First baby born from a uterus transplant donated by a deceased woman
In recent years, more than a dozen babies have been born in Sweden, the United States and Serbia thanks to donated and transplanted wombs from a living relative (often the donation is from the woman’s mother), but it is the first time that a baby born from a uterus donated by a deceased patient.
The event took place at the hospital of the University of São Paulo School of Medicine in Brazil.
Fewer than 5% of women in the world have a fertility problem related to the uterus. These are women who have structural alterations of the uterus that interfere with the ability to conceive and continue a pregnancy.
The Brazilian team, whose study was published in the authoritative scientific journal Lancet , followed the protocols established by Dr. Mats Brännström and his team at the University of Gothenburg, Sweden, where the first uterus transplant took place in 2013 , that from a living donor , which led to a full-term pregnancy in 2014.
From uterus transplant to pregnancy
The woman who had the organ transplanted was 32 years old at the time of the surgery and was born without a uterus due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, which affects one in 4,500 women.
This congenital disorder is characterized by aplasia (absence) of the uterus and upper (2/3) portion of the vagina but with normal development of secondary sex characteristics and a normal 46,XX karyotype. The woman’s ovaries were normal and functioning, and months before her uterus transplant, she underwent IVF. Her oocytes were collected, which were fertilized in vitro obtaining her or eight embryos of good morphology which were cryopreserved in the hope of being used after the uterus transplant.
The donor, a 45-year-old woman who died of a stroke, was chosen because she had had three vaginal deliveries in her lifetime, had no sexual history of disease, and her blood type, O-positive, matched that of her receiving.
The procedure to transfer the uterus from the donor to the recipient lasted more than 10 hours, by which time veins, arteries, ligaments, and the vaginal canal were connected with the donated uterus. The patient remained in the hospital for eight days and received five immunosuppressant drugs to curb the body’s natural instinct to fight and reject a transplanted organ.
Five months after the transplant, for the first time in her life, the transplant woman experienced menstruation.
After seven months of observations the doctors implanted a single fertilized egg, even though in previous uterus transplants, the doctors had waited a full year before implanting. The shorter waiting time was aimed at reducing the risk of rejection, as the chance of the body rejecting an organ can increase over time. The pregnancy was confirmed 10 days later. During pregnancy, all checks performed showed a normal fetus with no abnormalities.
Apart from the kidney infection treated with antibiotics at 32 weeks, the mother had no problems during her pregnancy and continued her regimen of immunosuppression to prevent rejection of the implanted uterus.
At 35 weeks + 3 days, on December 15, 2017, a girl weighing approximately 2.7 kg was born.
Brännström’s group recommends a delivery between 34 and 36 weeks due to the risk of fetal growth restriction due to immunosuppressant therapy.
The baby was born by caesarean section and had her transplanted uterus removed during the surgery so that the mother could stop using immunosuppressant drugs. Her mother and daughter were released from the hospital three days later and the girl will celebrate her first birthday on December 15, 2018. In the meantime, neither of them has had any complications.
The future implications
According to Dr. Andrew Shennan, professor of obstetrics at Kings College London, the uniqueness of this case is that the pregnancy occurred “although the uterus was without oxygen for 8 hours before the transplant “. In fact, the new study shows that this organ could remain functional after cold storage, without oxygen, at least four times longer than the average time taken after live donation: almost eight hours, compared to less than two.
According to Shennan, this case opens up the possibility of women donating their uterus after death, as they do with many other organs. Women who are infertile due to uterine factor infertility may therefore soon have another option than live donation, surrogacy or adoption.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.