Born without a uterus, a 21-year-old Indian woman may now be able to have children. Wanting her daughter to experience childbirth, the woman’s mother, 43, volunteered to have her uterus transplanted.
This procedure was the first of its kind to be done in India. On Thursday in the city of Pune in southwest India, a surgical team at Pune’s Galaxy Care Hospital performed the eight-hour surgery. Dr. Shailesh Puntambeka, the hospital’s medical director, led the surgery.
The two patients are reported to be doing well.
Nonetheless, doubts remain about the daughter’s ability to conceive. Only six babies have ever been delivered from a womb transplant, according to Dr. Mats Brännström, a professor of obstetrics and gynecology at the University of Gothenburg in Sweden. Two of these babies were from the same mother.
According to Dr. Puntambeka, “the procedure is difficult because multiple large arteries are to be joined there, and veins that are small and short. It is technically very tough.”
The complexity of the surgery makes successful uterus transplants very rare.
In 2014, Dr. Brännström’s Swedish surgical team led the first successful uterus transplant. Surgeons around the world had tried eleven times to perform the procedure before Dr. Brännström’s success.
Dr. Brännström’s surgical team has performed all five successful uterus transplants since then.
Dr. Puntambeka and his team practiced on cadavers in Germany and the United States for a year in order to prepare for the complex surgery. The uterus transplant they performed is only the 30th attempt in the world.
According to Dr. Brännström, attempts have also been made in the United States, Brazil, Sweden, China, Germany, Serbia, Czech Republic, Saudi Arabia and Turkey.
The Indian woman who received the transplant will have to wait a year before trying to become pregnant through invitro fertilization (IVF). Her body must have enough time to heal and adjust to the new uterus.
“We are responsible for the patient and fulfilling their dreams of becoming a mother, which was impossible for them until now,” said Dr. Puntambeka. Though he has a big “responsibility on his shoulders,” he is feeling “relaxed and confident.”
If the woman is able to conceive, she will give greater hope to the many women with uterine infertility, or Mayer-Rokitansky-Küster-Hauser syndrome, caused by an absent, removed or diseased uterus. One in 5,000 women of fertile age, approximately 1.5 million women, have the condition.
There are also numerous transgender women, as well as women with hysterectomies, who desire to have children.
Instead of having to adopt or find a surrogate mother, these women could soon have access to uterus transplants.
The transplant begins with IVF, during which the eggs are removed from the patient. Surgeons then fertilize the eggs with sperm and place them in a freezer.
Next, the surgical team removes the uterus from the donor and transplants it into the recipient.
To ensure the recipient’s body does not reject the new uterus, the recipient must wait about a year to attempt pregnancy. When a year has passed, surgeons take the embryos out of the freezer and implant them in the new uterus.
Following the embryo implantation, doctors monitor the patient for pregnancy.
If the transplant is successful, the patient soon conceives a child. After she has her desired amount of children, doctors usually remove the transplanted uterus so that the patient no longer has to take immunosuppressive drugs. Removing the uterus also minimizes the risk of long-term side effects and of the body rejecting the new uterus.
This removal, however, may not be necessary in some cases.
Nevertheless, it will take time for uterus transplants to become more accessible. According to Dr. Brännström, the procedure requires more research.
“We need more data from clinical trials,” said Brännström. “It will be at least 3-5 years before this will become a clinical procedure.”
