A uterus transplantation is a surgical procedure that transplants a healthy uterus into someone whose uterus is absent, or diseased. As part of normal sexual reproduction, a nonfunctional or absent uterus prevents pregnancy. This form of infertility is known as uterine factor infertility (UFI) for which a uterine transplant may be able to treat. There are two forms of UFI: absolute uterine factor infertility (complete lack of uterus) and Non-Absolute Uterine Factor Infertility (nonfunctional uterus). The etiology of UFI varies from congenital to acquired and includes disease processes such as "uterine agenesis, hysterectomies, uterine malformations, polyps, myomas, adenomyosis, synechiae, uterine irradiation". The first child born to a successful uterine transplant recipient was delivered by caesarian section in Sweden in 2014.
History
Studies In 1896, Emil Knauer, a 29-year-old Austrian working in one of Vienna's gynecological clinics, published the first study of ovarian autotransplantation documenting normal function in a rabbit. This led to the investigation of uterine transplantation in 1918. In 1964 and 1966, Eraslan, Hamernik and Hardy, at the University of Mississippi Medical Center in Jackson, Mississippi, were the first to perform an animal (dog) autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus. In 2010 Diaz-Garcia and co-workers, at Department of Obstetrics and Gynecology, University of Gothenburg in Sweden, demonstrated the world's first successful allogenic uterus transplantation, in a rat, with healthy offspring. As of 2023, more than 100 womb transplants have taken place, with around 50 babies having been born worldwide.
Notable cases
Germany Except perhaps in rare cases of intersex individuals, transgender women are born with a male reproductive system. While sex reassignment surgery can create a vagina for these women, the option of a uterus is unavailable to them, meaning they cannot carry a pregnancy and would need to take other routes to parenthood, whether it be a more traditional approach involving coitus or an alternative one such as adoption, egg donation, or a gestational carrier. Nonetheless, at least one uterine transplant for a trans woman occurred, for the Danish artist Lili Elbe (1882–1931). Hoping to have children with her fiancé, she underwent a uterine transplant in 1931, in conjunction with vaginoplasty, in Germany at the age of 48. However, she developed a postsurgical infection and died from cardiac arrest three months later.
Saudi Arabia The first modern day attempt at a uterine transplant occurred in 2000, in Saudi Arabia. Wafa Fageeh transplanted a uterus, taken from a 46-year-old patient, into a 26-year-old patient whose uterus had been damaged by hemorrhaging following childbirth. Because the patient ultimately needed the uterus to be removed after just 99 days, due to necrosis, whether or not the case is considered successful is disputed, but the uterus did function for a time, with the patient experiencing two menstrual cycles. Members of the medical community expressed concerns over the ethics of the procedure.
Turkey The first incidence of a uterine transplant involving a deceased donor occurred in Turkey on 9 August 2011; the surgery, performed by Ömer Özkan and Munire Erman Akar, at the Akdeniz University Hospital in Antalya, on Derya Sert, a 21-year-old patient who'd been born without a uterus. In this case, the patient enjoyed long-term success with the transplanted uterus, experiencing periods and, two years post-surgery, pregnancy. During that pregnancy, Sert underwent an abortion in her first trimester, after her doctor was unable to detect a fetal heartbeat, but this is a common complication and may not have been related to the transplant. Following another pregnancy that was initiated with in vitro fertilisation and sustained for 28 weeks, the patient finally delivered a baby on June 4, 2020.
Sweden In Sweden in 2012, the first mother-to-daughter uterine transplant was done by Swedish doctors at Sahlgrenska University Hospital at University of Gothenburg led by Mats Brännström. In October 2014, it was announced that, for the first time, a healthy baby had been born to a uterine transplant recipient, at an undisclosed location in Sweden. The British medical journal The Lancet reported that the baby boy had been born in September, weighing 1.8 kg (3.9 lb) and that the father had said his son was "amazing". The baby had been delivered prematurely at about 32 weeks, by cesarean section, after the mother had developed pre-eclampsia. The Swedish woman, aged 36, had received a uterus in 2013, from a live 61-year-old donor, in an operation led by Brännström, Professor of Obstetrics and Gynaecology at the University of Gothenburg. The woman had healthy ovaries but was born without a uterus, a condition that affects about one in 4,500 women. The procedure used an embryo from a laboratory, created using the woman's ovum and her husband's sperm, which was then implanted into the transplanted uterus. The uterus may have been damaged in the course of the caesarian delivery and it may or may not be suitable for future pregnancies. A regimen of triple immuno-suppression was used with tacrolimus, azathioprine, and corticosteroids. Three mild rejection episodes occurred, one during the pregnancy, but were all successfully suppressed with medication. Some other women were also reported to be pregnant at that time using transplanted uteri.
United States The first uterine transplant performed in the United States took place on 24 February 2016 at the Cleveland Clinic. The team was led by Dr. Andreas Tzakis. The transplant failed due to an undisclosed complication on 8 March, and the uterus was removed. In April, they reported a yeast infection had spread to one of the arteries the surgeons had connected to provide blood flow to the transplanted uterus, which damaged the artery and caused blood clots to form. In November 2017, the first baby was born after a uterus transplantation in the US. The birth occurred at Baylor University Medical Center in Dallas, Texas, by Drs. Liza Johannesson and Giuliano Testa, after a uterus donation from a non-directed living donor. The first baby born after a deceased donor uterus transplant in the US was at the Cleveland Clinic in June 2019.
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