A Womb Transplant – Fiction or Reality?

Almost one in 500 women in childbearing age experience infertility due to absolute womb related factors (absolute uterine factor infertility). This is the case where the women are born with birth defects of the womb. Such as like Mayer Rokitansky Kuster Hauser (MRKH) syndrome or been through hysterectomy or have Asherman’s syndrome.

In such cases, their only option of being the biological parent is to consider surrogacy. Surrogacy has its set of moral, ethical, financial, legal and religious challenges world over. This leads to considerable psychological distress. It is for this group of patients that womb transplant offers the hope of experiencing pregnancy and motherhood like other women.

A womb transplant was first attempted in 1960s. Over the next few decades, the development of fertility treatment such as IVF or ICSI gained most of the attention and resources. These treatments were more effective than any that existed at that time. The transplantation medicine in other areas of medicine such as liver or kidney progressed rapidly. This has been to the extent that these are now offered as treatment of choice for certain patients.

Since then, specialist published reports about the fertility-sparing surgery in the late nineties. The first womb transplant was reported from Saudi Arabia in 2000. But, it was not successful. It also highlighted the challenges. The second transplant was from Turkey, and the team are yet to report a childbirth despite many attempts at IVF.

Meanwhile, the womb transplant attracted the attention of other teams in Sweden, UK and USA. In 2014, a Swedish team reported the birth of the first baby to a transplanted womb recipient. Since then, they have reported more pregnancies and childbirths. This led to the convening of the world experts in the UK last year. Currently, the British team aims to perform ten womb transplants and report their results over the course of next few years.

To understand further on who can be the donor, what they have to go through and what recipients have to go through when they receive a womb transplant, different research groups have used live or deceased donors. Any potential donor should have had at least one child and should have completed their family if they are live donors. They should be relatively healthy. The donors are screened for a range of infections and medical conditions. They have to undergo a major surgery resulting in hysterectomy.

Womb recipients should not suffer from significant medical conditions such as kidney disease or clots in legs and chest. They should have a good ovarian reserve or have good number embryos frozen following IVF. They will have to undergo many screening tests and then a major surgery to receive the womb. They will also have to take the medicines to suppress the immune system and save the graft from the rejection.

Once the recipient’s body has accepted the transplanted womb, then they will have to go through the fertility treatment and transfer of the embryos. They will continue with the medication to suppress immune system all the way through the pregnancy. This is in addition to fertility drugs. Once they have completed their family, the transplanted womb will be removed. This is because of the risk of taking immune suppressants in long term far outweigh the benefit of keeping womb which has served its purpose. There are many major interventions involved for both the donor and recipient.

Once they have completed their family, the transplanted womb will be removed. This is because of the risk of taking immune suppressants in long term far outweigh the benefit of keeping womb which has served its purpose. There are many major interventions involved for both the donor and recipient.

So, what was fiction may be two decades ago, is now well on the path of taking shape as a reality. But, we are still many years away from being able to offer as one of the treatment of choice for an absolute uterine factor infertility. Currently, it is still in early stages of research. There are many years before the fertility specialists will be able to offer it as a treatment of choice for certain patients.

There are many different opinions about the availability of public funds for womb transplants. On the one side, they should be used for womb transplants as for many infertility is a quality of life issue. On the other side, for many, infertility is not life threatening disease.

As far as science is concerned, womb transplants have just started their journey towards hopefully one day becoming a reality for women trying to conceive.