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The uterine transplant is the surgical procedure whereby a healthy uterus is transplanted into an organism whose uterus is absent or diseased. As part of the normal mammalian sexual reproduction process, a diseased or absent uterus does not allow for normal embryonic implantation to occur, effectively rendering a female infertile. This phenomenon is known as uterine factor infertility (UFI). The uterine transplant is currently being proposed as a potential treatment to this form of infertility. The world's first successful uterine transplant was conducted by a team of doctors from Akdeniz University Hospital in southern Turkey on the 9th of August 2011.[improper synthesis?]
In 1896, Emil Knauer published the first study of ovarian autotransplantation documenting normal function (in a rabbit) and that led to the investigation of uterine transplantation in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform an animal (dog) autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus. In 2011 Edwin Ramirez M.D, et al.demonstrated that a pregnancy can be carried in a sheep transplanted uterus under the influence of immunosuppressive therapy. These experiments initiated in 2001 as a Ramirez family project at University of Texas, Odessa and ended in Bogota, Colombia at the La Salle University.
In humans: In 1931, Lili Elbe died from organ rejection three months after receiving one of the world's earliest uterine transplants. With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred (Confino et al. 1986). In Saudi Arabia in 2000, a uterine transplant was performed by Dr. Wafa Fagee from a 46 year old hysterectomy patient into a 26 year old recipient whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days, however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful. Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns, which have been addressed in the literature.
A 21-years-old Turkish woman named Derya Sert, who was born without a uterus, was the first woman in history to have received a womb from a deceased donor. The operation, performed on August 9, 2011 by Dr. Ömer Özkan, Dr. Munire Erman Akar and their team at Akdeniz University Hospital in Antalya, Turkish Riviera was and still is the world's first successful uterus transplant surgery. Ms. Sert has had 6 menstrual periods post-surgery and it is said that the uterus is fully functioning. However, the Turkish medical team who performed the delicate surgery is still cautious about declaring the operation a complete success. "The surgery was a success. But we will be successful when she has her baby", Ozkan said. "For now, we are happy that the tissue is living".
On the 12th of April 2013, Akdeniz University announced that Derya Sert was pregnant. The statement made by the university hospital also added that Sert would give birth by C-section to prevent any complications. On 14 May 2013, it was announced that Sert terminated her pregnancy in its 8th week following a routine examination where doctors failed to detect a fetal heartbeat.
Uterus transplantation starts with uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates. It may need to be stored for e.g. transportation to the location of the donor. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h. The following insertion procedure, with vascular anastomosis, has not been fully developed in animal models, indicated by frequent thrombosis formation.
The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation
In their paper entitled "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" published in Transplant International, Ariel Lefkowitz, Marcel Edwards, and Jacques Balayla from McGill University developed a set of criteria deemed to be required for the ethical execution of the uterine transplant in humans. These findings were presented at the International Federation of Gynecology and Obstetrics' 20th World Congress in Rome in October 2012. An update to "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" has since been published in Fertility and Sterility
Application on transgender women
- Women with Swyer syndrome have male genetics and lack ovaries, but have a uterus. Similarly to trans women, they need hormone replacement therapy to induce female puberty and maintain female secondary sex characteristics. Such women have had successful pregnancies, though obviously requiring egg donation and IVF.
- In the case of most trans women who began HRT past male puberty, the pelvis has failed to develop femininely and broaden as it would have before or during puberty. However, as proven by Nadya Suleman (octuplets), Lina Medina (youngest mother) and Stacey Herald (smallest mother at 71 cm ), a small pelvis is not an obstacle to gestation, even in extreme cases. Delivery would be via c-section.
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- Knauer, Emil (1896). "Einige Versuche über Ovarientransplantation bei Kaninchen" [An attempt at ovary transplantation in rabbits]. Zentralblatt für Gynäkologie (in German) 20: 524–8.
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- Ramirez, Edwin Ricardo; Ramirez Nessetti, Doris K.; Nessetti, Matthew B.R.; Khatamee, Masood; Wolfson, Marla R.; Shaffer, Thomas H.; Ramirez, Viviana Zuluaga; Ramirez, Hugo A. (2011). "Pregnancy and Outcome of Uterine Allotransplantation and Assisted Reproduction in Sheep". Journal of Minimally Invasive Gynecology 18 (2): 238–45. doi:10.1016/j.jmig.2010.11.006. PMID 21354071.
- "Nicole Kidman as the world's first reported woman with surgically corrected Harry Benjamin Syndrome". Shb-info.org. Retrieved 2012-11-20.
- Nair, Anjana; Stega, Jeanetta; Smith, J. Richard; Del Priore, Giuseppe (2008). "Uterus Transplant". Annals of the New York Academy of Sciences 1127: 83–91. doi:10.1196/annals.1434.003. PMID 18443334.
- Grady, Denise (March 7, 2002). "Medical First: A Transplant Of a Uterus". The New York Times.
- Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (2012). "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Transplant International 25 (4): 439–47. doi:10.1111/j.1432-2277.2012.01438.x. PMID 22356169.
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- "World's first successful uterus transplant performed in Turkey". Rt.com. Oct 2011. Retrieved 2012-11-20.
- "Nurse hopes to have world's first baby from a transplant womb donated by her own mother". The Daily Mail. 18-Oct-2011.
- Derya Sert'in gebeliği sonlandırıldı. CNNTurk.com. (Turkish)
- Brannstrom, M.; Wranning, C. A.; Altchek, A. (2009). "Experimental uterus transplantation". Human Reproduction Update 16 (3): 329–45. doi:10.1093/humupd/dmp049. PMID 19897849.
- A. Lefkowitz, M. Edwards, J. Balayla, O081 THE MONTREAL CRITERIA FOR THE ETHICAL FEASIBILITY OF UTERINE TRANSPLANTATION, International Journal of Gynecology & Obstetrics, Volume 119, Supplement 3, October 2012, Page S289, ISSN 0020-7292, http://dx.doi.org/10.1016/S0020-7292(12)60511-6
- Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation.A Lefkowitz, M Edwards, J Balayla - Fertility and Sterility, 2013. doi:10.1016/j.fertnstert.2013.05.026
- "World's smallest mother shows off baby number three". The Daily Mail. 2010-07-26.
- Documentary on Uterine Transplants
- Uterine Transplants
- New York Times Article on Successful Uterine Transplant