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Wednesday, February 1, 2023

First U.S. Woman Gives Birth From Transplanted Uterus

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uterine transplant, fetus“The first baby born in the U.S. from a transplanted uterus came into the world in November at Baylor University Medical Center in Dallas. BSIP/Getty Images

Back in the olden days of a few years ago, if you were a woman born without a uterus, or you had to have your uterus removed due to cancer or some other illness, you didn’t have much hope of ever giving birth. You can’t grow a baby without a uterus, after all.

But that was then, earlier in 2017; this is now. Times have changed!

The first baby born in the U.S. from a transplanted uterus came into the world in November, and the mother’s doctors at the Baylor University Medical Center in Dallas — the hospital that both performed the transplant and delivered the baby by cesarean section — are delighted by their success. This is the first birth to occur from a clinical trial involving eight women who received uterine transplants — the first ones ever performed in the U.S. Of these women, one has now given birth, one is pregnant and three others are currently trying to conceive.

This is not the first successful birth from a transplanted uterus though; transplants resulting in another eight live births were performed at one hospital in Sweden: the Sahlgrenska University Hospital in Gothenburg. Dr. Liza Johannesson, a uterus transplant surgeon from Gothenburg, moved to the United States to set up shop at Baylor to see if she could find the same success in a U.S. hospital.

The process of performing a uterine transplant is different from other organ transplants. Since the purpose of the procedure is to make sure the woman can gestate a baby for 32-36 weeks, surgeons don’t really know whether the transplant has been successful until they have a baby in hand. The woman who successfully gave birth last month received her transplant in September 2016, so it took over a year to find out whether the transplant worked. The process is long, and something could go wrong every step of the way.

The process goes a little something like this:

The first step involves taking the uterus from the donor. This is a five-hour operation — longer and riskier than a normal hysterectomy, because the surgeons have to make sure they have all the tissue necessary to perform a successful transplant. That uterus has a job to do later, after all. Donors can be dead or alive. The transplants done in Sweden were from live donors, mostly from the recipients’ mother or a sister, but a womb can also come from an "altruistic donor" — one unrelated to and unknown to the recipient.

Transplanting the organ into the recipient is another very tricky surgery, and the healing from that operation can be a little touch-and-go — four of the transplants in this trial failed and had to be removed. In Sweden, the doctors have waited a year to allow the patient to heal, but at Baylor they waited only a few months (because the women were young and healthy, and because the antirejection drugs have some undesirable side effects). After the woman begins menstruating, she is launched into a very high-risk pregnancy, and the birth is always done by C-section.

Oh, and once a woman has a baby or two with her new uterus, the organ has to be removed. The drugs that must be taken to prevent rejection are powerful and come with serious risks for her long-term health.

You’ve really got to want that baby to sign up for this, and you can see why the doctors at Baylor are so excited about their success.

So, where do you sign up? Well, you can’t yet, and even after it becomes part of normal medical practice (rather than experimental), the whole process will cost you possibly hundreds of thousands of dollars. And it’s not clear yet whether insurers will cover it.

But it might comfort you to know the option is out there.

Now That’s Interesting

Women who have received uterine transplants can’t conceive in the conventional way because their new uterus isn’t connected to their ovaries. Instead, they are impregnated through in vitro fertilization.

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