ASRM Video article: Technique of uterine procurement from a diseased donor for uterine transplant

Uterine transplantation is the final frontier in the quest to provide a child-bearing option for patients with absolute uterine factor infertility. This procedure can become a promising option for the approximately 1.5 million women worldwide for whom pregnancy is not possible because of the absence of the uterus or presence of a nonfunctional uterus.  Only recently we heard the news from Brazil about the first live birth following the uterine transplant from a deceased donor.

This informative and detailed video from the American Society of Reproductive Medicine (ASRM) outlines the key steps in the successful procurement of uterus from a deceased donor using illustrations and footage from a trial transplant.

The video also describes the advantage of deceased donor transplant over live donor transplant in terms of surgical time, ethical issues, larger availability and eliminating the risk of surgical complications in the live donor.

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News for ASRM 2018: Procuring enough uteri for transplant will be a challenge in coming years

Researchers predict that it will be a great challenge to procure enough organs to meet the increasing need and willingness to undergo uterine transplant (UTx) in near future report the results of a feasibility study presented at the American Society for Reproductive Medicine’s Scientific Congress in Denver, Colorado.

 Uterine transplant is the emerging treatment for thousands of women of childbearing age who suffer from absolute uterine factor infertility. The world recently saw the birth of the world’s 12th and India’s first baby born after a uterine transplant. There is a growing interest among the community about transplant procedure, as evident by the long waiting list of patients at the high-volume transplant centers around the world.

Researchers from Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania carried out this study to quantify and characterize candidacy and interest in UTx.

They examined the medical and social histories of all deceased donors from the database of large organ procurement organization (OPO), the Gift of Life Donation Program (GLDP) to see how many women would have been eligible to donate uterus after death. Of the 585 total donors, 186 were females, of whom 94 were of reproductive age.

After applying ‘liberal’ screening criteria, which included no evidence of active Hepatitis B/C, diabetes, and no active intravenous drug use only 31 were found eligible to be a potential donor. If in addition to above criteria more stringent criteria that includes parity, related gynecological conditions that could impact the future pregnancy, age < 45 years, and no smoking were set, only 6 women were left in the list as being eligible for the uterine donor.

The researchers report that only 1-5% of all organ donors from a large OPO could potentially be eligible to qualify as a deceased donor.

Abstract O-86 presented Monday, October 8, 2018. 
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India’s first baby born after uterine transplant delivered in Pune

Pune becomes the first city in India to have a baby girl delivered after successful uterine transplant 17 months back. The team at Galaxy Hospital Pune delivered the 1,4-kg baby girl at 12.12 am, after a 12-minute Cesarean section operation. Tears rolled down the cheeks of Meenakshi, 27 when she heard the robust cry of her baby girl.

Meenakshi received the uterus from her mother, thus giving birth to her daughter out of the same womb from which she was born. Meenakshi had Asherman’s syndrome after one term stillbirth and 5 miscarriages, one of which ended in uterine and bowel perforation.

She received a laparoscopic uterine transplant on May 18-19, 2017. The transplants in the US and Sweden were performed by open surgeries, but Meenakshi’s case both the organ retrieval and transplant were performed laparoscopically.

Meenakshi conceived after the first embryo transfer in March this year. She was kept under close observation for the last 5 months in the Galaxy Hospital. She developed borderline gestational diabetes because of immunosuppressant drugs.

She also developed Pregnancy Induced Hypertension and was scheduled for an elective cesarean at 34 weeks. However, her Amniotic fluid index fell sharply, and the team has to perform an emergency cesarean section at 12.12 A.M. on Thursday, October 18, 2018.

The man behind the first uterine transplant in India is Dr. Shailesh Puntambekar, a cancer surgeon, specialized in laparoscopic cancer surgery. He is considered as an expert in laparoscopic pelvic surgery and gynecological cancer surgery in the world and has developed laparoscopic radical hysterectomy for cancer cervix known world over as the 'Pune technique.'

Speaking about the first baby girl delivered he said, “History has been created. This is, in fact, a very proud moment for India, as figures show that this is the twelfth baby in the world to be born through a uterus transplant. Nine such babies were born in Sweden, two in the United States, and now this is the first one in all of Asia.”

More on Uterine Transplant:

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

India's first donor uterine transplant successfully performed in Pune.

Cleveland Clinics performs first Uterine Transplant from deceased donor in U.S.

First US baby born after uterine transplant delivered inTexas

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First US baby born after uterine transplant delivered in Texas

Dr showing the baby to mother. Courtesy Baylor University Medical Center at Dallas

The first birth as a result of  uterine transplant in the United States took place on Friday in Texas at the Baylor University Medical Center in Dallas. The women had undergone a live donor transplant and have received her uterus from Taylor Siler, 36, a registered nurse in the Dallas area.

The boy delivered by elective cesarean section is just named “baby number 9, as he is the 9th person in the world to be born out of transplanted uterus. 

“We’ve been preparing for this moment for a very long time,” says Dr. Liza Johannesson, an ob-gyn and uterus transplant surgeon at Baylor. “I think everyone had tears in their eyes when the baby came out. I did for sure.” The woman and her husband asked that their identity not be revealed in order to protect their privacy.

This is the first baby born as a part of hospital’s ongoing uterus transplant clinical trial, being conducted by Baylor Scott & White Research Institute. Uterine transplant is offered to patients with absolute uterine factor infertility (AUI). Most of the women in the trial have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

The trial is expected to enroll 10 patients and will end in January 2026. So far, there are 8 women enrolled in the study who have received a uterine transplant. Out of which 3 have failed and there is an additional ongoing pregnancy in a woman who received a live donor transplant.  

A similar trial was conducted in Sweden for women with uterine factor infertility, which resulted in seven uterine transplants and four live births. 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.

Giuliano Testa, MD, principal investigator of the uterine transplant clinical trial at Baylor University Medical Center at Dallas said, “This first live birth to a uterus transplant recipient in the United States was a milestone in our work to solve absolute uterine factor infertility; but, more importantly, a beautiful moment of love and hope for a mother who had been told she would never be able to carry her own child.”