Thursday, November 19, 2015

Uterine Transplant-------Is this the final frontier!



Cleveland Clinic announced Thursday the launch of a “groundbreaking” research study that will perform uterus transplants in 10 women. The first operation is expected to take place within the next few months, the New York Times reports.

Since the 1970s a number of teams around the world have been researching the possibility of developing a womb transplant procedure.

Transplant research, as a whole, has also tended to focus on life-saving transplantation (heart, kidney, liver) with womb transplant research being rather limited especially following advances in IVF techniques.

We have come a long way since 1905 which saw the first successful corneal transplant.

In 2000 the world’s first womb transplant was performed on a 26 year old woman in Saudi Arabia. But, the transplanted womb only lasted for 99 days.

In December 2010, our colleagues in Sweden were able to report a pregnancy as a result of a womb transplant on a rat.

In September 2014, Mats Brännström and colleagues report the first successful birth of a child following uterus transplantation. The recipient, a 35-year-old woman lacking a uterus (Rokitansky syndrome), received a cryopreserved embryo 1 year after transplantation, leading to a livebirth by caesarean section.
The first uterine transplant baby being delivered by Cesarean Section .    



The donated uterus came from the woman’s own mother, so the baby is also the first born to a woman using the same womb from which she emerged herself.

This team has since performed a total of nine uterus transplants that have resulted in five pregnancies and four live births.

This report marks an important development that will give women with congenital or surgical absence of the uterus an opportunity to give birth to a child.

The first clinical trial of uterus transplantation in the United States has begun at Cleveland Clinic in Ohio, where the process of selecting women to participate in the study is now under way.

The ground-breaking study will include 10 women with uterine factor infertility (UFI), a condition in which a woman was born without a uterus, has lost her uterus, or has a uterus that no longer functions.

It's thought that as many as 50,000 U.S. women might be potential candidates for the procedure.


Complex Protocol of the study 
After being approved for the trial, the woman follows a complicated protocol:
  • Clinicians begin the in vitro fertilization process by stimulating the woman's ovaries to produce multiple eggs.
  •  After retrieval of the woman's eggs, they are fertilized with sperm in a laboratory and frozen.
  •  After 10 embryos have been frozen, Lifebanc, an organ procurement agency, starts searching for a donor.
  •  When a uterus donor has been found, that person's next-of-kin signs an informed consent for the organ donation.
  • The donor uterus is transplanted into the patient's pelvis within 6 to 8 hours after harve
  • The transplanted uterus is allowed to fully heal over 12 months.
  •  After 1 year, the woman's frozen embryos are thawed and implanted, one at a time, into the woman until she becomes pregnant.
  • The woman takes Immunosuppressant drugs during her pregnancy.( tacrolimus, azathioprine, and corticosteroids).
  • A high-risk obstetrics team monitors the woman throughout pregnancy and childbirth.
  • The woman undergoes a cervical biopsy each month to monitor for organ rejection
  • An obstetrician delivers the baby by cesarean section.
  • After the woman has one to two babies, she undergoes a hysterectomy and stops taking Immunosuppressant drugs to reduce her long-term exposure to the medications.

Uterine Transplants are Unique in the sense that unlike any other transplants, they are ‘ephemeral,'” Cleveland Clinic lead researcher Andreas Tzakis said in the release. “They are not intended to last for the duration of the recipient’s life.” 

After 1-2 healthy pregnancies the transplanted uterus is either removed or allowed to disintegrate.

Vincent, One year now

Now, Vincent the first Baby born after uterus transplant is healthy one year old and the team of Dr.  Mats Brännström, the Swedish professor in obstetrics and gynecology of the University of Gothenburg and Sahlgrenska University Hospital, are looking forward to improve the technique and reduce the surgical procedure time.


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All Photos courtesy by Martin Valigursky/iStock/Getty Images
 



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