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World first gives birth to a woman after receiving a uterus transplant from a dead donor



A nurse operating an ultrasound machine.
Photo: Christopher Furlong (Getty Images)

A team of doctors in Brazil has announced a medical premiere that could one day help countless women who can not have children due to a damaged or missing uterus. A case report published Tuesday in the Lancet claims to have successfully given birth to a woman with a transplanted uterus from a deceased donor.

According to the report, the team performed surgery on an unnamed 32-year-old boy by a woman in a Brazilian hospital in September 2016. The woman was born with a rare genetic condition that left her without a womb, known as Mayer-Rokitansky. Küster-Hauser syndrome, but she was otherwise healthy. The donor was a 45-year-old woman who had suddenly died of a stroke. In the past, she had had three successful pregnancies delivered vaginally.

An example of performing uterine transplantation.
Illustration: Ejzenberg et al. (The Lancet)

Four months before transplantation, the recipient woman had received in vitro fertilization, yielding eight live embryos that had been frozen. After the 10-hour operation, during which the uterus and part of the donor's vagina were connected to the recipient's vagina and circulatory system, the woman ingested a regimen of immunosuppressants that prevented her body from rejecting the uterine donor. Seven months later, an embryo was successfully implanted. And thirty-and-a-half weeks later, she gave birth to a seemingly healthy little girl, who was delivered without complications via the cesarean section.

Since 2013, at least 10 women have been observed in transplanted uterine pregnancies. According to the authors, they are the first to do this with the uterus of a deceased donor (a documented attempt was made in 2011, but the pregnancy ended in miscarriage). The feat is something that could make the procedure a more appealing and realistic way for some women.

"The first uterine transplants of living donors were a medical milestone that provides the possibility of childbirth for many infertile women suitable donors and the necessary medical facilities. However, the need for a live donor is a major limitation as donors are rare and usually willing and entitled family members or close friends, "said lead author Dani Ejzenberg, gynecologist at the Hospital of Clínicas, School of Medicine, University of São Paulo. "The number of people willing and willing to donate organs after their own death is far greater than that of living donors and offers a much larger potential donor population."

Apart from the fact that doctors rely on a deceased donor for their uterus transplantation, the procedure would have made it less costly and dangerous. For live donors, doctors have been waiting at least one year after the transplant to seek a pregnancy. However, the authors believed that they could safely reduce the time to six months.

In the end, they stopped for another month after tests showed that the endometrium was not sufficiently thick to support implantation. Shortening the transitional period by five months, however, means that the recipient will need less medical attention and strong immunosuppressants to keep the uterus healthy. Unlike most organ transplants, a donated uterus can be safely removed after a successful pregnancy so that the woman can stop taking anti-rejection medication.

The authors say that their version of the procedure is not intended to replace the possibility of using a live donor, but rather gives women with uterine problems another option. And there are still many questions on how to refine the process better. During the transplant, there was a phase of blood loss that was eventually overcome, but could be avoided in the future by changing the way the organ is initially reconnected to the woman's circulatory system. It is possible that patients may not need as many immunosuppressants as they currently receive to fight off organism rejection.

There is no shortage of women and couples who want to use the procedure as it becomes easier and safer. According to the research cited by the authors, 10 to 15 percent of the couples that children could and do theoretically have in some way been infertile. One in 500 women in this population is infertile due to the lack of a uterus. Genetic conditions such as Mayer-Rokitansky-Küster-Hauser syndrome can cause this, but more often because women undergo an unexpected hysterectomy to prevent cancer or to treat painful conditions such as endometriosis.

As for the Brazilian and her child, a The representative of Ejzenberg told Gizmodo by email that both seem perfectly healthy. In fact, the child will celebrate his first birthday in about two weeks. The team is now authorized to conduct the trial with two other women.

[The Lancet]


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