Some want them desperately, others absolutely do not: children. Could uterus transplants help both sides in the future? A case study.
Many women suffer from an unfulfilled desire to have children. Others suffer from having to deal with being able to have children – even though they don't want to. Wouldn't it be wonderful if both of these problems could be solved with one procedure? Uterus transplants could help both parties, as a case study from the U.K. now demonstrates.
The Guardian reports a story of two sisters. One with an urgent desire to have children, the other with her family planning already complete. The eventual organ recipient suffers from the extremely rare Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), making her infertile. The orphan disease is characterized by the simultaneous presence of uterine aplasia and vaginal aplasia. The syndrome may also be associated with malformations of the urinary system such as horseshoe kidneys, double ureters, renal agenesis, and in approximately ten percent of cases, skeletal anomalies. The syndrome is presumably (probably) caused by a chromosomal defect.
Her older sister and organ donor, on the other hand, already has two children and doesn't want any more. So her uterus is virtually retired – why not just pass it on? That's what surgeon Isabel Quiroga and her team thought when they performed the first uterus transplant in the United Kingdom. So far, there have been about 90 such organ transplants worldwide, including Germany, the U.S., Saudi Arabia, the Czech Republic and China. These transplants have resulted in about 50 babies.
The patient received her sister's uterus, i.e. a living donation, in a procedure that lasted more than 9 hours. This is common for uterus transplants, at least so far. The surgery was a massive success, the surgeons said.
“She [the patient] was absolutely over the moon, very happy and is hoping that she can go on to have not one but two babies. Her womb is functioning perfectly and we are monitoring her progress very closely,” Quirogadem tells The Guardian. “I'm just really happy that we've got a donor who is completely back to normal after her big op and the recipient is, after her big op, doing really well on her immunosuppressive therapy and looking forward to hopefully having a baby,” adds her colleague Prof. Richard Smith, the clinical lead at the charity Womb Transplant UK and a consultant gynaecological surgeon at Imperial College London.
While pregnancy is not possible in Mayer-Rokitansky-Küster-Hauser syndrome due to the absence of a uterus, the ovaries can still produce eggs and hormones. Thus, in vitro fertilization is possible. “Before receiving her sister's womb, the woman had two rounds of fertility stimulation to produce eggs, followed by intracytoplasmic sperm injection (ICSI) to create embryos.” A first fertilization is planned for later this year. Surgeons expect the transplanted uterus to remain functional for about five years before it is removed.
In the future, uterus transplants via living donors could realistically be possible for 20-30 UK women per year. This would help not only women who have lost their uteri due to disease, accidents or birth defects, but also those who do not desire to have children. “We have women contacting the charity [...] such as young women who say 'I don't want to have children but I would love to help others have a child' or 'I've already had my children I would love other women to have that experience.' So yes, there will definitely be a time in which that is a main source of donors,” Quiroga summarizes.
Image source: Nadezhda Moryak, Pexels
