First successful womb transplants raise hope and fear

In Sweden, nine women have received womb transplants and will now attempt to become pregnant, according to The Verge.

 

Prior to the surgery, the women – a majority of them in their 30s – had no uteri for either of two reasons: they were born without them, or had them removed due to cervical cancer. They received the wombs as part of a groundbreaking experiment that aims to see if it’s possible for women to give birth to babies using donated uteri.

 

Patients have been receiving life-saving transplants of kidneys, livers, and hearts for several years. In some parts of the world, it is now even possible to transplant other body parts, such as hands and faces. Womb transplants are unheard of, especially ones that are only intended for temporary use – just enough time for the woman to bear her own child. Doctors in Saudi Arabia and Turkey made two previous attempts, but the transplanted wombs were unable to produce offspring.

 

“This is a new kind of surgery,” Dr. Mats Brannstrom, leader of the team behind the procedure, told The Associated Press. “We have no textbook to look at.”

 

Brannstrom is also the chair of the obstetrics and gynecology department at the University of Gothenburg.

 

The nine women are under observation by Brannstrom and his team. There were a few cases of infections and minor organ rejection, but overall they are doing well. None needed intensive care post-surgery, and all were able to leave the hospital within a couple of days.

 

Just six weeks after their operation, a majority of them had their periods, which is a good sign of healthy, functional wombs.

 

Revolutionary procedure

 

The transplant operations began in September 2012. The donated uteri were not connected to the women’s fallopian tubes, meaning they are unable to have natural pregnancies. Still, the women had functional ovaries, so, prior to the surgery, some of their eggs were removed and used to create embryos through in-vitro fertilization. These embryos were then frozen. The plan now is for the doctors to transfer the embryos to the women’s temporary wombs, so they could bear their own biological offspring.

 

Many women who cannot have children due to the absence of a uterus have found hope in the procedure. One girl in a 4,500 is born without a womb – a syndrome known as MRKH.

 

35-year-old Norwegian Lise Gimre, who runs an organization for women with MRKH, believes such women would be interested in the transplant if it proves effective and safe.

 

“If this had been possible when I was younger, no doubt I would have been interested,” said Gimre, who herself was born without a womb.

 

While fertility experts acknowledge the ingenuity of the project, they have openly emphasized the fact that whether or not the transplants will lead to healthy babies is still unknown.

 

 

Medical and ethical concerns

 

The pioneering procedure has given rise to some ethical concerns; for one, it is illegal in Sweden for a surrogate to carry a pregnancy.

 

Because the donors – who are relatives and even mothers of the recipients – are still alive, some critics are wondering if it’s ethical to use their uteri for an experimental surgery that isn’t aimed at saving lives. After all, removing the womb requires the severance of many surrounding blood vessels, which could lead to complications for the donor – a risk they don’t consider worth taking.

 

University of Manchester’s bioethics expert, John Harris, however, doesn’t see what the fuss is about, as long as the donors are told what their displaced organs are being used for. He also mentioned kidney transplants – how they don’t necessarily save lives, but are widely-accepted in the medical world.

 

“Dialysis is available, but we have come to accept and to even encourage people to take risks to donate a kidney,” he stressed.

 

A similar procedure is actually being planned in Britain, but it will acquire wombs only from the dead or dying. Last year’s Turkish effort did the same, and even succeeded in getting the patient pregnant. Sadly, the pregnancy failed in just two months.

 

“Mats has done something amazing and we understand completely why he has taken this route, but we are wary of that approach,” said head of UK charity Womb Transplant UK, Dr. Richard Smith.

 

The other concern is how the pregnancies will proceed.

 

“The principal concern for me is if the baby will get enough nourishment from the placenta and if the blood flow is good enough,” he said.

 

In the defense of the procedure, Brannstrom explained that live donors were used to ensure the donated wombs were functional and healthy, free of infections such as HPV.

 

 

The next stage: For babies and for science!

 

The next crucial stage of the experiment is for the doctors to transfer the embryos into some of the nine women. This will happen some time in the upcoming months. While uterus transplants in animals such as sheep, baboons, and mice have been successful, this is the first time such a technique will attempt to produce offspring in primates.

 

After two pregnancies, the wombs will then be removed from the recipients. This will allow the women to stop taking medication that could increase the risk of everything from diabetes and high blood pressure to cancer.

 

“What remains to be seen is whether this is a viable option or if this is going to be confined to research and limited experimentation,” said Dr. Yacoub Khalaf, who is the director of the Assisted Conception unit at Guy’s and St. Thomas’ hospital in London.

 

“This is a research study,” said Brannstrom, who is encouraging everyone to be optimistic about the experiment’s results. “It could lead to (the women) having children, but there are no guarantees… what is certain is that they are making a contribution to science.”

 

In the coming month, Brannstrom and his colleagues also plan to have the first-ever workshop that will detail how a womb transplant is performed. A scientific report about their efforts is also in the works. — TJD, GMA News