Infertility is a difficult experience, but it affects one in six adults worldwide. There is a wide range of reproductive health issues that can cause infertility and each person’s experience is different.
Medical technologies continue to advance, giving people more options when it comes to fertility medicine – one being a uterus transplant.
In 2014, the first successful uterus transplant was performed in Sweden. Not only can you have a uterus transplant, but people who have had this life-changing surgery have gone on to have healthy pregnancies.
Who is suitable for a uterus transplant?
A uterus transplant is a major surgery and is only recommended for certain people. These are some of the reasons someone may undergo a uterus transplant:
- They were born without a womb.
- They were subjected to a hysterectomy (hysterectomy) for a cancerous or benign medical condition.
- They were diagnosed with uterine factor infertility (UFI) – affects up to 5% of women worldwide.
It depends on your doctor and where you live, but eligible candidates usually have to meet other criteria, such as being otherwise in good health, being a non-smoker and being between 21 and 40 years old.
Different hospitals will have different eligibility criteria. For example, some need no history of diabetes or severe kidney disease, a history of cancer for at least five years, and no history at all HIV or hepatitis B or C.
Some hospitals may also require participants to be in a stable relationship for a certain period of time before undergoing surgery, regardless of their sexual orientation.
How does a uterus transplant work?
The entire uterus transplant process, including pregnancy, usually takes two to five years. Once you’ve been deemed an eligible candidate, which can be a rigorous process in itself, you’ll need to be matched with a suitable donor. Ideally, this comes from a family member, but it is not necessary.
A donated uterus can come from a person who is living or deceased. As with patient eligibility, different hospitals have different criteria for donors. For many hospitals, living donors must be women between the ages of 30 and 50, past their “reproductive” years, in generally good health, and negative for HIV, hepatitis, gonorrhea, chlamydia, and herpes.
Before undergoing the transplant procedure, patients will need to create embryos from their own eggs or donor eggs. Eggs are collected using it IVF procedure that involves taking fertility drugs to produce eggs and then removing them. The eggs are then fertilized using their partner’s sperm or donor sperm, and the resulting embryos are frozen for future use.
The transplantation involves removing the uterus from the donor and surgically placing it in the recipient. Patients must then take immunosuppressive drugs to help prevent rejection of the transplanted uterus, and should continue to take them while the implant is in place.
Pregnancy after uterine transplantation
What sets uterus transplants apart from most transplant procedures is one – that the uterus is not a medically necessary organ unless one wishes to become pregnant, and two – the uterus transplant is removed after the pregnancy is complete.
Because of this, the main goal of a uterus transplant is to enable people to become pregnant and carry their own babies to term. However, because it is a major surgery, patients must go through a period of recovery before starting the IVF process.
There is usually a minimum recovery time of six months between transplant surgery and the time one can become pregnant. After the recovery period, the patient will undergo IVF using the embryos that were frozen before the transplant. Unlike traditional IVF, usually only one embryo is implanted at a time.
Patients should also continue to take immunosuppressive drugs during pregnancy. A successful implantation is still considered a high-risk pregnancy and babies are born through Cesarean (caesarean section), and relatively early at 35 weeks. Because most babies born with a womb transplant are premature, they may need a stay in the neonatal intensive care unit (NICU).
Womb Transplants for Transgender Women
Another important application when it comes to uterus transplants is gender-affirming care. According to World Health Organisation (WHO), gender-affirming care “includes a range of social, psychological, behavioral and medical interventions “designed to support and affirm a person’s gender identity” when it conflicts with the gender they were assigned at birth. birth.
Some trans women who were assigned female at birth (AFAB) may want the option to carry their own children during pregnancy – something womb transplants can offer.
It’s important to note that gender-affirming care looks different for everyone. While some trans women may want vaginal reconstructive surgery and a uterus transplant, others may not. Even those who have had a vaginoplasty may not want children or have no desire to become pregnant. Although there are currently no known cases trans women receiving uterus transplants is possible.
Complications of uterine transplantation
As with any medical procedure, there are potential complications when it comes to a uterus transplant. Patients must undergo a number of medical procedures and surgeries, including IVF, caesarean section, implant insertion and removal.
In many hospitals, this surgery is a minimally invasive procedure performed with robotic surgery. The biggest possible risk of uterine transplants include:
- Nerve injury
- Blood vessel injury
- Injury to the bowel, bladder or ureters
- Reactions to immunosuppressive drugs, including diabetes and kidney damage
How to find a uterus transplant provider
This technology is still in its early stages, but has been undergoing clinical trials since May 2023. As of 2020, approximately 100 uterus transplants have been performed worldwide, although this number has since increased and is available in countries such as United States, Sweden, Czech Republic, India and Turkey.
Some people may practice medical tourism in order to find the best care at a price they can afford. Uterus transplants are most often performed in research hospitals. It is important to conduct extensive research to find the best possible care with providers who practice within a specific legal and ethical framework.
Medicine continues to improve every day, and uterus transplants are just one revolutionary advance in the fields of fertility and reproduction.
