By Prarthana Mitra and Aditi Agrawal
A woman, who had a uterus transplant from a deceased donor in September 2016, reportedly gave birth to a healthy baby girl in December 2017, according to a paper published in the Lancet on December 4, 2018. This is the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. Until this case, only uterus transplants from living donors had led to successful births.
In September 2016, surgeons at the University of São Paulo in Brazil conducted a 10-hour transplant operation to provide a woman born without a womb with one taken from a dead donor. After transferring an IVF-created embryo into the implanted uterus in 2017, they made history in December 2017, as the world welcomed its first baby born from a deceased woman’s womb.
About the procedure
The 32-year-old recipient suffers from Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome that causes improper development of the vagina and the uterus in one in every 4,500 women. Unable to conceive, she decided to opt for IVF and womb transplant. After the transplant, she was administered medicines to weaken her immune system to prevent her body from attacking and rejecting the transplanted uterus. This is part of immunosuppression therapy and is a standard procedure recommended for organ recipients.
The transplant was carried out in Hospital das Clínicas, University of São Paulo, Brazil. The womb donor was a 45-year-old mother of three who had Fischer 4 subarachnoid haemorrhage that caused brain death.
The recipient had undergone one IVF cycle four months before the transplant, which yielded eight blastocysts (a stage in embryogenesis, roughly 5-6 days after the ovum is fertilised by the sperm). These blastocysts were cryogenically preserved via the process of vitrification, that is, the hydrated living cells were cooled to cryogenic temperature for preservation without using ice.
Immunosuppression therapy was changed 5 months after uterine transplantation to prepare for embryo transfer. 7 months after transplantation, in April 2017, a single embryo transferred to the transplanted womb. Caesarean delivery occurred at 35 weeks and 3 days (on 15 December 2017), and the mother and baby girl were both discharged three days after birth. The baby weighed 2550 g and measured 45 cm in length at birth.
When the article was written, the baby was 7 months 20 days old, and had normal growth parameters (7·2 kg in weight and 62 cm in height). Both the mother and baby have have uneventful foolow-ups, according to the report.
Doctors Dani Ejzenberg and Wellington Andraus both initiated the study, performed surgery, followed up the patient, and wrote the report. Dr. Ejzenberg did the IVF. They were accompanied by other surgeons and doctors in the surgery, and in the report writing. All the doctors practice at the Hospital das Clínicas in São Paulo.
The Lancet report also observes how the use of dead donors would greatly broaden access to fertility treatments and pave a path to a healthy pregnancy for all women with uterine factor infertility.
There have been 39 womb transplants using a live donor so far, including mothers donating their uteri to their daughters. However, as the study also noted, uterine transplantation from a dead donor had never been succesful till this case.
In 2011, uterine transplantation from a deceased donor in Turkey led to an unsuccessful pregnancy and miscarriage 2 years later despite apparent health of the graft, casting uncertainty on feasibility of the use of dead donors for patients with infertility.
Uterus transplantation, even from living donors, is still a very new procedure. The first successful birth from a living uterus donor was in Sweden in 2014, and there have only been 11 babies delivered that way since. Only the aforementioned Swedish centre, and an American centre have previously published findings of livebirths from transplanted uteri.
Moreover, it is very difficult to find living donors willing to part with their uterus, but it might be easier to convince them to bequeath their womb as part of post-mortem organ donation.
Why it matters
Dr. Ejzenberg told the BBC, “The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities.”
He agreed that the need for a live donor posed a major limitation as donors are rare, typically being willing and eligible family members or close friends. But with that mandate now off the table, the results offered an extremely exciting future for womb transplant as a viable solution.
The news of successful conception from a womb of the deceased thus broadens the pool to include the dead and the living, increasing the number of available uteruses and giving millions of infertile women hope.
All images in this article are courtesy of Divulgação Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, and have been reproduced with permission.
Prarthana Mitra is a staff writer at Qrius. Aditi Agrawal is the sub-editor at Qrius.