In recent years, we’ve seen scientific breakthroughs that have changed the lives of women suffering from infertility. Now, news from an on-going clinical trial by Cleveland Clinic brought hope to women suffering from uterine factor infertility. The condition, whereby otherwise healthy women do not have a uterus, affects 60,000 women of reproductive age in the US.
The trial has been conducted to assess the efficacy of uterus transplants from deceased donors, and last week the second successful birth was celebrated. The Trial aims to enroll 10 subjects. Since its launch in 2015, the Cleveland Clinic team has completed 8 uterus transplants. Six have been successful and have resulted in 2 births of healthy babies, and 2 more are on the way.
To explain more about how uterine transplants work, Dr Quintini and his colleagues – maternal-fetal medicine specialist Uma Perni, MD and Director Emeritus of Transplantation Andreas Tzakis, MD, PhD, who spearheaded bringing uterus transplantation to Cleveland Clinic in 2015 – answer some frequently asked questions below.
Q: Why are you conducting the trial for deceased-donor uterine transplants?
A: We want to establish that Uterus Transplants can be performed safely and successfully, in order to become a treatment option for women with absolute uterine factor infertility (UFI). By using deceased donors, we avoid any risk to a potential living donor.
Both births that have resulted from the trial were incredibly joyous occasions for the families and for our entire transplant team. It is a very exciting time because we are finally seeing the amazing and life-changing outcomes this transplant can have.
Q: What causes uterine factor infertility?
A: Most candidates were born without a Uterus. This is a fairly common condition seen in 1/500 female births. These are otherwise healthy women. In few cases the uterus is removed during the reproductive age for life threatening bleeding, benign or malignant tumors.
Q: What are the options for women with uterine factor infertility who want to have children?
A: Other options are adoption or surrogacy. These are very valuable options for many women, but are not possible for others because of cultural, religious, or financial reasons. Additionally, with a uterus transplant, women carry the responsibility, the risk, and the joy of carrying and delivering their own baby.
Q: Is uterus transplant widely available?
A: It is a new procedure, so it is not widely available. It is still considered experimental and is only performed as part of a clinical trial.
Q: What does the process entail?
A: The first step is an evaluation to make sure a transplant can be done safely. The second step is to produce and store embrya, which will be used for future pregnancies. The third step is to place the patient on the waiting list and search for an appropriate donor.
When an appropriate donor is available, our recovery team goes to the donor hospital and recovers the uterus, which is transported back to Cleveland Clinic for implantation. The recipient receives immunosuppressive medications to prevent her immune system from rejecting the new uterus. Immunosuppression is needed from the time of the transplant and until the goal: one or two healthy babies are delivered. Our gynecological specialists perform the embryo transfer 6 months after successful transplant. The pregnancy and delivery are followed by our high-risk pregnancy team who ensure that pregnancy and delivery are carried out safely. The transplanted uterus is removed when the delivery (ies) are successfully completed.
Q: How is uterus transplant pregnancy different from a traditional pregnancy?
A: From our experience and that of others worldwide, these pregnancies resemble natural pregnancies of women who had a transplant. Thousands of kidney, liver, heart, and lung recipients have delivered their babies, while they are immunosuppressed. We know there is an increased risk of high blood pressure and preeclampsia. Delivery is accomplished with a Caesarian-section.
Q: What happens after the baby is born?
A: The uterus is removed after the woman delivers one or two babies, depending on her preference. This minimizes the amount of time she needs to be on immunosuppressant medications.
