First transplantation of a uterus

Pregnancy with transplanted uterus?

09/20/2012

Swedish doctors have successfully transplanted two wombs (uterus) to women so they can get pregnant. The procedure is highly controversial in the professional world, because on the one hand no statements can be made about the chances of success for a pregnancy and in case of an actual pregnancy, there may be a threat to the embryonic development of the transplanted organ.

The physicians of the Sahlgrenska University Hospital in Gothenburg transplanted the two patients' wombs from their mothers to enable them to get pregnant. In the opinion of the chairman of the German society for reproductive medicine, Christian Thaler, an ethically extremely borderline intervention. Although the Swedish doctors evaluate the smooth operation of the operation as quite successful, but they do not want to talk of a comprehensive success, even before the two women have not actually got pregnant.

Enables the uterus transplantation an artificial insemination?
The medical possibilities are subject to constant change, which opens up previously unimagined option. These include the now performed grafting of the uterus. Both patients would have been permanently denied without the intervention of the desire to have children. One patient had already been born without uterus, the other must be removed because of a cancer. The transplant was therefore the last option for them to get their own children. However, it can be said at the earliest in a year's time whether this attempt will succeed. Because as long as the women should wait with a pregnancy to minimize the risk of complications, explained the attending physicians to Mats Braennstroem of the Sahlgrenska University Hospital. After the one-year waiting period, the doctors plan the first attempt at artificial insemination. Patients should be given their own previously frozen eggs.

Maximum two pregnancies with transplanted uterus
Up to now, the Swedish experts have been unable to identify the chances of successful artificial insemination in women with a transplanted uterus. The head of the surgical team, Mats Braennstroem, explained that even with artificial insemination under normal circumstances, the chances of success are only 25 to 30 percent. Higher chances of success are therefore not to be expected for the two women with transplanted uterus, especially since the patients are already between the ages of 30 and 40 years. The transplanted uteri should be removed after presentation of the doctors at the latest after two pregnancies. For as long as the transplanted organs are in the patient's body, women must take medicines that suppress their immune system and prevent organ rejection. Despite the medication, the likelihood of rejection is about 20 percent, explained the doctors. According to the Sahlgrenska University Hospital, the two weekend operations were the first of their kind and were based on a decade of previous research into the possibilities of such an intervention. Previously, comparable transplants were previously performed on mice only.

Uterine transplant ethically borderline
According to the chairman of the German Society for Reproductive Medicine, Christian Thaler, has been with the current operation „an experiment with two patients“ whose outcome is uncertain. His principle concern was, „During the course of pregnancy, the uterus has to undergo a variety of changes that are of the utmost importance to the well-being of the child“ and there are considerable doubts as to whether and to what extent this will work for a transplant, said Thaler to the news magazine „TIME Online“. If a successful fertilization actually takes place, this is no longer reversible and thus becomes one „Experiment with two patients each - mother and baby.“ Although he has a basic understanding of the desire of women and their willingness to leave no stone unturned, but the current uterus transplants are „ethically absolutely borderline.“

More uterine transplants planned
How many women could benefit from such an operation, the Swedish doctors clarified by case numbers to the patients without utero. In Sweden, about two to three thousand women remain childless because they have no uterus. Although a transplantation could create the basic conditions for a successful pregnancy, it would not be guaranteed. Due to ethical concerns, Sweden's Ethics Council initially blocked the current interventions, but approved operations in May, with the requirement that a dedicated committee monitor the transplants and their consequences. After the interventions on the weekend went without complications, corresponding operations are now planned at eight other women. (Fp)

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Picture: Martin Büdenbender