procedure.
“These women know exactly what this is about,” said Tzakis. “They’re informed of the risks and benefits. They have a lot of time to think about it, and think about it again. Our job is to make it as safe and successful as possible.”
Unlike traditional transplant surgeries, this type of surgery is not medically required to save the life of the recipient. Risks include complicated surgery to implant the uterus, strong anti-rejection drugs to keep the uterus healthy and functioning, and follow-up surgery to remove the uterus after the child or children are born. In addition, all pregnancies will be considered high-risk.
Researchers believe as many as 50,000 women in the United States could be potential candidates for uterus transplant surgery.
Dr. Tomer Singer is a reproductive endocrinologist at Lenox Hill Hospital in New York City. Singer said that the uterus transplant procedure "opens the door to an innovative and promising advancement within reproductive medicine. We believe that tens of thousands of women will benefit from this advancement in the future, while realizing that there are still challenges to overcome before we offer this procedure routinely.”
Sources:
New York Times. Uterus Transplants May Soon Help Some Infertile Women in the US Become Pregnant. Denise Grady. Web. December 28, 2015.
http://www.nytimes.com/2015/11/13/health/uterus-transplants-may-soon-hel...
Medline Plus. First Uterus Transplant Planned in US. Margaret Farley Steele. Web. December 28, 2015.
https://www.nlm.nih.gov/medlineplus/news/fullstory_155712.html
Medscape. Uterus Transplant: First US Clinical Trial Begins. Troy Brown, RN. Web. December 28, 2015.
http://www.medscape.com/viewarticle/854649
Reviewed December 29, 2015
by Michele Blacksberg RN
Edited by Jody Smith