A major advancement in infertility was the first birth from
in-vitro fertilization in 1978. Since then, there haven't been many treatment
options for women with other major forms of infertility. That is until Dr. Mats
Brannstrom and his team preformed the first uterine transplant that resulted in
a live birth. The healthy baby boy was born last month, and is the first child
to be born to a uterine transplant. Although uterine transplants have been performed
since 2000, there hadn't been any successful births before last month.
The patient that received this uterine
transplant was born without a uterus (Rokitansky Syndrome), and received her
donor uterus from a close family friend with the same blood type. The patient
was 35 years old at the time of the surgery, and the donor was 61 years old.
The donor had previous birthed two children, and was post-menopausal. The
surgery went as planned, and the patient started to have regular menstrual
cycles with the donor uterus. In-vitro fertilization was performed and one
resulting embryo was inserted into the uterus about 12 months after the
surgery.
Obviously the 61-year-old uterus
functioned in the now 36-year-old patient, raising the question: is an older
uterus better? There was a uterine transplant performed in Turkey in 2011 that
was the first to be done with a brain-dead donor. The donor was 22 years old,
and had never been pregnant. The patient that received her uterus successfully
became pregnant, however, the pregnancy was found to be non-viable at 8 weeks.
Research has shown that although the younger uterus may have had better
vasculature, there are disadvantages to using a younger uterine donor. For
example, the 61-year-old donor in the recent success story had given birth to
two healthy children, proving the functionality of the organ. That's not to say
that if a living 22-year-old wanted to donate her uterus, it wouldn't be
functional, especially if she had maintained healthy pregnancies in the past.
There is also an advantage in having a live donor, regardless of age, because
it allows the medical team to carefully test and assess the uterus prior to surgery.
This advancement is instrumental in the field of reproductive
sciences, and gives hope to many couples experiencing issues with infertility.
The information that has been recorded from this successful procedure will give
surgeons better information on what to look for in a donor uterus in the future.
References:
http://download.thelancet.com/flatcontentassets/pdfs/S0140673614617281.pdf
http://www.npr.org/blogs/thetwo-way/2014/10/04/353691555/a-first-uterus-transplant-gives-parents-a-healthy-baby
Wow! This is interesting! I would expect the younger uterus to be more functional than an older one because with most things, they don't function like they used to over time. It would maybe be worthwhile to get genetic counseling done on the recipient of the 22 year old uterus to see if there are chromosome abnormalities or something along those lines that contributed to an unsuccessful pregnancy. Considering all the other infertility solutions out there that have had greater successes, will uterine transplants become a viable option or simply be reserved for extreme cases such as the women born without a uterus? This is truly amazing because it questions the idea about age vs functionality but also shows how remarkable the human body is. This reminds me of the upcoming TBL where one of the papers discusses how putting older stem cells in a younger environment leads to the stem cells acting like younger stem cells. Considering that that paper is discussing muscle and age, and the uterus is largely smooth muscle, it would be interesting to see what type of environment different aged uterine tissues thrive in thus, possibly, offering more insight into how an older uterus can be more functional and work like new.
ReplyDeleteThe fact that a healthy baby was born through a uterine transplant is amazing. I think it’s important to recognize that this has only occurred one time and that there may be risks that have not been identified yet. For example, women who undergo uterine transplants must be on immunosuppressants for life (including during pregnancy) in order to prevent rejection, (Smith 2014). Though Doctors at the Sahlgrenska Academy believe that it is safe, the long term effects of the immunosuppressants are not known. Additionally, many of the women who have received uterine transplants that are trying to get pregnant are women who were born with out a uterus. The women go through in-vitro fertilization in order to carry their own biological children. I worry that the children being born from mothers who had the missing uterus may have mutations that would be passed onto the children. How severe these mutations could be is unknown but it brings in another question of ethics into the picture. Overall, information learned through uterine transplants and pregnancy will give more insight in the reproductive sciences and in organ transplants as a whole.
ReplyDeleteSmith, Rebecca. The first baby has been born following a womb transplant. 2014 October 03. The Telegraph. [Internet]. [Cited on 2014 October 05]. Available from: http://www.telegraph.co.uk/health/healthnews/11139991/The-first-baby-has-been-born-following-a-womb-transplant.html
Wow, this is a really interesting topic!!
ReplyDeleteAs I was reading your post, I was thinking about whether something like this really is necessary. I understand that women want to have their own biological children and to experience being pregnant, but there are so many options out there, does the benefit outweigh the risk? If women want to have biological children but don’t have a uterus, surrogacy is an option—but then I found this news article (linked below) that said that in Sweden, where this surgery took place, and other European countries, surrogacy is illegal. Factors like this likely drive the need for such radical research.
The article also touched upon the fact that the surgery for the donors is quite risky. Surgery to remove the uterus is similar to a radical hysterectomy, except the surgeons also have to remove a large portion of the surrounding vasculature to ensure proper circulation after the uterus has been transplanted into the recipient. The removal of extra vessels poses a great risk to the donor—who, in this case, is alive and healthy and is expected to continue living past the transplant. This is why countries like Britain use donors who are dead or dying—they cannot justify posing that sort of a risk to a donor for a surgery that is not life-saving.
http://www.cbsnews.com/news/nine-swedish-women-undergo-uterus-transplants/
This article, for me, was particularly interesting. I notice also that the only commenters on this post do own a uterus. I do not have a uterus, last time I checked. =]
ReplyDeleteWhat is most striking to me about this procedure is that the uterus is not a vital organ but it is clear that many women consider bearing children and pregnancy a vital part of womanhood. The swirling bioethics surrounding this topic are immense. The girls above highlight the fact that the risks are numerous to the conceptus and mother and are a significant factor to undergoing this transplantation. I think this article as a whole serves to highlight the lengths women are willing to go to experience child birth. I think it is peculiar that many women are actualized by this 9-month period because I believe that being a "parent" and a "mother" is learned process throughout the duration of the childhood years. With that being said, I think we need to examine how we as a society may be glorifying the pregnancy state, so much so, that we are driving women to these risky surgeries. Do not get me wrong, I think that child birth is miraculous, but I think what is even more miraculous, is getting up, and doing the best you can and parenting every day for 18+ years.
CNN reports that from 2004, adoption rates have dropped more the 50% in the US. They site that this decrease is due to more regulations associated with the adoption process. Do you think that this pregnancy drive and glorification may be contributing to lower adoption rates? If a women is willing to accept some foreign origin, why does she feel less inclined to accept a foreign child and love it as her own.
I think it may be helpful to analyze the psyche of our nation in regards to child-birth and understand if we a perpetuating a stigma unto women about how important this process is to feeling like a woman. Regardless, I still think that this is really amazing science. I feel like with every procedure, it is important to understand that we have to do investigatory attempts to fully understand the caveats of the procedure and get to a point where one day the benefits do out weight the risk. It is important to note that most transplant patients, whether they are receiving a uterus or a liver, do need to maintain regiments of immunosuppressants, but I think Jenny is correct in highlighting the fact that immunosuppressant long-term affects are not clearly defined. Additionally, immunosuppressants may affect the development of a child's healthy immune system. If this implantation is projected to be associated with subsequent child-birth, then we must define the affects of immmunosuppression on both the mother and fetus.
http://www.cnn.com/2013/09/16/world/international-adoption-main-story-decline/
ReplyDelete