On the 24th February this year, history was made at the Cleveland clinic when a 26-year-old woman underwent the first uterus transplant in the USA as part of a new clinical study.
The operation took 9 hours, and the surgeons reported that the transplant was successful, and the patient, Lindsay, was recovering well.
Like Lindsay, one in 4,500 women (3-5% of women worldwide) are born without a uterus, a condition known as uterine infertility factor, or have had their uterus removed due to illness or disease, in a procedure called a hysterectomy. This consequently means that women cannot conceive naturally, but the up and coming success stories of uterine transplants offer a new alternative method.
Looking back, this is not the first time that surgeons have tried transplanting a uterus. In 2011 the first successful transplant was carried out in Turkey, from a deceased donor, and even more successful still was that this recipient then went on to experience normal menstrual cycles, and even conceive. Unfortunately, despite the initial success, the pregnancy had to be terminated due to a failure to detect the baby’s heartbeat during an early scan, although it’s not known whether this was related to the uterus transplant. Another team in Sweden in 2012, managed to successfully transplant a patient’s mother’s uterus demonstrating the first transplant using a live donor. The first baby was born to a transplant recipient in 2014, also in Sweden, and since this four other transplant patients have amazingly given birth to healthy babies.
So even though this transplant wasn't the very first, it aims to be the first in the way of using these patients to gain a better understanding of uterus transplants, as right now it’s use is still tightly controlled and only as a last resort. The Cleveland clinic intends to carry out 10 uterus transplants in total, and monitor transplant patients afterwards as well as throughout their pregnancies in the hope it may become a foreseeable and realistic option for women.
So then that’s it, right? Not necessarily. These patients must remain on immunosuppressant drugs like any other organ transplant recipient to prevent the chance of their body rejecting the transplant. This isn’t great as these drugs essentially suppress the immune system, which consequently leaves the patient more at risk from simple infections and reduces their capability to fight them. In addition to this, if the patient were successful in conceiving with their new uterus, they would deliver the baby via caesarean which is associated with risks of its own also. Furthermore, it’s still not plain sailing, due to immunosuppressant drugs having this effect and the transplant in this case not being ‘life saving’ as the patient, not long after giving birth, must have the uterus removed. This totals to 3 major surgeries for the patient, and there is always the chance the patient could still reject the uterus, or not be successful in conceiving.
These are not the only problems that some people have with uterine transplants; many ethical issues arise in this area, including those of other alternatives available to women who cannot conceive for example adoption or surrogacy. There is some guidance around this in the form of the Montreal criteria. This is a set of conditions that women opting for transplants would have to meet developed at McGill University and published in Transplant International in 2012. This would further limit the eligibility for some women.
So overall, uterine transplants sound like an exciting new prospect that gives infertile women an amazing opportunity, but it is not without risk. The transplants are still in their infancy, and doctors have stressed that they should still be considered experimental but do remain hopeful they will soon be able to help thousands of women. However, in a sad end to the story, on the 8th March, Lindsay had to have the transplant uterus removed due to a sudden complication, and the surgical team are still determining what went wrong.