According to the World Health Organisation, infertility affects 1 in 6 people worldwide. There are many causes of infertility, both men and women. However, there are also many options to assist conception and pregnancy.
But for women with absolute uterine factor infertility (AUFI), things are more difficult. They do not have a uterus (perhaps due to being born without a uterus because of a genetic condition, or having had a hysterectomy at an age before starting a family), or do not have a functional uterus which is capable of carrying a pregnancy.
AUFI affects 1 in 500 women worldwide, and approximately 15,000 women in the UK. Until recently, the only option for starting a family has been through surrogacy and/or adoption.
However, many women experiencing AUFI want to give birth to a child of their own. And science has now made that possible, thanks to uterine (womb) transplants, a procedure which has been developed over 25 years.
Womb transplants so far
So far, 90 women worldwide have received uterine transplants which have resulted in 49 babies. It is important to continuously monitor the development of these babies, especially as the sole goal of the uterine transplant is for a live birth of a healthy infant.
It is particularly relevant and promising to see that the babies have grown well during pregnancy, with no evidence of growth restriction, and are meeting age-appropriate neonatal and developmental milestones for the 2 years they have been monitored.
Read more:
- 11 massive medical breakthroughs, in pictures
- Dr Michael Mosley: The ten most powerful daily habits for boosting your health and happiness
Excitingly, the first uterine transplant in the UK took place earlier this year. The patient was a 34-year-old with a genetic condition called Mayer-Rokintansky-Küster-Hauser syndrome (MRKH), which affects 1 in 5,000 women. This means she has AUFI as she was born with ovaries but no Fallopian tubes or uterus.
She wants children, but specifically she wants to give birth and have a biological relationship with her offspring. This ruled out adoption and surrogacy.
But her sister, who doesn't have MRKH – and was born with ovaries, Fallopian tubes and a uterus – wanted to donate her uterus to help enable this. She had completed her family, having had two successful uncomplicated pregnancies and given birth to two healthy babies.
Both women had to undergo significant pre-op medical and psychological preparation to ensure their health and wellbeing were optimised and the operation could be a success. The operations for both women involved major surgery which carries its own risk.
In addition, the major concern for a recipient is the possibility of the body ‘rejecting’ the donor womb. To avoid this, anti-rejection drugs and close postoperative monitoring are used to boost the chances of a successful transplant.
How womb transplants work
The operation to retrieve the uterus from the donor took 8 hours and 12 minutes, whilst the implantation operation took 9 hours and 20 minutes.
The most difficult stage of the procedure is preserving the blood supply, and transplanting and establishing a connected blood supply in the recipient as quickly as possible. Blood flow is monitored closely during the procedure and post-operatively.
Provided rejection is avoided, testing the function of the uterus and the success of the transplant, initially comes down to the recipient having a period – evidence that the ovaries and uterus are working together throughout a menstrual cycle. At the time of writing, the recipient has had three periods – the first she has ever experienced. She is now planning to undergo embryo transfer later this year.
If the patient becomes pregnant and everything progresses normally, the baby will be delivered by C-section. She then has a choice of trying for a second baby in due course should she wish. The uterus will then be removed and the immunosuppression treatment can be stopped, thus removing the associated risks.
Joint team Leader and Consultant Transplant Surgeon, Isabel Quiroga, said the patient was “incredibly happy” following the lengthy operation. “She was absolutely over the moon, very happy and is hoping that she can go on to have not one but two babies,” she added.
“Her womb is functioning perfectly and we are monitoring her progress very closely. As a team, we are incredibly proud to contribute to this programme and hope that it will lead to many other women benefiting from this procedure.”
There is now a uterus donor programme, including both living and deceased donors. In fact, live donors now make up 40 per cent of donors in the UK set up by the charity Womb Transplant UK.
They say they hope that based on the surgery's success, “womb transplants become a sustainable option for women suffering from the same condition. The team is dedicated to creating a long-term and sustainable transplant programme that will help women, who are currently unable to bear their own children, to realise their dream.”
About the expert, Isabel Quiroga
Isabel is the Clinical Lead for Organ Retrieval at the University of Oxford and has been the course director of the National Organ Retrieval Masterclass in the UK for 9 years.
She has a D.Phil in Transplant Immunology from the University of Oxford and a Masters in Humanitarian Medicine from The University Miguel Hernandez in Alicante, Spain She also helped to establish the first uterus transplant programme in the UK.
Her research has been published in the British Journal of Obstetrics & Gynaecology, Frontiers in Medicine and Clinical Obstetrics and Gynaecology.
Read more about women's health: