Image by : Pixabay / Marjon Besteman
According to the World Health Organization, infertility impacts 1 in 6 people globally, with various causes affecting both men and women. While there are numerous options to assist with conception and pregnancy, women facing absolute uterine factor infertility (AUFI) encounter unique challenges. AUFI refers to the absence of a uterus, whether due to a genetic condition resulting in being born without one or having undergone a hysterectomy before starting a family.
Approximately 1 in 500 women worldwide, totaling around 15,000 women in the UK, are affected by AUFI. Until recently, the primary options for these women to start a family involved surrogacy and/or adoption.
However, advancements in science have opened up new possibilities for women experiencing AUFI through uterine (womb) transplants, a procedure developed over the course of 25 years.
Womb transplants so far
To date, 90 women worldwide have undergone uterine transplants, leading to the successful birth of 49 babies. The ongoing monitoring of these infants is crucial, given that the primary objective of uterine transplants is the live birth of healthy babies.
Promisingly, the observed development of these babies during pregnancy has been positive, showing no signs of growth restriction. Furthermore, the infants have consistently met age-appropriate neonatal and developmental milestones throughout the two years of monitoring.
In an exciting development, the first uterine transplant in the UK occurred earlier this year. The patient, a 34-year-old woman, faced Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), a genetic condition affecting 1 in 5,000 women. MRKH meant she had absolute uterine factor infertility (AUFI) as she was born with ovaries but lacked Fallopian tubes and a uterus.
Desiring to have children and a biological connection with her offspring, adoption and surrogacy were ruled out. However, her sister, without MRKH and born with ovaries, Fallopian tubes, and a uterus, volunteered to donate her uterus to facilitate this process. Having already completed her family with two successful pregnancies and births to healthy babies, she was eager to help her sister.
Both women underwent extensive preoperative medical and psychological preparations to ensure their optimal health and well-being and increase the chances of a successful transplant. The surgical procedures for both involved major surgery, carrying inherent risks. Additionally, a significant concern for the recipient is the potential rejection of the donor womb by the body. To mitigate this risk, anti-rejection drugs and meticulous postoperative monitoring were employed to enhance the prospects of a successful transplant.
How womb transplants work
The procedure to retrieve the uterus from the donor lasted 8 hours and 12 minutes, while the implantation operation took 9 hours and 20 minutes. Preserving the blood supply during the transplant, establishing a connected blood supply in the recipient swiftly, and closely monitoring blood flow during and after the procedure are critical stages.
The success of the transplant, assuming rejection is avoided, is initially determined by the recipient having a menstrual cycle, indicating the collaborative functioning of the ovaries and uterus. As of the current update, the recipient has experienced three periods—the first in her life. She is now planning to undergo embryo transfer later this year.
If the patient becomes pregnant and the progression is normal, the baby will be delivered by C-section. Following this, she has the option to attempt for a second baby if she wishes. The uterus will then be removed, and the immunosuppression treatment can be discontinued, eliminating associated risks.
Isabel Quiroga, Joint Team Leader and Consultant Transplant Surgeon, shared that the patient was "incredibly happy" following the extensive operation. Quiroga added, "She was absolutely over the moon, very happy and is hoping that she can go on to have not one but two babies."
The recipient's uterus is functioning perfectly, and her progress is being closely monitored. The medical team takes pride in contributing to this program and hopes that it will pave the way for numerous women to benefit from this groundbreaking procedure.
The establishment of a uterus donor program, encompassing both living and deceased donors, is now in place. Live donors constitute 40 percent of donors in the UK through the efforts of the charity Womb Transplant UK.
With the success of the surgery, the goal is to make womb transplants a sustainable option for women facing similar conditions. The team is committed to establishing a long-term and sustainable transplant program, offering hope to women currently unable to bear their own children and helping them realize their dream.
About the expert, Isabel Quiroga
Isabel Quiroga is the Clinical Lead for Organ Retrieval at the University of Oxford. She has been the course director for the National Organ Retrieval Masterclass in the UK for nine years.
She earned a D.Phil in Transplant Immunology from the University of Oxford and holds a Masters in Humanitarian Medicine from The University Miguel Hernandez in Alicante, Spain. Notably, Quiroga played a key role in establishing the first uterus transplant program in the UK.
Her research contributions have been featured in prestigious journals such as the British Journal of Obstetrics & Gynaecology, Frontiers in Medicine, and Clinical Obstetrics and Gynaecology.
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