A condition where a woman cannot carry a pregnancy because she was born without a uterus, has lost her uterus, or has a uterus that no longer functions. It’s an irreversible condition affecting 3% to 5% of women worldwide.
The exact incidence of UFI is unknown, but experts estimate that it affects thousands of women of childbearing age worldwide. Some have congenital UFI, meaning that the uterus is absent at birth (as in Mayer-Rokitansky and other syndromes). Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and uterus to be underdeveloped or absent. Affected women usually do not have menstrual periods due to the absent uterus. Often, the first noticeable sign of MRKH syndrome is that menstruation does not begin by age 16 (primary amenorrhea). Women with MRKH syndrome have a female chromosome pattern (46,XX) and normally functioning ovaries. They also have normal female external genitalia and normal breast and pubic hair development. Although women with this condition are usually unable to carry a pregnancy, they may be able to have children through assisted reproduction.
Others acquire UFI, after hysterectomy or because of damage from a serious pelvic infection, or abdominal or pelvic surgery.
Women who are coping with UFI until now had few existing options. Adoption and surrogacy were the only option for parenthood, but both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.
Uterus Transplant offers a Ray of Hope.
Recently after a number of trials and attempts of uterus transplant, it was University of Gothenberg team which was able to achieve its first birth in September 2014. To date, the Swedish group has performed nine uterus transplants, achieving five pregnancies and four live births.
There is completly no doubt that close coordination among the reproductive and transplant surgeons, infertility and IVF specialist, and high-risk obstetrician is crucial to the procedure to be a success.
With UFI still in its experimental stage, Cleveland Clinic began screening 21-to-39-year-old women with UFI for transplant in September. Each candidate faces extensive rounds of medical and psychological evaluations by experts from different disciplines and must be unanimously approved by the team.
Once a patient is approved for the study, she follows this complex, intricate protocol:
- Her ovaries are stimulated to produce multiple eggs, starting the in vitro fertilization (IVF) process.
- Her eggs are retrieved, fertilized with sperm in a laboratory, and frozen.
- Lifebanc, an organ procurement agency, begins the search for a donor.
- The donor’s next-of-kin signs an informed consent for uterus donation.
- The donor uterus is transplanted within six to eight hours into the patient’s pelvis.
- Over 12 months, the transplanted uterus fully heals.
- One year after transplant, the frozen embryos are then thawed and implanted, one at a time, into the patient until she becomes pregnant.
- During her pregnancy, she takes anti-rejection drugs.
- She is monitored by a high-risk obstetrics team throughout pregnancy and delivery.
- She has a monthly cervical biopsy to check for organ rejection.
- The baby is delivered by cesarean section.
- After one to two babies, she has a hysterectomy to remove the transplanted uterus.
- Her anti-rejection drugs are stopped after hysterectomy to reduce long-term exposure to transplant medications.
The transplant is not intended to last for the duration of the recipient’s life, but will be maintained for only as long as is necessary to produce one or two children.
For women with UFI, this temporary measure offers the possibility of lasting change as they experience pregnancy for the very first time.