Womb transplants in nine women have been declared a success in Sweden. It was announced Monday that the efforts, led by Mats Brannstrom, chairman of the OB/GYN division at the University of Gothenburg in Sweden, were a success. In February, he and his colleagues are to lead a pioneering womb transplant workshop and are expected to produce a full scientific report in the near future.
Brannstrom reports that all the candidates are faring well, and that many began menstrual cycles within six weeks of the procedure, indicating proper function and recovery. The majority of the women were in their 30s, and all were discharged from the healthcare facility within days. Neither the donors nor the recipients needed extensive aftercare, though one of the women reported a minor uterine infection. The health of the donors was checked extensively for viruses, such as HPV to ensure there was no spread of disease to the recipients. According to university orator Krister Svahn 10 transplants had initially been planned, but as a result of a medical condition one of the women could not continue.
Some of the women had their wombs removed because of cancer, and others were born with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, a congenital defect where one is born without a uterus. MRKH affects one in 4500 females.
The women in Sweden will need to undergo in-vitro fertilization (IVF), despite all having ovaries and successfully producing their own eggs, as the transplant did not connect the uteri to the Fallopian tubes. The women have previously frozen embryos awaiting implantation. The wombs will be removed after a limit of two pregnancies because of the side effects of anti-rejection drugs, which can include hypertension, diabetes, anemia, inflammation and psychological effects. Based on previous transplant studies it is thought that these drugs do not cause harm to fetuses. Similar transplants have been successful in mice, sheep and baboons, though no offspring were produced from the primates.
“This is a new kind of surgery,” Dr. Mats Brannstrom told The Associated Press in an interview from Gothenburg. “We have no textbook to look at.”
Two previous womb transplants were attempted in Saudi Arabia and Turkey but both failed to produce children. The instance in Turkey involved a 23-year-old woman, Derya Sert, who received a transplant from a deceased donor in Aug 2011. Her pregnancy was announced in April 2013 after receiving IVF. Unfortunately, she miscarried two months later.
The first ever procedure where a womb was transplanted into a human patient was in Saudi Arabia in 2000. A live donor was used, but the womb had to be extracted from the recipient three months later due to a blood clot.
Dr. Richard Smith, head of the United Kingdom charity Womb Transplant UK, says he understands why Brannstrom chose the route he did and called the procedure “amazing,” as the womb transplant was a success in Sweden. But he also says he remains circumspect about the outcomes of potential pregnancies; his primary concern is whether the fetuses will receive enough placental nourishment and if the in-utero blood flow will be sufficient to sustain life.
An opposing view comes from John Harris, a bioethics expert at the University of Manchester, who says he see no problem as long as all donors are properly informed. He compared the removal of uteri to a radical hysterectomy, except with increased risk to the donor because of the need to remove a larger area of the surrounding blood vessels to ensure adequate blood flow to transplanted organ.
Harris goes on to state that British officials question the ethics of the procedure and that the use of living donors is controversial, being that the procedure does not save lives. British doctors plan to use only the wombs of dead or dying donors. Hungary also has plans for womb transplantation, though Sweden is most advanced.
Lise Gimre, a 35-year-old Norway woman who was born without a uterus and runs an organization for women with MRKH, says she thinks the procedure would appeal to many women with MRKH if it substantiates effectiveness and is deemed low risk. Producing children via surrogacy is illegal in many countries in Europe and, as a result, Swedish and Norwegian women who are unable to conceive naturally are left with few choices to have biological children.
Brannstrom remains optimistic about the womb transplant success in Sweden, though he doesn’t discount the possibility that his revolutionary technique may not lead to the production of offspring. “This is a research study,” he said. “It could lead to [the women] having children, but there are no guarantees. What is certain is that they are making a contribution to science.”
By Apryl Legeas