FIRST BABY BORN AFTER UTERINE TRANSPLANTATION

Newborn feetA few days ago, Swedish scientists announced the birth of a baby whose mother had received a uterine transplant, as reported in the prestigious journal The Lancet.

The mother, a 36-year-old who was born without the uterus, had received the womb of a 61-year-old donor. Before the surgery, the woman underwent in-vitro fertilization and freezing of the embryos. One and a half month after transplantation she had her first menstruation and about one year later she got one embryo transferred. She became pregnant, received treatment to avoid transplant rejection throughout pregnancy and by end September delivered a healthy baby boy.

According to declarations of Dr. Brannstrom, the leader of the Swedish medical team, both mother and baby are doing fine. The baby was delivered by cesarean section at 8 months because the mother developed high blood pressure (preeclampia) and the baby monitoring revealed that the heart rate was abnormal.

A breakthrough in gynecology

The achievement of a birth after uterine transplant is a veritable breakthrough if we consider the complexity of the procedure. I had the opportunity to follow a lecture by Dr. Brannstrom, where he explained the procedure in detail. The surgery is performed by a multidisciplinary team, and is extremely lengthy. Uterine transplant, as opposed to kidney of heart transplant, has extra challenges: the uterus in its non-pregnant state is about the size of a pear, and weights about 60 grams, but during pregnancy it reaches about 900 grams and gets a very large amount of blood flow, including new vessels that develop during pregnancy.Thus, extreme care should be given to what is called vascular anastomosis (the connection of the vessels). In addition, the uterus needs to be properly anchored to the nearby organs. After surgery, there are other difficulties to overpass such as the possibility of rejection, especially during pregnancy, where the treatment needs to take in consideration both the mother and the developing baby. Needless to say, the Swedish team had done many years of extensive research in animals before deciding to move forward and try in humans.

Women that may benefit

This surgery has very specific indications. The woman that underwent this operation had a very rare disorder called Mayer-Rokitansky-Küster-Hauser syndrome, which means that she was born without the uterus. This condition accounts for 1 in 5000 births (Queen Amalia of Greece had it…). Other candidates for this procedure are women who had their uterus removed due to cancer, fibroids, etc. Up until now, the only options for these women were adoption or surrogacy.

Ethical and medical concerns

This procedure raises several questions. First, unlike the kidneys or the heart, the uterus is not a vital organ. The risks of undergoing such a complex and burdensome surgery, together with the risks of the immunosuppresive therapy which put both the woman and the baby in danger, does it pay? Is it ethical? The possible risks of the donor should also be considered. In addition, the woman will most likely need to remove the uterus after family completion because the immunosuppresive therapy would eventually damage the uterus.

Like any procedure so revolutionary and avant-garde, future will show if it becomes routine care. In any case, the Swedish team should be congratulated for their efforts and contribution to help infertile women.

If you want to see an interview to Dr. Brannstrom and his team:

 

References

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61728-1/fulltext

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