For the first time the recipient of a womb transplant has given birth, marking a milestone in the treatment of infertility.
The 36-year old mother, whose name has not been made public, has Mayer-Rokitansky-Kuester-Hauser (MRKH) syndrome, in which women are born without part or all of their womb or vagina. The success of artificial vaginas to treat some forms of MRKH was confirmed earlier this year, but a womb is a more challenging organ to replicate.
A team led by Professor Matts Brännström of the University of Gothenburg have indicated they will report in The Lancet on a successful birth from a transplanted uterus. Brännström had previously announced transplanting uteri from nine donors into women who either had MRKH syndrome or previous hysterectomies, in one case from mother to daughter. Seven of these transplants appear successful, with the women beginning to menstruate within 2-3 months. In the other two cases hysterectomies needed to be performed as a result of infection or clotting.
Even where the transplants are showing promise, the women's immune systems sometimes started to reject the new wombs - three times in the case of the eventual mother. However, adjustment of the corticosteroid drug regimes brought the problems under control in all cases. Unfortunately, these drugs have side-effects, so the wombs will be removed once the recipients no longer want more children.
A year after the 10-hour surgery was completed an early stage IVF embryo was inserted in the mother. Since her ovaries were unaffected by her MRKH syndrome, her own eggs were used.
"Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility," Braennstroem told The Lancet.
The authors noted, "Absolute uterine factor infertility is the only major type of female infertility that is still viewed as untreatable." This can no longer be considered the case, even if the success rate of such treatments is yet to be established. Brännström has acknowledged that it is likely to be a long time before the procedure will be common, and concerns have been expressed about the health impact for live donors.
A caesarian was conducted 8 weeks prematurely as a result of pre-eclampsia, and both mother and son are doing well a month later.
The transplanted womb came from a 61 year old friend of the recipient who had experienced menopause seven years earlier, making for a much larger pool of potential donors than would be available if only pre-menopausal wombs were viable.
Two other hospitals are known to have attempted womb transplants, but both proved unsuccessful.