1. The implantation of an embryo, created through in vitro fertilization, into a transplanted human uterus resulted in normal pregnancy of nearly 32 weeks.
2. The transplant patient experienced three cases of mild rejection that were treated with corticosteroids, and pre-eclampsia at 32 weeks that resulted in a cesarean section procedure to deliver a healthy baby.
Study Rundown: Until the findings of this study, women with absolute uterine factor infertility (AUFI) were diagnosed as untreatable. Causes of AUFI include the congenital absence of the uterus, a hysterectomy, or intrauterine adhesions. The authors of this study are currently running the first clinical trial of uterus transplantation from live donors, with nine participating recipient women. This particular study reports the results of the first patient in the cohort of 9 to achieve a pregnancy that resulted in the birth of a baby.
The patient in this study, age 35, suffered from AUFI caused by congenital absence of the uterus, and the donor of the uterus was a family friend, age 61. Prior to transplantation surgery, the viability of the uterus was evaluated while in the donor, and embryos were created from the recipient and her male partner via in vitro fertilization. Following surgical transplantation of the uterus from the donor to the recipient, doses of immunosuppressive therapies were administered to reduce the risk of transplant rejection. Implantation of the embryo occurred one year after transplant, and resulted in a successful pregnancy. When the patient presented with pre-eclampsia (cause unknown) at 32 weeks post-implantation, a cesarean section was performed. The baby was normally developed, requiring little post-birth care, and was released 16 days later. While the implications for sufferers of AUFI hinge on subsequent patient studies, this report serves as an exciting proof-of-concept for human birth from a transplanted uterus.
Relevant Reading: First clinical uterus transplantation trial: a six-month report
In-Depth [case report]: This study reports the first live human birth from a transplanted uterus. The healthy donor of the uterus had experienced two previous pregnancies resulting in healthy births, as well as menopause prior to the uterus donation. The transplantation of the uterus involved (1) the isolation of the uterus with bilateral venous and arterial vascular pedicles, and (2) the attachment of the uterus to the recipient’s vasculature as well as their stabilizing ligaments and connective tissue. The extraction surgery lasted approximately ten hours, and the transplantation surgery lasted nearly five hours. The recipient patient received multiple courses of immunosuppressive and steroid therapy following transplantation and during pregnancy, including anti-thymocyte globulin, methylprednisolone, and tacrolimus.
The recipient’s first menstruation occurred spontaneously 43 days after transplantation surgery. Histological evaluation of uterine cervix biopsy samples revealed 3 mild transplant rejection events: 2 before pregnancy, and another during. These events were resolved through corticosteroid treatment. The implantation of an embryo to the transplanted uterus resulted in a successful pregnancy, with normal fetus development. At 31.7 weeks, that patient presented with pre-eclampsia, and a cesarean section was performed. Following delivery, the baby was of normal weight for its development stage, and required only room air and phototherapy treatment. The mother was released from hospital three days after delivery, and observation will continue to assess the continued viability of the uterus.
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