17 June 2022

Safe and efficient enough

Uterus transplantation and IVF help with "hopeless" cases of infertility

Daria Listratova, PCR.news

Scientists from Sweden have published the results of a clinical study of the effectiveness and safety of IVF after uterine transplantation. This operation is indicated in cases when the uterus is removed, for example, due to cancer, is absent from birth or has a developmental pathology that makes it impossible to implant an embryo. Attempts to perform a uterus transplant have been made since the 1930s, but the first birth took place in 2014 in Sweden, at the University of Gothenburg Hospital. The patient with Rokitansky syndrome (congenital absence of the uterus) was 35 years old, the organ donor was a woman who gave birth twice at the age of 61 — a family friend. Pregnancy occurred as a result of in vitro fertilization (IVF), carried out a year later, when it became clear that the transplant was stable.

The technology at the University of Gothenburg has been developed since the beginning of 2000 in animal experiments, in 2010 for the first time they received offspring from a rat with a donor uterus. In 2012, two uterine transplants from mothers to daughters were performed for the first time, then several more such operations were performed. Since then, a research team from the university has transferred the methodology to several other research centers outside Sweden. By the end of 2021, the number of uterus transplants in the world has reached 90, of which 20 were carried out in Sweden. About 50 children were born worldwide after uterus transplantation.

In the new work, a team from Sweden assessed the reproductive and long-term effects of uterine transplantation, as well as the possibilities of wider application of this procedure.

All the study participants had uterus transplants from healthy and, importantly, living donors (mostly women's mothers). Of the nine transplants, seven demonstrated long-term survival, which made IVF attempts possible. Two-day-old or five-day-old embryos were transferred according to the natural menstrual cycle of the recipients. Then the fetal development processes and the condition of the children and their mothers were closely monitored. Pregnancy took place against the background of immunosuppressive drugs.

In one case, success could not be achieved, pregnancy occurred, but ended in miscarriage. The remaining six women gave birth to nine babies: one of them had twins, and two more had two successful pregnancies. For two–day-old embryos, the total frequency of clinical pregnancy was 12.5% of all transfer procedures, the frequency of live births was 8.6%. For five—day-old embryos - 81.8% and 45.4%, respectively. Approximately the same indicators are achieved with the usual IVF procedure without uterus transplantation. Fetal development and blood flow were normal in all pregnancies.

Cesarean delivery occurred from the 31st to the 38th week. Three women had preeclampsia, and four newborns developed respiratory distress syndrome. Nevertheless, all the children were healthy and grew normally for two years. They are planned to be monitored until adulthood. The long-term health indicators of both donors and recipients were favorable.

After childbirth, the transplanted uterus was removed from women, those who gave birth to two children — during the last caesarean section, Hysterectomy was also performed on the seventh patient who could not bear a single child, six years after transplantation, at her own request.

Most of the research groups from different countries that perform uterine transplants enter data on donors, recipients, transplants, childbirth, complications and other information into the international registry created by researchers from Gothenburg. It is expected that this registry under the auspices of the International Society for Uterine Transplantation (ISUTx) will become a valuable research tool and make this procedure even safer and more effective.

Article by Brännström et al. Reproductive, obstetric, and long-term health outcome after uterus transplantation: results of the first clinical trial is published in the journal Fertility and Sterility.

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