Could uterus transplant be the next fertility treatment?
Friday, November 13, 2015
Transplant medicine has come a long way — from the first attempts of wartime field surgeons attempting skin grafts to the first successful kidney transplant between two twins in Boston in 1954. It has been an amazing journey of evolution of medicine.
Although a newer field of medicine, transplants of various forms have now become commonplace in the attempts to save lives and improve quality of life for patients. Currently, successful transplants have been performed of kidneys, pancreas, liver, lungs and heart, to name a few. Now, the uterus may be added to the list of viable options — once again pushing the envelope of possibilities in transplant and reproductive medicine.
Medical experts at the Cleveland Clinic have announced they are close to enrolling their first recipients for a uterine transplant. This groundbreaking research study has begun to screen eight women who seek the experience of bearing children they would otherwise not be able. All are considered uterine factor infertility, meaning they were born without a uterus, lost their uterus or it no longer functions. The transplant donors will be from deceased persons, much like heart and lung transplants currently.
Uterine transplantation is not new. A program at the University of Gothenburg made history in September 2014 when the first transplanted woman delivered a healthy, normally developed baby boy. Of the nine women who have received transplants, four have given birth, with another due in January 2016. Two of the transplants have failed and have subsequently been removed — one for infection and the other due to a blood clot.
There have been other attempts in Saudi Arabia and Turkey, but both have failed. Currently, Great Britain and the United States are the only other countries with active programs.
In all the programs, the transplanted uteri are considered "ephemeral," or temporary. After one to two successful births, the organ will then be removed and the recipient will no longer need immunosuppressant therapy to thwart off rejection.
Unlike the Cleveland Clinic program that will only use cadaveric donors, the Swedish teams have used live donors — some from their own mothers. This has certainly created multiple ethical questions that always surround transplant medicine.
Should a health individual be put at risk for a temporary, nonlife-sustaining benefit? Is quality of life for the recipient worth the surgical risk of two relatively health lives? These and many other complex, ethical questions were considered for more than a year by the 15-member ethical board that evaluates research projects at the Cleveland Clinc, and the final vote was in favor of the project.
For the Cleveland Clinic trail, the women will need to donate their eggs prior to the surgery — essentially starting the in vitro fertilization process. They will then be retrieved, fertilized and frozen for later implantation.
Once the uterus has been transplanted, the woman will need to heal for over 12 months, at which time the implantation process will begin. During her pregnancy she will take anti-rejection medications, ultimately delivering the child by cesarean section. After 1-2 babies have been born, the transplanted uterus will then be removed and anti-rejection medications stopped.
Once again, medicine is pushing the envelope of the capacity of the human body and the abilities of scientific discovery.
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