By Sandy Hemphill, Contributing Writer, BabyMed


On February 24, a team of transplant and gynecological surgeons at Cleveland Clinic performed the first uterus transplant surgery in the United States.  The procedure is highly experimental and was performed as part of an on-going study for which the Ohio clinic is actively seeking new volunteers.  In recent years, a similar study in Sweden has resulted in four births for the nine women getting uterus transplants there.

First US Uterus Transplant

The 26-year-old woman to receive the first US uterus transplant is said to have absolute uterine factor infertility (UFI), an irreversible condition said to affect between 3% and 5% of all women around the world.  While officials at Cleveland Clinic haven’t revealed many details of the surgery, it is known that the procedure lasted nine hours and the transplanted uterus came from a deceased donor.

The Swedish Study

This study, led by Dr. Mats Brannstrom of the Sahlgrenska Academy in Gothenburg, Sweden, involved nine women who received uteri from living donors.  Most living donors were the study participants’ mothers, sisters, and friends who considered their own families complete or were post-menopausal.

Previous studies in Saudia Arabia and Turkey involved unsuccessful transplants of uteri donated from deceased strangers.  As with all organ transplants, the recipient must take immune-suppressing medications to prevent organ rejection.

The Swedish researchers hoped using the wombs of relatives might minimize the need for strong doses of these drugs that could harm a pregnancy.  A relative’s donated organ would contain a considerable amount of DNA that matches the recipient’s and this genetic match is thought to minimize the risk of organ rejection.  Theirs were also the first uterus transplants to use organs from living, rather than deceased, donors.

Baby Vincent

In September 2014, Malin Stenberg, 36, gave birth to the first baby born after a uterus transplant performed by the Swedish research team.  She and partner, Claes Nilsson, kept the circumstances of their son’s birth to themselves until baby Vincent celebrated his first birthday.  They chose to share their story to bring hope into the lives of many women who, like Stenberg, have healthy ovaries but were born without a uterus or are infertile due to uterine damage caused by injury or disease.

Stenberg’s donor was a 61-year-old family friend who has two sons and four grandchildren.  She’s now baby Vincent’s godmother.  The transplant occurred in 2013.

Vincent was born prematurely, at 32 weeks, after Stenberg developed preeclampsia.  The 3.9-pound boy was delivered via C-section and is in excellent health.

Mother and Child from Same Womb

Another woman in the Swedish study lost her uterus to cervical cancer when she was in her 20s.  This woman, who chooses to remain unnamed, was recipient of her mother’s uterus and, now, has a child of her own.  They are the first mother and child ever nurtured by and born from the same womb.  The baby, a boy, is thriving and “will always know how wanted he was,” according to his mom.

The other two Swedish mothers choose to remain anonymous at this time.

Surgery and Fertilization

As with all pregnancies following uterine transplant, Vincent was conceived by in vitro fertilization (IVF) uniting his mother’s egg and father’s sperm.  Uterine transplants involve removal and reattachment of the uterus and its blood vessels.  The transplanted uterus is not surgically attached to the fallopian tubes, however, making spontaneous conception impossible.  Recovery takes about a year before pregnancy can be attempted.

After a transplant recipient has a child or two, the transplanted uterus is removed to eliminate the need for powerful immune-suppressing drugs for any longer than necessary.  Stenberg chose removal instead of trying for another child in fear the second pregnancy would be even riskier than the first.

Who Might Benefit from a Uterus Transplant

The Cleveland Clinic press release announcing the transplant indicates the American recipient had UFI although no further details were given.  Stenberg has Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, which affects approximately one in 5,000 women.  Patients with MRKH are born with no uterus and their vagina and cervix can be affected as well.  Injury, cancer, and other medical conditions can lead to hysterectomy at a young age and, if the ovaries remain healthy, uterine transplant may restore fertility long enough to have a baby or two.

Transgender women (born male but gender-correction therapies strengthen female identities) may someday benefit from a uterus transplant but more research is needed.  Gender-correction therapies cannot overcome the XY-chromosomes of trans women.  This chromosomal difference complicates uterus transplants, fertilization, and the chance for pregnancy viability in trans women that does not exist in other women born with the XX-chromosomal signature.


Sources:
"Cleveland Clinic Performs Nation's First Uterus Transplant." Cleveland Clinic. Cleveland Clinic, 25 Feb. 2016. Web. 1 Mar. 2016.

"Womb Transplants Becoming Viable Reality in Sweden." babyMed. BabyMed.com, Jan. 2014. Web. 1 Mar. 2016.

Orange, Richard, and Fiona Macrae. "Celebrating turning one, the first baby born after a womb transplant." Daily Mail. Associated Newspapers Ltd., 21 Sept. 2015. Web. 1 Mar. 2016.

"Baby born from grandmother's donated womb." The Guardian. Guardian News and Media Limited, 25 Aug. 2015. Web. 1 Mar. 2016.

Miller, Korin. "How Does a Uterus Transplant Work, Exactly?" SELF. Condé Nast, 29 Feb. 2016. Web. 1 Mar. 2016.

Johannesson, Liza, and Stina Järvholm. "Uterus transplantation: current progress and future prospects." PMC. International Journal of Women's Health, 5 Feb. 2016. US National Library of Medicine / National Institutes of Health. Web. 1 Mar. 2016.