Childbirth after uterus transplantation: details
Mother and uterus
Alexandra Bruter, <url>In early September, in the Swedish city of Gothenburg, the first child was born, carried out by a mother after transplantation of a donor uterus.
An article about this was published online in the authoritative medical scientific journal Lancet on October 6 (Brannstrom et al., Livebirth after uterus transplantation). Up to this point, the absence of a uterus or its insufficient development remained the only fundamentally incurable variants of female infertility.
The project was started at the University of Gothenburg back in 1999 and finally brought results. In total, the uterus was transplanted to nine women, and now the first of them had a baby.
Why can't women have a uterus? Firstly, it can be removed due to a malignant neoplasm. Secondly, there are congenital malformations. A woman who gave birth to a child after a uterus transplant had a genetic anomaly known as Rokitansky syndrome.
Rokitansky syndrome is a congenital disease that manifests itself as a complete or partial absence of the uterus and sometimes a violation of the development of other genitals. All the required hormones, however, are present and functioning, so in due time girls develop secondary sexual characteristics, but menstruation does not begin. It is at this point that the disease is usually detected. Since the ovaries work as usual and ovulation occurs, such women could become mothers thanks to in vitro fertilization and surrogacy. The disease is relatively common: 1 case per 4-5 thousand women with genotype XX. It turned out that the carrier of the disease was the Queen of Greece Amalia of Oldenburg. The inability to produce an heir was supposedly the reason for the overthrow of her husband Otto I in 1826 .
The events leading to the development of Rokitansky syndrome occur in the early stages of embryonic development. They occur in the so-called Muller Duct. Approximately at the sixth week of embryonic development, the Muller duct is formed in embryos of either sex. Then, in boys, under the influence of the so-called anti-Muller hormone, it is largely reduced, and in girls, almost all genitals are formed from it. Therefore, the anomalies of the development of the Muller duct can not particularly harm boys, and girls – very much.
The main mutation leading to the development of Rokitansky syndrome has been identified – it is a mutation in the Wnt4 gene. The WNT4 protein is part of the WNT family, which controls the development of many things.
The uterus is not a vital organ, so until recently there have been isolated attempts to transplant it. Uterus transplantation has two main problems. The first, common to all transplanted organs, is the search for a histocompatible donor. The second is that for the subsequent normal gestation of pregnancy, it is necessary that the blood supply of the transplanted organ does not differ much from the blood supply of an ordinary uterus. This may be particularly difficult in patients with an absent uterus, because in the absence of the uterus, the corresponding vessels could develop unpredictably.
From the point of view of histocompatibility, uterus transplantation is slightly easier than other organs. There is a high probability that there may be a related donor who has already passed the childbearing age. On the other hand, even in such a situation, it may be necessary to take immunosuppressive drugs, which can lead to complications of pregnancy.
In 2013, a 35-year-old patient underwent a uterus transplant. The donor was a 61-year-old woman, a family friend, a mother of two children. Before transplantation, eggs were taken from the expectant mother, in vitro fertilization was performed and 11 embryos were preserved. After 43 days, the recipient began menstruating and continued until pregnancy. The only embryo was transplanted a year later, and pregnancy occurred from the first time. The pregnancy proceeded well, under the close supervision of doctors. It was regularly checked whether the fetal blood supply was sufficient.
During the time that has passed since the uterus transplantation, three minor episodes of rejection of the donor organ have occurred, one of them during pregnancy. All of them were quickly stopped by immunosuppressants.
At the 32nd week of pregnancy, the patient developed preeclampsia (her risk is considered increased with IVF) – a potentially dangerous condition for mother and child associated with a significant increase in blood pressure in the mother. The cause of preeclampsia could be the absence of one kidney in the patient, the kidney as well as the uterus was absent from birth. According to the results of cardiotocography, it was decided to perform a caesarean section. As a result of the operation, a completely healthy boy weighing 1775 grams was born, this is a normal weight for such a period of pregnancy. Everyone feels good.
Doctors believe that after two successful births, it will be safer to remove the uterus. First of all, because of immunosuppressive drugs, which otherwise you will have to take all your life.
Meanwhile, eight more participants of the project are waiting for their turn.
Portal "Eternal youth" http://vechnayamolodost.ru13.10.2014