ArticlesLivebirth after uterus transplantation
Introduction
Absolute uterine factor infertility is the only major type of female infertility that is still viewed as untreatable. The major causes are congenital absence of the uterus (Rokitansky syndrome, also called Mayer-Rokitansky-Küster-Hauser syndrome), previous hysterectomy, and severe intrauterine adhesions.1, 2, 3, 4 In the UK alone, more than 12 000 women of childbearing age are thought to have absolute uterine factor infertility.5 The available motherhood options for women with this disorder are adoption (to acquire legal motherhood), or pregnancy in a gestational surrogate carrier to acquire genetic motherhood, followed by adoption to also acquire legal motherhood. However, surrogacy is not allowed in many countries because of ethical, legal, or religious reasons.
We have undertaken preclinical research into uterus transplantation for more than a decade, using a step-by-step logical developmental approach, in which we have used several animal species, ranging from rodents to non-human primates.6, 7 Recently, we initiated the first clinical trial of transplantation, involving nine women who received uteri from live donors. Two of the women had to undergo hysterectomy during the initial months, with the causes being uterine artery thrombosis and severe intrauterine infection.8 The other seven women began menstruation during the first 2–3 months and the grafts remained viable, with regular menstruations during the first post-transplantation year. Occasional subclinical episodes of mild rejection were detected on cervical biopsies, which were effectively reversed by short courses of increased immunosuppression.
Except for our clinical trial of nine women, only two other human uterus transplantation efforts have been reported. The first case resulted in progressive uterine necrosis during the initial months, and a fully necrotic uterus was removed 3 months after transplantation.9 The second case involved a uterus from a deceased donor being transplanted into a patient with Rokitansky syndrome.10 The patient underwent embryo transfer 18 months after transplantation and two pregnancies that miscarried before gestational week 6 have been reported.11 No further reports exist about this case.
In this report, we describe the clinical course of the first patient in our cohort who achieved a clinical pregnancy resulting in delivery of a baby.
Section snippets
Patient
In 2013, a 35-year-old patient underwent uterus transplantation at Sahlgrenska University Hospital (Gothenberg, Sweden) as part of our clinical trial of uterus transplantation in nine women with absolute uterine factor infertility (ClinicalTrials.gov number NCT01844362). The study was approved by the regional ethics board of the University of Gothenburg. The donor, recipient, and her male partner had given their written informed consent. The 6-month outcomes of the study have been published.8
Results
The first menstruation in the recipient occurred spontaneously 43 days post-transplantation and continued for 4 days. She then had regular menses with a median interval of 32 days and ranging between 26–36 days. The endometrium showed typical changes in median width (maximum 11·3 mm; range 7·9–15·3 mm). The blood flow velocity waveforms of the uterine arteries were similar on the left and right side and were within the low to normal range throughout the observation period. Median pulsatility
Discussion
Despite remarkable advances in infertility treatment, since the birth of the first in-vitro fertilisation baby in 197816 major forms of uterine factor infertility have remained untreatable. Our demonstration of a livebirth after uterus transplantation in a woman born with no uterus has eradicated the diagnosis of absolute uterine factor infertility.
This livebirth after human uterus transplantation comes after more than a decade of intensive animal research in this specialty by several groups
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