Uterus transplantation

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.

History

In 1896, 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.^{[citation needed]}

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.

The first mother-to-daughter womb transplant was done by Swedish doctors at Gothenburg University.

Turkey

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 the first female to have successfully received a uterus transplant was pregnant. The statement made by the University Hospital also added that Mrs. Sert would give birth by C-Section to prevent any complications. On 14 May 2013, it was announced that Mrs. Sert terminated her pregnancy in its 8th week following a routine examination where doctors failed to detect a fetal heartbeat.

Procedure

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.^{[citation needed]}

Application on transgender women

It may be possible for trans women to receive uteruses in the future. Some concerns regarding genetics, anatomy and hormones addressed below:

1. 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.
2. 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.

External links

• Documentary on Uterine Transplants
• Uterine Transplants
• New York Times Article on Successful Uterine Transplant