The idea of uterine transplant is not a new concept in medicine. In 1918, a uterine transplant was attempted attempted, but unsuccessful. The latest attempted uterine transplant was in Saudi Arabia in 2000. Unfortunately, about three months after the transplant, the recipient developed blood clots and the lack of adequate blood supply caused the uterus to deteriorate. No documented attempts have been made since. However, researchers are hopeful and feel that with more study and trials, uterine transplants may be a viable method of treating infertility. In 2007, a team of doctors at New York Downtown Hospital begun selecting potential recipients for the first transplant in the United States. Actual transplantation may be years away, however.
How Would a Uterine Transplant Be Completed?Although no standard practice of uterine transplantation has been created, the procedure would be done along the same lines as any other organ transplant. First, the recipient must be screened and deemed medically acceptable to receive a transplanted uterus. A healthy uterus must be found, and like all other potential transplant organs, it must be a genetic match to the recipient. A uterus used for transplanting may come from healthy donors, but is much more likely to be harvested from the deceased. It is not likely that many healthy women would be willing to donate their uterus -- a symbol of their womanhood. Hence, that is where there is the need to turn to organ donations from the dead.
Once the uterus is transplanted, careful measures for monitoring organ compatibility are taken. Immunosuppressant drugs are given to help prevent the body from rejecting the uterus, but these drugs can be unsuccessful. The body can reject the uterus and surgery would be needed to remove it.
If the transplant is successful and there are no rejection issues, pregnancy would be the next step. More than likely, frozen embryos would be implanted rather than traditional conception. Infection prevention is of the utmost important and conception through intercourse could potentially introduce bacteria into the vagina that could compromise the transplant. Keep in mind that when people are taking immunosuppressant drugs, their immune systems aren't as effective at fighting off infection. Any infection could potentially threaten the success of the transplant and pregnancy.
Throughout the pregnancy, anti-rejection drugs would be continued to prevent rejection. If pregnancy reaches term and there are no complications, then the baby would be delivered by c-section -- too many possible complications are involved with a vaginal birth. The transplanted uterus would also be removed to prevent the mother from having to take immunosuppressant therapy for the rest of her life.
Risks Involved with Uterine TransplantHow the uterine transplant and pregnancy would possible be done sounds simple, but in reality, it is far from it. A uterine transplant is uncharted territory -- a successful transplant has yet to be used as a model. It is still experimental, which means that it is basically a process of trial and error. Any experimental procedure is not without major risks, including the risk of loss of life for the mother and/or baby. We do know that the uterus can be successfully harvested and is viable for about 12 hours, but the actual transplantation itself and the sustainment of pregnancy is a whole other story.
Organ rejection would be one the greatest risks. The human body is clever and will treat the transplanted uterus as a foreign body and will reject it to prevent any potential threat. Immunosuppressant drugs will be given for a minimum of three months following the surgery to ensure stability, but these drugs are not guaranteed to successfully prevent rejection.
Many researchers believe that the immunosuppressant drugs may be to toxic for the fetus, but this is debatable. Women who have undergone other transplants like liver and kidney transplants have successfully given birth to healthy babies. It may just be a matter of giving certain anti-rejection drugs and avoiding others. Again, this is purely speculation.
There is also a chance that a woman will not become pregnant. If she does become pregnant, even more risks are involved. Early and late miscarriages, intrauterine fetal death, and preterm birth are all possible outcomes of having a uterus transplant. Of course, the pregnancy would be closely monitored, but the health of the fetus cannot be guaranteed.
Blood clots are also a major concern with any transplant and can be life threatening. This is an issue that can be possibly prevented with more original blood vessels being transplanted or the better use of anticoagulants in the donor before harvesting. There are many possible solutions, but until an actual uterine transplant is again attempted in a human, we are left to speculate.
The bottom line is that we have little data regarding uterine transplants. The only successful transplants have been in mice. This is encouraging because mice are biologically similar to humans, but this doesn't warrant absolute hope. Plenty of procedures and drugs are effective in mice. Yet when tested on humans, they do not work. Thus, there is a need for experimentation and clinical trials. Current research is also focusing on other animals, like sheep and primates.