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Posted on: July 15, 2019 at 7:47 pm
Last updated: August 3, 2019 at 12:49 pm

On Tuesday, July 9, the Cleveland Clinic in Ohio announced that the first baby gestated in a uterus transplanted from a deceased donor has been born in North America [1]. The girl was conceived through in-vitro fertilization and born through Caesarean section in the hospital. According to the clinic, they performed five trials with uteruses from late women and three were successful. This baby is the first to be born and two of the women are awaiting embryo transfers.

1 out of every 500 women of reproductive age is affected by Uterine Factor Infertility, an irreversible condition which renders a woman unable to get pregnant [2]. She could either have been born without a uterus, had it removed due to a medical condition, or for some reason, the uterus isn’t functioning properly. Fertility treatments and IVF would be unable to help the situation. Surrogacy was the first medical breakthrough for these women, whereby their babies are carried by other women. However, surrogacy usually comes with legal complications and in certain situations, it’s restricted, banned or completely unavailable. 

In 2012, for the first time in world history, Dr. Mats Brannstrom, a Swedish doctor led his team to perform nine uterine transplants from living donors [3]. 7 were successful and resulted in five pregnancies. They set the pace for other doctors to explore possibilities with uterine transplants. In 2017, the first baby from a deceased donor’s transplanted womb was born in Brazil [4]. The 32-year-old woman who had been born without a womb received one from a 45-year-old woman who died of a stroke. The delivery was successful Brazil set the record. In June 2019, the second of such transplants resulted in a live birth in the U.S.

The first of its kind in North America

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The baby’s mother is a patient in her mid-30s who was born without a uterus. According to the hospital, the entire process lasted about fifteen months and for this woman, pregnancy was “not excessively complicated”.

The clinic aims to make uterus transplantation a less tedious and strenuous journey for the women who need to have them done.

“The transplantation of a uterus into a woman is a complex procedure that requires suppression of her immune system response,” says Andreas Tzakis, transplant surgeon. “Through this research, we aim to make these extraordinary events ordinary for the women who choose this option. We are grateful to the donor. Their generosity allowed our patient’s dream to come true and a new baby to be born.”

The doctors explained that the procedure itself was a tricky one because the donor is deceased. Transplants involving a living donor would have been easier to coordinate with fewer risk factors to consider since the organ can be extracted and immediately transplanted. The transplant team was uncertain of the viability of the uterus from the deceased donor, making the entire process one big, dangerous gamble. Fortunately, the scale tipped in their favor. 

The entire process

The clinic is looking to perform more transplants soon, but they are emphasizing the fact that the process is still in the research phase.

“It’s important to remember that this is still research, but it’s exciting to see what the options may be for women in the future,” says Uma Perni, A maternal-fetal medicine specialist at the clinic.

According to an Infographic on the clinic’s website, the entire procedure spans eight phases, starting from the examination process to the birth of the child [5].

It starts with the screening process whereby each woman is tested for the feasibility of the procedure. She must have total UFI which cannot be managed by any other form of treatment. The clinic plans to perform more transplants on ten women between the ages of 21-39 as part of the research study.

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The second step is a more in-depth evaluation where the several medical teams, psychiatrists and social workers would evaluate each woman’s mental and social fitness for the procedure. They would also be given extensive explanations of the risks and limitations involved.

Next, the search for a viable uterus from a deceased donor begins. If a good match is found, the recipient’s next of kin would be required to sign their consent for the main process to begin.

IVF comes next whereby the ovaries are stimulated to release multiple eggs at once. After extraction and fertilization, six of the most viable embryos are selected and frozen. 

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Preceding the transplant is the anti-rejection drug therapy. Organ rejection is one of the major reasons why transplants failed in the early 2000s (along with thrombosis and infection). The recipient’s body would sooner or later begin to reject the organ, so anti-rejection medications are administered to prevent the occurrence. The uterus is extracted from the donor’s body, transplanted into the recipient’s, and the blood vessels would be very careful connected. The entire procedure lasts about 6-8 hours. 

The next step is to wait for the uterus to heal completely. A few months after the surgery, the recipient would begin to have her periods again. After a period of 6 months, the uterus would be fully healed. The embryos would then be transplanted and implantation may begin.

Organ rejection is such a serious limitation that the recipient would have to take anti-rejection pills throughout the pregnancy, also coming in for monthly biopsies to keep things on track.  A highly-specialized team of obstetricians would monitor the pregnancy from start to finish.

At the end of the gestation period, the baby would be delivered via C-section. The woman is only allowed to have one or two kids and a hysterectomy would be performed. This is done because the anti-rejection medications would have to be discontinued after a short while. Long-term exposure to these drugs can be harmful.

If all factors and everything goes according to plan, a new life would be created through a priceless gift from a deceased donor. 

Sources:

  1. The Associated Press. Baby born from dead donor’s transplanted womb in U.S. first. CTV News. https://www.ctvnews.ca/mobile/health/baby-born-from-dead-donor-s-transplanted-womb-in-u-s-first-1.4500433. Retrieved 11-07-19
  2. Hur et al. Uterine Factor Infertility: A Clinical Review. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/31021928. Retrieved 11-07-19
  3. Gholipour, Baha. Swedish Doctors Transplant Wombs into 9 Women. Live Science. https://www.livescience.com/42530-women-received-womb-transplants.html. Retrieved 11-07-19
  4. Associated Press. Brazilian baby is first born using uterus from deceased donor. NBC News.https://www.nbcnews.com/health/health-news/brazilian-baby-first-born-using-uterus-deceased-donor-n944006. Retrieved 11-07-19
  5. Admin. For the First Time in North America, a Woman Gives Birth After Uterus Transplant From a Deceased Donor. Cleveland Clinic. https://health.clevelandclinic.org/for-the-first-time-in-north-america-woman-gives-birth-after-uterus-transplant-from-deceased-donor/. Retrieved 11-07-19
  6. Admin. What is uterine factor infertility? Altora Health. https://altorahealth.com/what-is-uterine-factor-infertility/. Retrieved 11-07-19
  7. Admin. Using a Surrogate Mother: What You Need to Know. Web MD. https://www.webmd.com/infertility-and-reproduction/guide/using-surrogate-mother. Retrieved 11-07-19
  8. Staff writer. Deep Vein Thrombosis (DVT). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557. Retrieved 11-07-19
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