July 27, 2018

Is a Uterine Transplant an Option for a Woman Who Needs a Gestational Carrier?

Uterine Transplant

The transplantation of solid, vital organs (heart, lungs, kidneys) has been on the forefront of pushing medicine’s frontier. The advances and understanding the science has afforded many the opportunity to live fulfilling lives as mothers, fathers, children and contributing community members. Organ donors are heroes. This same science and progress has allowed for exploration of the possible transplant of another solid organ essential to reproduction, the uterus. In our basic infertility workup, we explore: eggs, sperm and the place they will meet and thrive (the uterine cavity). In cases where the uterus has proven to not be a willing carrier of pregnancy or in cases where the intended parent has medical conditions preventing pregnancy and carriage, a gestational carrier is used. Is a uterine transplant an option for a woman who needs a gestational carrier?

There exists a small subset of women who would be otherwise suitable carriers except for the uterus is missing. It is a cruel act post-conception where molecular signals become crossed and the uterus does not develop. The maternal chromosomes are normal and she has functional ovaries, but there is no uterus. Other candidates are women who may have been born with a uterus but it has been rendered either ineffective or removed secondary to illness (cancer) or traumatic childbirth in a lifesaving measure.

In these cases, women have had no choice other than to have a gestational carrier if they were wishing to have children that were genetically related to them. The idea of uterine transplant is not new and has been explored. Most studies and reports have emanated from European teams. In fact, since 2014, a Swedish team, has reported 8 babies born of mother’s with transplanted uteri. All babies have reportedly done well in utero and are thriving currently.

In late 2017, the first baby born of uterine transplant in the United States (Baylor) was reported.  Both mother and baby were doing well. This woman was the first to give birth; there are 10 women in the uterine transplant trial. Four of the ten women had organ rejection after the uterine transplantation.

The transplant itself, is meant to be temporary, until the family can complete childbearing. It, thus limits, the amount of anti-rejection medication exposure. But even in the circumstances of anti-rejection medications, like in other solid organ transplantation, the body can recognize the organ as foreign and reject.

It is for this reason that uterine transplantation will not be the mainstay for women with uterine factor but it is important to always be looking upon the horizon. If you have questions, please contact us for a free initial consult. We are here to help you!

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Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility