- Women with an absent or dysfunctional uterus cannot hope to go through a pregnancy. The only options for them to have a child is through adoption or through gestational surrogacy.
- Landmark uterus transplant procedure by Indian surgeons offers 21 year old Indian woman the opportunity to go through a pregnancy by in vitro fertilization (IVF).
- Nevertheless, the procedure is complicated and fraught with risks both for the donor and the recipient.
is still in its infancy and not many successful transplants have taken place in the world, though several attempts have been made so far. Uterus transplantation for the first time brings together the fields of assisted reproductive technology and transplant medicine. It is a not a life-saving transplant surgery but improves quality of life of the recipient by making it possible for her to have her own baby. However, there are strong ethical, legal, and social considerations that need to be taken into account for performing such a non-life saving transplantation, when other methods like surrogacy are available, and far safer, achieving the same results.
Few such successful surgeries have been performed in a few countries like Sweden and USA where successful babies have been delivered. Once the baby is born, the uterus is removed through another operation to avoid dependancy on life long immunosuppressive drugs.
‘Uterus transplant offers women the opportunity of successfully carrying a pregnancy. However the risks of the surgery and immunosuppression treatment has to be weighed against the benefits.’
The current procedure has been carried out at Galaxy Care Laparoscopic Institute in the bustling city of Pune, in the western part of India. Whatever maybe the ethical considerations, it no doubt heralds a new chapter in the Indian transplant program, which so far has resulted in transplants of organs and composite tissues such as heart, lungs, liver, kidneys, pancreas
, small intestine, hand, larynx and now uterus. Many of these organs have come from brain dead donors where the family has consented to donate. Last year, in India it is estimated that close to 2,300 organs transplants took place from brain dead donors and 10,000 transplants happened from live donors.
Indeed this effort is laudable, offering a young woman the possibility of going through a pregnancy and giving birth.
Womb Transplant Procedure in Pune - The Unfolding of Events
- The 21 year old woman who received her mother's uterus suffers from a congenital absence of the uterus, a condition referred to as absolute uterine infertility.
- She decided to opt for a uterus transplant operation as she wanted to undergo a pregnancy and have her own baby. Fortunately, the doctors found her mother to be a suitable candidate for the womb donor.
- The donor's uterus was retrieved using a minimally invasive laparoscopic technique and transplanted into the recipient in a procedure that lasted more than 10 hours.
- The recipient will be observed closely over the next fortnight to see if she is stable and to monitor the transplanted uterus by regular ultrasound imaging to see if it is
functioning normally and receiving proper blood flow.
- If the recipient remains healthy and well, and the uterus is functional, she will be discharged and will need to continue taking immunosuppressive drugs to ensure that her body does not reject the new uterus, a major cause of failure of transplants in general.
How Will The Recipient Undergo A Future Pregnancy?
- To enable the woman to have a pregnancy, her eggs have already been retrieved and frozen. In the near future, sperms will be implanted by In Vitro Fertilization (IVF) and the resulting embryos will be frozen for future use.
- A year after the transplant, having ensured that the uterus is not at danger of rejection, the frozen embryos will be implanted into the uterus and the woman monitored for pregnancy.
- Should a pregnancy result, the woman will be closely monitored during the entire pregnancy and the baby delivered by Cesarean section.
- Once the woman has delivered a baby, the transplanted womb will be removed and she will be taken off the immunosuppressive agents.
What The Critics Say About The Procedure
While the country, and the medical fraternity in particular, has reason to feel proud of this successful landmark procedure, voices of disapproval are being raised about the safety and the need for this procedure.
- The biggest argument against the procedure is that, there is no guarantee that the procedure will result in a pregnancy.
- It is a relatively risky and complicated procedure for both the donor as well as recipient.
- The pregnancy for the transplanted recipient needs help of assistive reproductive technology whose success itself is around 30%.
- The immunosuppressive drugs to avoid rejection of the uterus may harm the baby.
- Other simpler methods can be easily encouraged like adoption and gestational surrogacy.
All these risks combine together to make uterus transplant a relatively unpopular method. Even internationally, this is one transplant that has created substantial uproar.
Future Prospects of Uterus Transplant
Current research in the field of tissue and organ engineering is evolving in a big way. In the future, if a uterus happens to be engineered in the lab from stem cells, and proves to be functional, it could be transplanted without the need for immunosuppressive therapy,
and the fear of rejection looming large like a Damocles sword.
To sum it up
Like all things in life, there are different ways to look at the same situation. Whilst the critics have their points, the supporters may argue that any major surgery carries a certain amount of risk and the joy of holding one's own baby following the culmination of a successful pregnancy is worth the risk.
All things said, the procedure is currently in its nascent stages and has a long way to go before it evolves. The techniques need much refinement, ensuring improvements to minimize the risks and improving outcomes
that are acceptable in a clinical setting. Only time will tell. Let us wait and see, and hope for the best.
- Uterus transplantation: current progress and future prospects - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4751897/)