A baby has been born to a mother who had a uterus transplant from a deceased woman, in a world first.
An unnamed 32-year-old woman, who was born without a uterus, received the womb of a 45-year-old donor in September 2016, during an operation at the University of São Paulo, Brazil.
The donor died of a brain hemorrhage caused by a stroke. In life, she had given birth to three children, according to a case study published in the latest edition of The Lancet journal.
In a 10-hour operation, surgeons linked the donor's uterus to the woman's arteries, veins, ligaments and vaginal canal. Four months prior to the operation, the recipient had one IVF cycle, providing her with eight fertilized eggs which were then frozen.
Doctors implanted the fertilized eggs seven months after the procedure. Ten days later, the woman was pregnant, and gave birth to a healthy baby daughter via C-section in December 2017.
Surgeons removed the uterus during the C-section, and the woman was allowed to stop taking immunosuppressant drugs.
It is hoped that this, the first ever uterine transplant involving a deceased donor and the first uterine transplantation in Latin America, could enable more women struggling with fertility issues to undergo treatment without having to wait for a live donor.
In the U.S., around 10 percent of women aged between 15 to 44 struggle with fertility, according to the Centers for Disease Control and Prevention. According to the authors of the case study, around one in 500 women have infertility associated with the womb. Before uterine transplants, these women could only adopt children, or use a surrogate.
The first successful live uterus transplant took place in Sweden, in 2014, prompting a rise in uterus transplant programs across the world, wrote the authors of the case study.
But past treatments involving deceased donors failed. In one case in 2011, doctors in Turkey attempted to use a dead donor’s womb to carry through a pregnancy, but the expectant mother miscarried two years later, even though the graft appeared healthy.
Dr Dani Ejzenberg, a gynecologist of the University of São Paulo who worked on the paper, told Newsweek that the baby’s motor and neurological skills are developing normally, and the mother hasn’t experienced any complications.
Dr Wellington Andraus of the department of Gastroenterology at the University of Sao Paulo who also worked on the case study told Newsweek the woman’s story is a “source of hope” for patients struggling with fertility caused by the uterus or a lack thereof.
Next, the team will repeat the procedure in two more patients. “We are focused on improving our protocol to be able to repeat this success story,” Ejzenberg said.
Dr. Richard Kennedy, President of the International Federation of Fertility Societies, who was not involved in the work, commented that the organization “welcomes this announcement, which is an anticipated evolution from live donors with clear advantages and the prospect of increasing supply for women with hitherto untreatable infertility."
However, he cautioned: “Uterine transplantation is a novel technique and should be regarded as experimental.”
As with all medical developments, he continued, approval from institutional review boards is needed and appropriate safeguards must be put in place before it can become a common treatment.
Dr Srdjan Saso, senior registrar in obstetrics and gynecology at Imperial College London, U.K., said the authors should be congratulated for their “extremely exciting” work.
“This successful demonstration demonstrates a few advantages over live donation. It enables use of a much wider potential donor population, applies lower costs and avoids live donors’ surgical risks,” he said.
