Uterus transplantation

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The uterus transplant is a surgical procedure whereby a healthy uterus is transplanted into an organ that has no uterus or diseased. As part of normal mammalian sexual reproduction, the sick or absent uterus does not allow normal embryo implantation, which effectively makes women infertile. This phenomenon is known as absolute uterine factor infertility (AUFI). Uterine transplantation is a potential treatment for this form of infertility.

Video Uterus transplantation

Histori

Studi

In 1896, Emil Knauer, a 29-year-old Austrian working in one of Vienna's gynecological clinics, published the first study of ovarian autotransplantation that documented normal function in rabbits. This led to the investigation of uterine transplants in 1918. In 1964 and 1966, Eraslan, Hamernik and Hardy, at the University of Mississippi Medical Center in Jackson, Mississippi, were the first to autotransplant animals (dogs) from the womb and subsequently provide a pregnancy from the uterus. In 2010 Diaz-Garcia and co-workers, at the Department of Obstetrics and Gynecology, University of Gothenburg in Sweden, showed the world's first successful uterine transplant, in mice, with healthy offspring.

Cases

Transplant

In 1931 in Germany, Lili Elbe, a Danish transgender woman, died of organ rejection three months after receiving one of the earliest uterine transplants in the world. With the availability of in vitro fertilization in 1978, uterine transplantation studies were suspended.

In Saudi Arabia in 2000, a uterine transplant was performed by Dr. Wafa Fagee, from a 46-year-old hysterectomy patient to a 26-year-old recipient whose own uterus has been bleeding after childbirth. The transplanted uterus works for 99 days, but eventually has to be removed after failure due to blood clots. In the medical community there is a debate whether or not transplantation can really be considered successful. Postoperatively, the patient experiences two spontaneous menstrual cycles, followed by amenorrhoea; Exploratory laparotomy confirms uterine necrosis. This procedure has raised some moral and ethical issues, which have been discussed in the literature.

In Turkey, on August 9, 2011, the world's first uterine transplant from dead donors was conducted by a team of doctors at Akdeniz University Hospital in Antalya. The 21-year-old Turkish woman, Derya Sert, who was born without a womb, was the first woman in history to receive the womb from dead donors. The surgery, performed by Dr. ÃÆ' â € "mer ÃÆ'-zkan, Dr. Munire Erman Roots and their team, is the world's first long-term uterine transplant surgery that gains long-term function, as evidenced by the fact that Ms. Sert has undergone six menstrual periods. postoperative and is said to have a fully functioning uterus. Turkish medical teams that perform complex operations, however, are still cautious to declare the operation as a full success. "The operation was a success, but we will succeed when she gives birth to her baby," Ozkan said. "For now, we're glad that the network is alive". On April 12, 2013, Akdeniz University announced that Derya Sert was pregnant. The statement made by the university hospital also added that Ms Sert will be delivered by C-section to prevent complications. On May 14, 2013, it was announced that Ms. Sert ended her pregnancy at week 8 after a routine check in which the doctor failed to detect the fetal heartbeat.

In Sweden in 2012, the first mother-to-child uterine transplant was performed by a Swedish doctor at Sahlgrenska University Hospital at the University of Gothenburg led by Mats BrÃÆ'¤nnstrÃÆ'¶m.

The first uterine transplant performed in the United States took place on February 24, 2016 at the Cleveland Clinic. The transplant failed due to complications on March 8 and the uterus has been removed. In April it was revealed that a fungal infection by Candida albicans has caused damage to the local artery that compromises the blood support of the uterus and necessitates its removal.

The first uterine transplant performed in India took place on May 18, 2017 at the Nursing Hospital Galaxy in Pune, Maharashtra. The 26-year-old patient was born without a womb, and received her mother's uterus in transplant.

The first successful pregnancy

In October 2014 it was announced that, for the first time, healthy babies had been born for uterine transplant recipients, at an undisclosed location in Sweden. The British medical journal The Lancet reported that the baby boy was born in September, weighing 1.8 kg (4.9 pounds) and that the father said his son was "extraordinary". The baby was born prematurely at about 32 weeks, with a caesarean section, after the mother had developed pre-eclampsia. Swedish woman, aged 36, has received a uterus in 2013, from a 61-year-old living donor, in an operation led by Dr. BrÃÆ'¤nnstrÃÆ'¶m, Professor of Obstetrics and Gynecology at the University of Gothenburg.

