For about five percent of women, pregnancy is impossible even with the latest in vitro fertilization technology. These women have a condition called uterine factor infertility (UFI). UFI is a uterus that can not hold a pregnancy. Women with UFI may have had their uterus removed (hysterectomy) for medical reasons or they may have been born with a deformed uterus or without any uterus, a rare condition called MRKH syndrome.
For women with UFI, the only options for having a child were a surrogate pregnancy or adoption. A new option may be a uterus donation from a living or deceased donor. This procedure is still experimental and is only available at a few transplant centers around the world, but it has been successful and there are now more than a dozen babies born with a transplanted uterus.
The first successful births were in Sweden in 2014. The first successful birth in the United States was at Baylor University Medical Center in Dallas in 2017. The University of Pennsylvania in Philadelphia is also recruiting women for possible transplant.
Who Donates a Uterus?
In all the early successful pregnancies, the uterus was donated by living donors. In order to be eligible, the donors must be in good health, age 30 to 50, have had successful pregnancies, and be willing to forego any future pregnancy.
In 2018, in Brazil, the first successful pregnancy with a uterus donated by a deceased donor was reported in the medical journal The Lancet. Deceased donor donation works the same way as deceased donor donations for kidneys or hearts. A woman agrees to be a donor in the future, at the time of her death. If she meets the requirements for uterus donation when she dies, her uterus is removed soon after death and transplanted into a waiting donor.
What Happens During Transplant and Pregnancy?
To be eligible for the transplant a woman must have UFI, be between age 20 and 35, have healthy ovaries, and be in good health. She should be a healthy weight and a non-smoker. These are the steps:
- Before the transplant, the woman starts a usual IVF cycle. Medications may be given to stimulate ovulation, and eggs are removed from the ovaries. The eggs are fertilized with a sperm sample and embryos created in the lab are frozen for future implantation into the new uterus.
- A healthy uterus is removed from a live or deceased donor.
- The transplant operation is done. During the procedure blood vessels are attached from the donated uterus to pelvic arteries and veins in the recipient and the uterus is placed inside the pelvis.
- The recipient must take a cocktail of anti-rejection drugs along with medications to prevent blood clots and infection. The anti-rejection drugs are given as long as the transplanted uterus is in the body, right through pregnancy. Although the long-term effects of these drugs on a developing baby are not known, there has been no evidence that they increase birth defects so far.
- Recovery from surgery can take about 6 weeks. When studies show that the transplant has taken and the new uterus is functioning normally (menstruation is occurring), a single frozen embryo is implanted.
- If the embryo takes hold, and a pregnancy begins, the pregnancy is followed by a team of high-risk pregnancy care providers.
- If all goes well, the baby is delivered by C-section at about 37 weeks.
- A woman may elect to have another pregnancy or not.
- Once the decision is made to not have another pregnancy, the transplanted uterus is removed so that the anti-rejection drugs can be stopped.
It is important to remember that this procedure is still very experimental. The first uterus transplant attempted in the U.S. by the Cleveland Clinic in 2016 failed because of an infection and the transplanted uterus had to be removed within weeks of the procedure.
It is still early days for uterus transplantation, but many have been successful and they do offer new hope for women with UFI. If you or someone you know is interested in participation in a clinical trial for uterine transplant, go to ClinicalTrials.gov and search for uterine transplant. There are several active trials in the United States and in foreign countries.
Medical science is amazing, and here is a final mind-blowing thought. If a uterus can be transplanted into a woman, why not into a man? Could the first man to become pregnant be alive today? There are some technical details to work out and a lot of preliminary research to do in animals, but this is a real possibility. According to the outgoing president of the American Society for Reproductive Medicine, the first recipient will probably be a transgender woman, and there is no reason to believe that it won’t happen.
