Central Idea

• In the UK, doctors at the Churchill Hospital Oxford conducted the nation’s first uterus transplant.
• The procedure involved removing a uterus from a 40-year-old woman and transplanting it into her 34-year-old sister, who faced reproductive challenges due to a rare medical condition.

Why discuss this?

• While the transplanted womb is functional, its success can only be confirmed by a live birth in the future.

Understanding Uterus Transplants

• Not Life-Saving: Unlike heart or liver transplants, uterus transplants are not life-saving procedures. Instead, they are akin to limb or skin transplants, significantly enhancing individuals’ quality of life.
• Addressing Uterine Infertility: Uterus transplants offer hope to women facing uterine factor infertility, enabling them to fulfill their reproductive aspirations.

Pioneering Success in Sweden

• Historical Context: In 2014, Sweden achieved a milestone by witnessing the first live birth following a uterus transplant. This success paved the way for addressing uterine factor infertility.
• Affordability Challenge: Efforts are ongoing to make uterus transplants more accessible, especially in countries like the UK, where the National Health Service estimates the procedure’s cost at GBP 25,000 (Rs 25.26 lakh).

Uterus Transplants in India

• Indian Achievement: India joined the ranks of countries with successful uterus transplants, alongside Turkey, Sweden, and the United States. The country celebrated its first uterine transplant baby’s birth on October 18, 2018, approximately 17 months after the recipient underwent the procedure.
• Affordable Option: The cost of uterine transplant surgery in India currently ranges from Rs 15-17 lakh, making it a more cost-effective choice for many.

Step-by-Step Procedure

• Recipient Evaluation: Before transplantation, recipients undergo thorough evaluations to assess their physical and mental health.
• Donor Assessment: Whether the donor is living or deceased, their uterus undergoes viability checks before qualifying for donation. Live donors also undergo comprehensive gynecological examinations, including imaging scans and cancer screenings.
• In Vitro Fertilization (IVF): Uterus transplants do not connect the uterus to the fallopian tubes, necessitating IVF to create embryos. These embryos are then cryopreserved until the transplanted uterus is ready for implantation.
• Harvesting and Transplantation: The donor’s uterus is carefully removed, with the procedure becoming less invasive due to advancements in robot-assisted laparoscopy. The uterine vasculature and other critical connections are meticulously re-established during transplantation.

Pregnancy after Transplant

• The success of the transplant is assessed through three stages: the first three months focus on graft viability, followed by six months to one year for monitoring uterine function.
• Only after this period can the recipient attempt conception.

Issues with such transplants

• Challenges and Risks: Pregnancy after a uterine transplant entails a higher risk of rejection, spontaneous abortion, intrauterine complications, low birth weight, and premature birth. Close monitoring and follow-ups are essential.
• Immunosuppressant Use: Recipients must take immune-suppressing drugs to prevent rejection of the transplanted uterus. These drugs are selected to ensure they do not harm foetal development but can cause side effects such as kidney toxicity, bone marrow issues, and an increased risk of diabetes and cancer.
• Long-Term Follow-Ups: Post-uterus removal, recipients are advised to undergo regular follow-ups for at least a decade to monitor potential long-term effects of immunosuppressant drugs.

Exploring Artificial Uteri

• Future Possibilities: Successful uterus transplants have opened doors to exploring artificial uteri. These bioengineered organs, grown from stem cells on 3D scaffolds, could eliminate the need for live donors and ethical concerns. However, research is still in its early stages, and it may take about a decade before artificial uteri becomes efficient and safe for human use.
• Inclusivity Considerations: Artificial uteri could benefit not only women but also members of the LGBTQ+ community. However, certain complications, such as hormone-related considerations for trans-women recipients, remain to be addressed.

Conclusion

• Uterus transplants represent a remarkable medical advancement offering hope and possibilities for individuals facing uterine factor infertility.
• While challenges persist, ongoing research and technological progress continue to expand the horizons of reproductive medicine.

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