First uterus transplant in US offers hope of pregnancy for women with UFI

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A team of Cleveland Clinic transplant surgeons and gynecological surgeons have performed the nation’s first uterus transplant during a nine-hour surgery.
 

Transplantation is seen as an option for candidates with uterine factor infertility (UFI). Women with UFI cannot experience pregnancy because they were either born without a uterus or their uterus no longer functions. It is an irreversible condition that affects 3-5% of women globally.

Until now, surrogacy has been the only option for women with UFI, but in the US, the process is legally complicated, and in many countries it is either highly restricted or banned.

An infographic created by Cleveland Clinic describes a uterus transplant as “life-enhancing” as opposed to “life-saving.”

A uterus transplant has to be accompanied by drugs to ensure the body does not reject the foreign organ, and it is designed to be a temporary measure to allow 1-2 pregnancies. After that, the anti-rejection drugs will be stopped and the transplanted uterus either removed or allowed to disintegrate.

Uterus transplants: moving toward success

Globally, 11 transplants have taken place so far. The first was carried out in Saudi Arabia in 2000; unfortunately, the uterus had to be removed after 3 months due to complications related to thrombosis.

The first successful transplant took place in Sweden. By 2015, nine transplants had taken place, leading to five pregnancies and four births. The babies have been born healthy and the risk to the mothers has been minimal.

The current 26-year-old patient, who is not being identified publicly, was reported to be in a stable condition on Thursday afternoon. The transplanted uterus came from a deceased organ donor.

Fast facts about infertility

  • 10.9% of American women aged 15-44 years have impaired fertility
  • 6% of married women aged 15-44 years are infertile
  • 7.4 million women have used fertility services at some time.

Learn more about infertility

Cleveland Clinic began screening candidates for uterus transplants in 2015, and the team is continuing to screen for a total of 10 suitable candidates. All must be aged 21-39 years and have UFI.

Following selection, the first step is to stimulate the woman’s ovaries to produce eggs, which will be removed for in vitro fertilization (IVF). Ten embryos will then be selected and frozen.

A uterus will be donated by a deceased donor, who must be aged 18-40 years. When one becomes available, the candidate for surgery will begin anti-rejection drugs to enable her body to accept the new organ.

Transplantation must take place within 6-8 hours, and the blood vessels will be connected to those of the receiver. Menstruation will begin after a few months and it will take around a year for the uterus to heal.

At this point, the embryos can be thawed and implanted, one by one, hopefully leading to a successful pregnancy.

During pregnancy, careful monitoring will take place to check for hypertension, preeclampsia, intrauterine growth restriction, premature rupture of membranes, preterm delivery and intrauterine fetal demise.

The mother-to-be will continue to take anti-rejection drugs, and delivery is likely to be via cesarean section.

The research team, consisting of transplant specialists, obstetricians, gynecologists, bioethicists, psychiatrists, nurses and social workers, will continue to monitor the baby for negative outcomes. Such outcomes could include birth defects, perinatal infections, low birth weight and neonatal intensive care unit admissions.


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