Your ethical and medical questions about uterus transplants answered:
Recently, a Swedish woman who lost her uterus to cancer had her mother’s uterus transplanted into her, became pregnant through in vitro fertilization (IVF) and delivered a baby boy. In a sense, the grandmother was also the mother, or at least her uterus was. One uterus used by three generations is remarkable – and an encouraging sign of ongoing advancements in fertility preservation for cancer patients.
Uterine transplants can give fertility back to women whose uterus was damaged beyond function by cancer treatment, as well as for women who are born without a uterus (about 1 in 5,000 women). Many more female cancer patients each year lose the function of their uterus, causing them to become infertile because they cannot carry a pregnancy.
Surgeons only began doing successful uterine transplants in January 2014, when Swedish doctors transplanted nine uteruses into women, all from live donors who were family members or friends. In October 2014, the first baby was born to a woman with a transplanted uterus – and it came from a 61-year-old woman who had gone through menopause and had previously given birth to two children.
This was accomplished by Dr. Mats Brannstrom, a professor of obstetrics and gynecology at the University of Gothenburg and Stockholm IVF. He’s been involved in the uterine transplant breakthrough from the start and also did the transplant of the mother’s uterus to her daughter, mentioned above.
The mother who donated her uterus to her daughter was alive. Surgeons have also transplanted uteruses from recently deceased women. Physicians say the uteruses from live donors can be assessed for proper function and lack of disease. Some surgeons are working with live-donor uteruses and others with deceased-donor uteruses.
Successfully removing a womb is very difficult and successfully grafting it to the recipient’s body, particularly to major arteries and veins, is also very tricky. And while it is not currently a go-to treatment for women who have lost uterine function due to cancer or cancer treatment, it holds a lot of promise.
Ethical & medical questions about uterine transplants
Some physicians question the appropriateness of uterine transplants, saying that such a life-threatening surgical procedure for non-essential reasons is a waste of medical resources. That thinking holds that it is unethical for a donor to take such risks of mortality when the transplant will not save the recipient’s life, which is not in jeopardy. She just might be able to have a baby afterward.
And there’s another topic to consider: will babies born in transplanted wombs be healthy? Will they get appropriate nutrition and blood flow in those altered wombs? It’s just too early to see how such babies will fare in the long run – as well as in the short run, for that matter.
And what about the woman with the transplanted uterus? She has to take anti-rejection drugs continuously. Doctors say those anti-rejection drugs do not appear to harm the baby born in the transplanted womb. But after two pregnancies, women who received transplanted uteruses need to have them removed so they can quit taking the anti-rejection medications, which can cause problems, such as elevated risks for some cancers.
While uterine transplants are promising options for some women, there’s a lot of work left to be done. Right now, it isn’t known if this procedure will be anything more than an interesting experimental procedure. It may never become a valid treatment option, and if it did it would only be an option for a small number of women.
However, uterine transplants may provide another option for women who want to have a baby. Although there have been no experimental procedures in the U.S. yet, many may be watching to see how the medical facts play out in uterine transplants.