For women with uterine factor infertility who want to be mothers, the odds have always been heartbreakingly against them: No uterus means no pregnancy. But in 2014, all this changed dramatically when Swedish doctors delivered a healthy baby that was the result of a successful uterus transplant.
Now, doctors at Baylor University confirmed that a woman born with no uterus has delivered a baby after a successful transplant. The fact that the procedure was successfully replicated outside of the pioneering hospital, brings new hope to uterine infertility sufferers. The success of this marked another step forward for transplant surgery which is not only aimed at saving lives but improving it in ways never visualized before.
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A first for the United States, the mother received the transplant from a living donor last year and then gave birth to the bouncing baby boy at Baylor University Medical Center in Dallas. At the request of the family, no details about the family have been released to safeguard the family’s privacy.
But according to reliable sources, the donor of the uterus was Taylor Siler, a Dallas nurse with two children of her own. She said she wanted to offer another woman the chance to give birth.
While this most recent birth is indeed a giant leap of progress, uterine transplantation surgery is still in its very early days, and doctors have conceded that there were in fact setbacks, particularly with the earliest volunteers.
Since the pioneering procedure in 2014, eight other babies have been born to women who had uterus transplants, all in Sweden, at the Sahlgrenska University Hospital in Gothenburg.
Uterus transplants are seen as a source of hope for women who are unable to give birth because they were either born with no uterus or had to have it removed because of cancer, other illness or complications from childbirth. It is estimated that in the United States alone, 50,000 women might be potential candidates for this new frontier type surgery.
Uterine transplant procedures differ from other kinds of transplants in that they are meant to be temporary. They are inserted and left in place long enough for a woman to have her one or two babies, and then they are removed again. This removal is to prevent her from having to take immune-suppressing drugs that are needed to prevent the organ being rejected.
Dr. Liza Johannesson, a uterus transplant surgeon who left the Swedish team to join Baylor’s group, said the birth in Dallas was, in fact, significant as it showed that it could be successful elsewhere. If the procedure is to grow successfully, it is vital that it be reproduced as this would make it available to more women. Groups of women suffering from this kind of infertility have contacted her from all over with regards to the procedure, as they have been given hope.
“It was a very exciting birth,” Dr. Johannesson said. “I’ve seen so many births and delivered so many babies, but this was a very special one.”
At Baylor, eight other women who were included in the clinical trial have had transplants, including the new mother. One recipient is pregnant, and two others — one of whom received her transplant from a deceased donor — are trying to conceive. There were four other transplants that 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 said in a telephone interview. “The first three women ‘paid for it’ in a certain way. I feel very thankful for their contribution, more so than I can express.”
Not being able to conceive and give birth when it is all you want to do, can be devastating to women. Both Dr. Johannesson and Dr. Testa said that a large part of their motivation came from meeting patients and coming to understand how distraught 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.’”
The transplants are now still in an experimental phase, with much of the cost covered by research funds. But they come at a huge cost, and if they become part of medical practice, will probably cost hundreds of thousands of dollars. It is not clear that insurers will pay, and Dr. Testa acknowledged that for many of those women who pin their hopes on this transplant method, they simply will not be able to afford it.
In February 2016, The Cleveland Clinic also performed its first uterine transplant, after the patient suffered from a yeast infection that caused life-threatening hemorrhage and required emergency surgery to remove the organ, the clinic paused the program for an extended period. However, it has since re-kindled it and according to spokesperson Victoria Vinci, there is a waiting list in place.
The process involves significant risks to both recipients and donors alike. Donors undergo a five-hour operation that is very complex and takes more tissue than a standard hysterectomy to remove the uterus. The transplant surgery is also difficult, and in some ways, is comparable to a liver transplant, Dr. Testa said.
Their pregnancies are considered high-risk, and the babies have to be delivered by cesarean section to avoid putting too much strain on the transplanted uterus. So far, all the births have happened earlier than the normal gestation period of 40 weeks. — usually between 32 and 36 weeks.
Obviously, women who have uterus transplants cannot conceive naturally, since their ovaries are not connected to the uterus, so there is no way for an egg to implant itself. Instead, they need to undergo in-vitro fertilization. Before the transplant, women are given hormone treatment to cause their ovaries to release multiple eggs, which are then harvested, fertilized and frozen. Once the woman has fully recovered from surgery and begun menstruating, the eggs are implanted into the uterus, one at a time, until she conceives.
In Sweden, doctors waited a year after the transplant before trying to start a pregnancy, to allow the women time to heal. At Baylor, the team moved much faster and began trying to impregnate the women within a few months of the surgery, soon after they began menstruating.
Prof Mats Brannstrom who led the transplant team in Sweden described the birth in Sweden as a joyous moment.
“That was a fantastic happiness for me and the whole team, but it was an unreal sensation also because we really could not believe we had reached this moment. Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility.”
Liza Johannesson, a gynecological surgeon in the team, said: “It gives hope to those women and men that thought they would never have a child, that thought they were out of hope.”
However, there are still doubts about the safety and effectiveness of the invasive procedure if it is carried out on a larger scale.
Dr. Brannstrom and his team are working with another eight couples with a similar need. The results of those pregnancy attempts will give a better picture of whether this technique can be used more widely.
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