It has been a long time that researchers have been trying to help women who had been either born without a uterus or lost them for medical reasons to carry their own children. Only about a dozen babies out of about 50 attempts worldwide have now been born from a uterus provided by living donors, but never from a deceased doner…until now.

The first successful case was just published in The Lancet.. A 32-year-old woman born without a uterus (as a result of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome) but otherwise healthy, received a donated uterus from a 45-year-old mother of three who died from a rare type of stroke. She also donated her heart, liver and kidneys. The child born from this transplant has just turned one year old and is perfectly healthy and happy.

“The use of deceased donors could greatly broaden access to this treatment, and our results provide proof-of-concept for a new option for women with uterine infertility.” says Dr Dani Ejzenberg, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, who led the research. “The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities.”

The Successful Surgery

The transplant was performed September 20, 2016. The uterus was removed from the donor and then transplanted into the recipient. The surgery lasted 10.5 hours. It involved connecting the donor uterus’ and recipient’s veins and arteries, ligaments, and vaginal canals. The recipient was required to remain in intensive care for two days after surgery. She then spent six days on a specialized transplant ward. There she received five immunosuppression drugs, as well as antimicrobials, anti-blood clotting treatment and aspirin. Immunosuppression had to be continued outside of hospital until the birth.

Five months after transplantation, the uterus showed no signs of rejection. Her ultrasound scans showed no anomalies, and the recipient was having regular menstruation. She had one in-vitro fertilisation (IVF) cycle four months before transplant which resulted in eight fertilised eggs. They were cryopreserved. These fertilised eggs were then implanted, seven months after her transplant. Normally they have to wait one year to implant the eggs after the transplant but she was doing so well that they were able to do it sooner.

The pregnancy:

• Ten days after implantation – the recipient was confirmed to be pregnant.
• 10 weeks after – prenatal testing was done showing a normal fetus.
• At 12 and 20 weeks – ultrasound scans revealed no fetal anomalies.
• Throughout her pregnancy – there were no issues other than a kidney infection at 32 weeks which was treated with antibiotics in hospital.

On December 15, 2017 the baby girl was born via caesarean section (after 35 weeks and three days) at the Hospital das Clinicas, University of Sao Paulo School of Medicine. Ejzenberg said he wanted to deliver the baby a few weeks early to avoid potential problems late in the pregnancy. The baby weighed 2550g (around 6lbs). The transplanted uterus that was removed during the caesarean section showed no anomalies.

Medical team hold the first baby born via uterus transplant from a deceased donor at the hospital in Sao Paulo, Brazil December 15, 2017 in this picture handout obtained on December 4, 2018. Hospital das Clinicas da FMUSP/via REUTERS

3 days after birth both the recipient and baby were discharged with an uneventful early follow-up. The immunosuppressive therapy was suspended at the end of the hysterectomy. At the age of seven months and 20 days (when the manuscript was written), the baby, who was perfectly healthy, continued to breastfeed and weighed 7.2kg (15lbs and 14oz).

The authors from the study in The Lancet noted that the transplant involved major surgery and recipients for uterus transplants would need to be healthy to avoid complications during or after this.

Previous Attempts

The first time a procedure like this had been attempted was back in 2011 by a team in Turkey; But the procedure did not lead to a live birth. Although, this attempt did inspire Ejzenberg to begin a program in Brazil that lead to the success story. Before starting the program he traveled to Sweden to learn from doctors there who have the most experience with uterine transplantation.

The procedure is very complicated and several of the Swedish women who had received a uterus from living donors experienced complications from the immunosuppressive medication needed to keep their bodies from rejecting the transplant. The nonliving donation is even more complicated because of the timing. With a living donor you schedule the surgeries to remove, then implant immediately after removal, so it’s a little tiny bit easier. The surgery takes between 9 to 11 hours straight to complete.

There was also another attempt on a different Brazilian woman with this procedure of using a deceased woman’s uterus, but she had to have the uterus removed two days after the operation because of complications. He has two more women in his program willing to try that are awaiting suitable donors.

The Potential For Transgender Women

With uterus transplants becoming more and more successful transgender women now see hope that they could one day become pregnant — despite having been born biological males. It is theoretically possible but the body would need an immense amount of preparation.

The process would involve first a traditional male-to-female surgery – doctors would have to create a vaginal canal. Second, they would also need to make space for the uterus which would require widening the pelvic inlet since it is substantially narrower in men. Then they would need to wait about a year to heal before finally undergoing the womb transplant. That’s phase one.

Phase two: If she had stored sperm before transitioning, she could use it to fertilize a donor egg for implantation, so her baby would be genetically related to her. They would have to carefully administer hormones that would help the patient sustain her pregnancy. This would all require close monitoring.

The patient with a uterus transplant would have to take powerful drugs to prevent her body from rejecting the donor organ. After childbirth the uterus would have to be removed because these transplants are designed to be temporary. It required too many drugs to keep the body from rejecting the organ.

These are still early days for uterine transplants. Anything is possible. The great thing is, by expanding the donor pool to include deceased persons, it will greatly increase the number of uteri available for transplantation. That in turn increases the number of infertile people who could benefit from such a surgery.

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