Answer to Question #113580 in Human Anatomy and Physiology for Khushpreet Kaur Brar

Question

How uterus transplantation is a feasible alternative to surrogacy

Answer 1

When a uterus is transplanted, a healthy uterus is transplanted to a patient in whom the uterus has been removed for one reason or another or there are congenital abnormalities of the uterus that prevent her from carrying a pregnancy. Currently, such operations are considered to be largely experimental so far, and basically such a transplant is performed from mother to daughter in order to minimize the risk of rejection. Uterus transplantation has become a reality in modern clinical conditions after more than 10 years of structured animal studies.

 Since there is no successful treatment for absolute infertility, the opportunity for these women to become a mother is often associated with surrogate motherhood, which is currently prohibited in many countries.

Technically, an uterine transplant operation consists in cutting the uterus without appendages - fallopian tubes and ovaries, with blood vessels and putting it into the recipient's small pelvis, where the uterine blood vessels are fixed and sutured. We note right away that since in traditional transplantology, organ transplantation, which is carried out not from relatives, but from a corpse or other living donor, requires lifelong use of special drugs that suppress the immune system in order to prevent the organ rejection reaction, uterine transplantation is best done from a genetic relative - mother or sister.

On average, such operations that were carried out earlier last up to 10 hours. Such an operation is considered to be quite complicated in technical terms, so it lasts so long that it is connected with the fact that the uterus has many blood vessels that feed it, as well as with the difficulty of planting this organ in the small pelvis - a very anatomically small space. When the uterus is taken from the donor, the ovaries and fallopian tubes remain in place. The cervix also remains. Of course, after such a transplantation of the uterus without the cervix of labor, if the pregnancy in the donor uterus occurs and the woman carries it before the end of the term, they are performed by cesarean section. The first uterine transplant operation was performed in Turkey in 2011 from a dead woman. In 2012, the uterus was first transplanted in Sweden from mother to daughter. In the United States, a uterus transplant was performed in 2016, and in India in 2017, also from the mother of a daughter who was born without a uterus.

The first report of childbirth in a patient with a transplanted uterus came from Sweden in 2014. It was reported that the baby was born at 32 weeks by Caesarean section.

It is also important to take into account the fact that uterine transplantation is a temporary operation, and after one or two pregnancies that ended with a cesarean section, the uterus is removed so that the patient can stop the course of immunosuppressive therapy.

Today, uterine transplant operations are carried out in specialized clinics in Western Europe, Israel, USA, India, Turkey. Note that the uterus is suitable for transplantation, even from older women who have entered menopause. Uterus transplantation is an experimental treatment, therefore, doctors offer patients more proven methods of treating infertility.