Uterine transplants coming to America

Transplantation of uterus coming to Cleveland

Reproductive surgeons at the Cleveland Clinic to start uterine transplant program

Organ transplantation has been a part of medicine for some time. Even as a medical student over 25 years ago, I had the opportunity to scrub in on transplant surgery which at that point had become somewhat routine, at least at the University of Pittsburgh where I went to school. In Obstetrics, Gynecology and Reproductive Medicine, however, organ transplantation is a relatively new phenomenon.

The idea of transplanting the uterus though is not a new one. Researchers a century ago tried this in animal studies initially without much success. The idea of performing uterine transplantation in women ultimately gained traction in Reproductive Medicine after doctors at the University of Gothenburg in Sweden reported several successful live births in 2014 following uterine transplantation.

Why would someone want or need a uterine transplant?

All successful pregnancies develop inside the uterus or womb, regardless of whether fertilization of the egg occurs naturally in the fallopian tube or in a laboratory as with IVF. Reproductive science at this time cannot enable embryos to grow or even survive outside of the body past the blastocyst stage, which is about 5-6 days after fertilization, so for the time being at least, an artificial womb is not an option.

Some women have no uterus due to congenital birth defects of the reproductive system, such as those who have a condition called Rokitansky syndrome. Others have had their uteri removed during a hysterectomy done for fibroids or uncontrollable bleeding at the time of a delivery. Still others have scar tissue (synichiae) inside the uterus from prior surgeries or infections making it impossible for a pregnancy to implant and grow.

For these women, IVF using a gestational carrier has really been the only option. Since many of these women have their own eggs, their ovaries can be stimulated to produce eggs which are then fertilized in the laboratory. A third person, known as the gestational carrier (often mistakenly called a surrogate) will then carry the pregnancy and deliver the baby.

There are several problems with using a gestational carrier including:

  • Since the carrier is paid for carrying the pregnancy and requires health insurance to cover their medical bills, this type of treatment can be very costly.
  • Not all states (or even all countries) have laws to protect the intended parents, and in some cases the parents are required to adopt their own genetic offspring.
  • The intended mother will not get to experience delivering her own child.

Why uterine transplants may not necessarily be the best idea

Organ transplantation is usually done to treat life threatening conditions. The transplantation process usually involves considerable expense and risk to the patient, including surgery (oftentimes major surgery) and years of drugs that suppress the immune system and can increase the risk of serious infections and even certain types of cancer. 

Usually that risk is well justified. Someone with liver failure will not survive without a new liver and a person with kidney failure will need frequent dialysis to live and even then they are likely to have a shorter life expectancy. The same holds true for many other types of transplantation, but is that true for uterine transplantation?

In all medical decision making, there is an attempt to balance between the risk and the benefits. So, what are those risks and benefits?

First the potential positives of uterine transplantation:

  • enables women to have a baby without "borrowing" another person's uterus

Next the potential negatives:

  • risks of surgery for the mother
  • anti-rejection drug risks to mother
  • anti-rejection drugs risks to baby
  • still need to do IVF
  • we currently have a relatively safe and effective technique
  • not neccessarily any less expensive than current techniques

Only time will tell if transplantation of the uterus is a safe and viable option, or a risky solution to a problem that already has a solution. Kudos though to the docs at Cleveland Clinic for trying to answer that question.