A baby was recently born to a mom with transplanted uterus
in Texas. The birth took place at Baylor, the first birth in the hospital’s
ongoing uterus transplant clinical trial. Women who are participating
in the trial have absolute uterine factor infertility (AUI), which means their
uterus is nonfunctioning or nonexistent. Most of the women in the trial have a
condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and have lived
their entire lives under the assumption that they would never be able to be
pregnant or give birth to a baby. The procedure could also work for women with
other medical issues, such as certain cancers.
In spite of the recent success, women who choose a uterine
transplant faces extreme challenges. The process requires three surgeries: The
transplantation itself; a caesarian section to deliver the baby, and then a
final surgery to remove the uterus after childbirth so the recipient doesn’t
need to continue taking powerful drugs to prevent her body from rejecting the
organ. Since this is fairly experimental procedure in reproductive medicine, there
is no evidence of increased risks for children born from uterus transplant to
date. Among other concerns is the fact it is not a lifesaving procedure but a temporary fix as the uterus is removed after a woman is done having children. Womb
donors can be from a live or deceased person. Like any surgery, it carries the risk
of infection and complications, but transplant surgeries include the additional
risk of organ rejection and the medical complexities that come with those
immunosuppressant drugs. Not to forget, the multiple risky surgeries involved. Moreover, due to the lack of sufficient data on its safety,
is it justified to expose a person and its fetus to unforeseen dangers? While
this may give women a chance, it also targets vulnerable individuals who so
desperately want to have a child that they may not recognize or be fully
informed of all the risks and benefits of experimental procedures. Saying that the donor, recipients and their
families want the transplantation is not ethical. It’s for the physicians to
underline the many potential complications of this experimental surgery for
both the donor and recipient and determine the pressures that are driving women
to take such risks. Though this particular case was successful, it is
still a very new and experimental procedure and not all women is going to have the
same result.
References:
Testa, G., & Johannesson, L. (2017). The ethical
challenges of uterus transplantation. Current Opinion in Organ
Transplantation, 1. https://doi.org/10.1097/MOT.0000000000000467
Petrini, Carlo and Morresi, A. (2017). Uterus transplants and
their ethical implications. Ann Ist Super Sanità 2017, 53(1),
25–29. https://doi.org/10.4415/ANN
https://www.washingtonpost.com/news/to-your-health/wp/2017/12/03/a-woman-with-a-transplanted-uterus-just-gave-birth-a-first-for-the-u-s/?utm_term=.239862220033
This transplant was carried out as part of a clinical trial to study new infertility treatment options for women who don't have a functioning uterus. It was surprising to find out that these transplanted uterus can only be used once and then must be removed. As of now, we do not use the uterus in other organ transplants, so why not get some use out of a donated one? However, I'm curious to know what medication regiment did these women (and others within this clinical study) have to take? Are there any possible side-effects to these medications? Do they outweigh the possible gain of having a biological child? How much do these three procedures cost- are they accessible to all women with AUI? These women also need to wait a year after transplantation into order to see how their body reacts to the new organ. If all goes well, an embryo is transferred to the transplanted uterus and then closely monitored until a cesarean delivery. The uterus transplant was unsuccessful for the first three patients in the case study because the transplanted organ was rejected by the body or was not receiving adequate blood flow to it. Do the gains of having a biological child outweigh the apparent risks and costs?
ReplyDeleteI think the medications referred to in this are likely a battery of anti-rejection drugs whose primary function is immunosuppression. So, possible side effects are high rates of disease and infection and decreased ability to recover from the same. I do not, however, follow their logic of needing anti-rejection drugs seemingly forever. As far as I know, it is not necessary to continue anti-rejection meds forever after receiving a transplant so I don't understand why the uterus is a special case in this respect.
DeleteA uterus transplant, might be able to allow a women to give birth to her own child, butte as you outlined there are a number of risks for the mother. Does this form of fertility, impact the baby at all? Is there a greater risk of injury the baby during birth, or have there been any developmental issues associated with it?
ReplyDeleteThis is something that I think is a very interesting avenue of research. You mention that this is currently only used for women who have disease that prevent them from having children. I wonder if this could one day be seen as a type of fertility treatment for women who do not have a uterus that would be able to sustain a pregnancy. Do you think that one day women who are infertile yet want to experience carrying their own child would be able to undergo a uterine transplant to do so?
ReplyDeleteThere are two possible risks I can see that may be associated with this. It has been well-studied that a woman may retain genetics from her children that exert genetic influence on her as long as decades after the pregnancy. This is likely a result of the body's immuno-suppression during pregnancy as well as placental transfer of fluids. However, if a foreign uterus acts as an intermediary of this process, could it complicate this process or introduce some genetic influence from the donor uterus? Sure it is probably a long-shot, but I think there is likely enough precedent for it to be considered as a possible outcome. Secondly, recent studies on fruit flies suggest that chemicals from previous mates remain in the female and exert non-genetic influence on future progeny sired by other males. Obviously, humans aren't fruit flies and the situations are not totally analogous, but it still gives one pause. Is there a potential for influence on progeny from chemicals in the donor uterus from previous partners?
ReplyDeletehttps://www.smithsonianmag.com/science-nature/babys-cells-can-manipulate-moms-body-decades-180956493/
Park, A. (2014, October 3). The Problem With Ex-es: How Previous Partners Affect Your Offspring. Retrieved December 06, 2017, from http://time.com/3461485/how-previous-sexual-partners-affect-offspring/