In a first, Woman Gives Birth Via Womb Transplant
The history of all transplants is one of weighing risk against reward. The risks are many – there is risk from surgery itself, from infection and complications after surgery, from years of anti-rejection drugs, all of which have side-effects; from the rejection of the organ if the drugs fail.
When deciding to transplant something life-saving, like a heart, liver or lung, the reward, by definition, justifies the risk. When the “organ” is a hand or a face, as has been made possible much more recently, the reward becomes quality of life, and while this equation is less clear, ethicists have generally approved this new line.
But when the reward is the ability to carry a child?
This is when everyone stands gobsmacked. And this is where the clear line between religion and science becomes blurred- a miracle has ensued.
For women with uterine factor infertility who want to be mothers, the calculus has always been heartbreakingly simple: No uterus means no pregnancy.
However, this equation changed drastically in 2014, when Swedish doctors delivered a healthy 3.9-pound baby that was the result of a successful uterus transplant. And now, doctors at Baylor University on the
same successful path have helped a woman born without a uterus give birth to a baby after a successful transplant, the first time the surgery has worked outside of the Swedish hospital that pioneered the procedure.
“This first live birth to a uterus transplant recipient in the United States was a milestone in our work to solve absolute uterine factor infertility; but, more importantly a beautiful moment of love and hope for a mother who had been told she would never be able to carry her own child,” said Giuliano Testa, MD, principal investigator of the uterine transplant clinical trial at Baylor University Medical Center at Dallas. The new mother received a uterus transplant as part of a “landmark clinical trial conducted over the past year and a half.”
Dr. Liza Johannesson, a uterus transplant surgeon who left the Swedish team to join Baylor’s group, said the birth in Dallas was particularly important because it showed that success was not limited to the hospital in Gothenburg. “To make the field grow and expand and have the procedure come out to more women, it has to be reproduced,” she said.
At Baylor, eight women have had transplants, including the new mother, in a clinical trial designed to include 10 patients. One recipient is pregnant, and two others — one of whom received her transplant from a deceased donor — are trying to conceive. Four other transplants failed after the surgery, and the organs had to be removed, said Dr. Giuliano Testa, principal investigator of the research project and surgical chief of abdominal transplantation.
“We had a very rough start, and then hit the right path,” Dr. Testa says.
Both Dr. Johannesson and Dr. Testa said that a large part of their motivation came from meeting patients and coming to understand how devastated they were to find out that they would not be able to have children.
Dr. Testa said: “I think many men will never understand this fully, to understand the desire of these women to be mothers. What moved all of us is to see the mother holding her baby, when she was told, ‘You will never have it.’”
There have been at least 16 uterus transplants worldwide, including one in Cleveland from a deceased donor that had to be removed because of complications. Wombs can come from both living and dead donors, and the transplants are not meant to be permanent. A woman who received a womb transplant must take powerful drugs to prevent organ rejection, so the uterus would be removed after one or two successful pregnancies.
Doctors hope that womb transplants will enable as many as several thousand women born without a uterus to bear children. To be eligible for the Baylor study, women must be 20 to 35 years old and have healthy, normal ovaries. They will first have in vitro fertilization to retrieve and fertilize their eggs and produce embryos that can be frozen until they are ready to attempt pregnancy.
After the uterus transplant, the embryos can be thawed and implanted, at least a year after the transplant to make sure the womb is working well. A baby resulting from a uterine transplant would be delivered by cesarean section.
Currently, the uterus transplant procedure is very expensive — up to $500,000. Additionally, the success of the procedure and the emerging field is still new. It’s certainly not out of the question to think that in the coming decades, procedures like this will be more commonplace — and therefore, hopefully, more affordable. We still need to do a lot more research and experimentation before this type of procedure becomes more widely available — let alone routine. But this latest success proves that it’s not just possible, but life-changing for the patients who experience it.
