In mid-September, doctors at Baylor University Medical Center in Dallas performed four uterus transplants on female patients who were born without the organ.
Doctors at the Cleveland Clinic had already performed the first uterus transplant in the United States back in Februaury, but the organs used in those procedures had come from deceased donors. All of the organs used in the recent transplants at Baylor came from living donors, marking the first time such transplants have been performed in the United States.
The women who participated in these studies at Baylor and the Cleveland Clinic all had a condition known as uterine factor infertility. According to the Cleveland Clinic, women with this condition are unable to become pregnant either because they were born without a uterus, or their uterus was removed by hysterectomy, or it was damaged by an injury or infection in such a way that it no longer functions.
Women between the ages of 21 and 45 were eligible to participate in the studies, but in order for women over the age of 40 to be included in the study, they must have undergone fertility treatments to create and freeze embryos before they turned 39.
A couple of the women who underwent uterus transplants suffered from Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. MRKH syndrome is a disorder that occurs in females and primarily affects the reproductive system, causing the vagina and uterus to be underdeveloped or absent altogether. Affected women are usually unable to have menstrual periods due to the absence of a uterus.
Out of the four uterus transplants that were recently performed at Baylor, only one was successful, with no current signs of rejection. The other three women in this study needed to have their uteruses removed after follow-up tests indicated that the organs were not receiving proper blood flow.
The patient at the Cleveland Clinic who received the first transplanted uterus in the United States also needed to have the organ removed due to a yeast infection that developed and caused multiple complications.
There are 16 uterus transplants in the world that have been reported, eight of which were not successful. The main challenge for doctors performing uterus transplants is that the surgery procedures are still very new and will take time to perfect. The uterus itself, as well as the surrounding blood vessels, are situated deep inside the pelvis, making them difficult to access. Surgeons who participated in the Baylor and Cleveland Clinic studies all agree that the organ’s location is what makes a uterus transplant slightly more difficult than the transplant of other organs.
Uterus transplants can ultimately fail for the same general reasons as all other organs — organ rejection, which is when the patient’s immune system attacks the organ; problems with the organ’s blood supply (which happened in the Baylor cases) or an infection of the organ (which happened in the Cleveland case).
There is something to be learned from the unsuccessful surgeries at Baylor and Cleveland Clinic. Doctors at Baylor realized that more specific attention needs to be paid to the thickness of uterine veins both during and post-operation. Surgeons are now well equipped with the necessary knowledge and experience to recommend changes to be made to the surgery protocols, with the hope of improving future outcomes.
One patient from the Baylor study still has her transplanted uterus and doctors are optimistic that she could be the first case of a uterine transplant in the United States to make it to the milestone of uterine functionality. In 2014, nine women in Sweden received uterus transplants, using organs donated from living relatives. Each of these nine women who underwent surgery were either born without a uterus due to MRKH syndrome or had it removed due to cervical cancer. In two of these cases, the transplanted organs had to be removed post-surgery but overall, the transplants proved to be successful as five women were able to become pregnant and give birth.
Some of the Swedish doctors assisted in the Baylor surgeries and they are eager to see the results of the uterus transplants in the United States. The plan is for that the patient whose transplant was successful will undergo in vitro fertilization in the next six to 12 months, where an embryo will be transferred into the uterus. If the fertilization is successful, the patient will be able to give birth to her own biological child.