The woman has a healthy ovary but is born without a womb, a condition that affects about one in 4,500 women. This procedure uses embryos from the laboratory, made using female ovum and sperm of her husband, which is then implanted into the transplanted uterus. The uterus may have been damaged in the course of caesarean delivery and may or may not be suitable for future pregnancies. A three-immune suppression regimen is used with tacrolimus, azathioprine, and corticosteroids. Three episodes of minor rejection occurred, one during pregnancy, but all were successfully suppressed with drugs. Several other women were also reportedly pregnant at the time using a uterine transplant. The unnamed mother, who received a donated uterus from a friend, said she hoped the treatment would be refined to help others in the future.

The transplant is meant for a while - the recipient will have a hysterectomy after one or two successful pregnancies. This avoids the need to take lifelong immunosuppressive drugs with the consequent increased risk of infection.

This procedure remains the last option - expensive and not covered by insurance and, unlike other methods for fertility and treatment assistance, is a relatively new and somewhat experimental procedure, performed only by certain specialist surgeons at selected centers, where the risk of a surgical organ transplant officer is relatively invasive, including infection and organ rejection. Some ethical specialists consider the risks to living donors, as opposed to post-mortem donors, as being too large, and some find the whole procedure ethically questionable, especially since transplantation is not a life-saving procedure.

Second center to succeed

In Nov 2017 the first baby was born after a uterine transplant in the US. Births occurred at Baylor University Medical Center in Dallas, TX, after donation of the uterus from a non-directed live donor.

Maps Uterus transplantation

Description

Procedures

Uterine transplantation begins with uterine surgery on the donor. Working techniques for this exist for animals, including primates and humans recently. The recovered uterus may need to be stored, for example for transport to the receiving location. The study of cold-ischemia/eperfusion shows ischemic tolerance for more than 24 hours.

The recipient must look at the possibility of three major operations. First of all, there is a transplant operation. If a pregnancy is established and performed for the survival of a caesarean section is performed. Because the recipient is treated with immunosuppressive therapy, finally, after delivery, hysterectomy is necessary so that immunosuppressive therapy can be stopped.

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Ethics

Montreal Criteria

In addition to consideration the cost of uterine transplants involves complex ethical issues. The principle of autonomy supports the procedure, while the principle of non-maleficence is against it. In connection with the principles of kindness and justice, the procedure seems vague. To address this dilemma, the "Montreal Criteria for Ethical Appropriateness of Uterine Transplantation" was developed at McGill University and published in Transplant International in 2012. The Montreal Criteria is a set of criteria deemed necessary for the ethical implementation of uterine transplantation at human. The findings are presented at the 20th International World of Gynecology and Obstetrics' World Congress in Rome in October 2012. In 2013 renewal for "Montreal Criteria for Ethical Feasibility of Uterine Transplantation " was published in Fertility and Sterility and has been proposed as an international standard for the implementation of ethical procedures.

Criteria establish conditions for beneficiaries, donors, and health care teams, in particular:

1. The recipient is a genetic woman without medical contraindications for transplant, has no uterine absence that has failed another therapy, has "personal or legal contraindication" for other options (surrogacy, adoption). Asked that he wants a child, fit to be a mother, fit psychologically, tends to be in line with care, and understands the risks of the procedure.
2. A donor is a woman of reproductive age without contraindications to procedures that have concluded that she gave birth or agreed to donate her uterus after her death. Asked for no coercion and responsible and healthy donors to make informed decisions.
3. The health care team belongs to an agency that meets Moore's third criteria of institutional stability and has provided informed consent to both parties. Requested that there be no conflict of interest, and anonymity can be protected unless the recipient or the donor discharges this right.

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See also

• Male pregnancy
• Transplanted organs and tissues

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References

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External links

• Nine Swedish women underwent a uterine transplant
• Renewal of a uterine transplant project at Sahlgrenska University Hospital
• Womb and IVF transplantation at Huffington Post
• Documentary on Uterine Transplantation
• The New York Times article on successful Uterus transplantation
• What Uterine Transplant Means For a Fighting Pair With Fertility

Source of the article : Wikipedia