All You Need To Know About Womb Transplantation

Womb transfer is a major surgery with risks involved so all necessary precautions and permissions are taken before undertaking this procedure

About 15 per cent of women in the reproductive age group are infertile and out of this number, three-five per cent is due to the uterine dysfunction. However, medical science and research has proved time and again that miracles do happen I Absolute uterine factor infertility was the only factor whereby the only option a woman is left with, was adoption or surrogacy. But the technique of womb transplant has made this too possible!

In 2014, a Swedish woman became the first woman in the world to give birth from a transplanted womb, She was suffering from rokitansky syndrome (the uterus is absent) which is the cause of absolute uterine factor infertility. After ten years of research on rodents and non-human primates, a team of Swedish researchers led by Dr Mall Brannstorm successfully carried out a uterine transplantation in a human being, followed by the success of a baby being born from a transplanted uterus.

Causes Of Uterine Factor Infertility That Can Be Treated By Uterine Transplantation

1. Absent Uterus

Congenital absence of uterus

2. Hysterectomy (uterus has been removed surgically)

Cervical or uterine malignancy
Obstetric hysterectomy
Placenta accrete/percreta
Atony
Fibroids
Uterine rupture

3. Uterus Present

Uterine malformation
Multiple miscarriages
Implantation failures
Radiation damage

4. Intrauterine adhesions not treated by hysteroscopic resection

How It Works

Women who undergo this surgery can conceive through In Vitro Fertilization (IVE). The eggs can be retrieved prior to the procedure and can be frozen, either as eggs or embryos depending on the patients requirements. For this procedure, the donor and recipient have to undergo many screening tests and after successful matching, they are taken for surgery. Womb transfer is a major surgery with risks Involved, so all necessary precautions and permissions are taken before undertaking this procedure.

This can be done with a deceased or live donor. After the successful transplantation from a live donor in Sweden, this surgery has given hope to women with uterine factor infertility. The women undergoing transplant have to take an immunosuppression therapy to avoid rejection by the recipient.

Initial concerns were the teratogenicity associated with immunosuppressant drugs but after the successful transplant and live birth by the Swedish woman, that concern has also been resolved. However, immunosuppression has to be continued in the post-partum period as well.

The First Successful Pregnancy After Transplant

The first successful pregnancy after transplant was uneventful till 31 weeks of pregnancy, after which the pregnant woman developed pre-eclampsia and for the well-being of the baby, she underwent a C-section. The baby was kept in NICU for a month and during the time of discharge, the baby weighed around two kilos.

During the pregnancy the patient was given immunosuppression drugs and throughout the pregnancy she was doing well, except for a mild rejection during the second trimester. However, the subsequent two births reported were without any adverse events.

Risks Involved With Womb Transplantation

Availability of organ donor
Risk of rejection
Need of immunosuppression
Increased chances of hypertension, diabetes, nephrotoxicity and increased arteriosclerosis

Recently in India, a Pune based hospital carried out a uterine transplant in the month of May 2017 and there were some ethical and medical concerns involved with the procedure. However, ICMR has given permission for uterine transplantation at a Bangalore based hospital.

Future Prospects Of Uterine Transplantation

This procedure provides a new hope for patients with absolute uterine factor infertility.
More modifications such as angiographic mapping of vessels preoperatively and pen-operatively will make It easier to carry out the procedure with increased success rates.
Laparoscopic and robotic techniques will also definitely evolve with advancements and it would be great in terms of time consumption and patient recovery.
The next leap in this aspect would be a successful bio-engineered uterus whereby this uterus can be implanted in women suffering from absolute uterine factor infertility without the need for a donor.
The bio-engineered uterus will have several advantages such as avoiding surgery In the live donor, organ shortage cease and also immunosuppressant drugs will not be required, as the uterus will be created from one’s own stem cells.

Footnote

Womb transplantation is a new and viable option for the treatment of absolute uterine factor infertility, provided it is done at a recognized centre with proper permissions. Also, these centres should specialize in human reproduction and skills related to organ transplantation.