Uterine Transplant

Happy 2018, everyone!  I’ve been meaning to write since I read this article about the first baby born in the United States from a uterine transplant:

http://time.com/5044565/exclusive-first-u-s-baby-born-after-a-uterus-transplant/

A woman who was certain she did not want any more children donated her uterus to a woman who did not have a functioning uterus herself.  It’s kind of like a kidney transplant.  The recipient had functioning ovaries, so she was able to conceive using her own eggs and her husband’s sperm via IVF.  This is part of a larger study being done at Baylor University, and this was the first live baby that resulted from the study.  Previously, this had only been done in Sweden.

My limited understanding of transplant medicine is that because the organ is being donated by another person, then the recipient must be on immunosuppressant medications so that their body hopefully doesn’t reject the donated organ.  In some cases, the body does start to attack the transplant as foreign, and it must be taken out.  Which means that in the case of say, a kidney transplant, they’d need another kidney.

I’ve occasionally taken care of pregnant patients who’d had kidney transplants.  So there is a precedence for women who have had a transplant and are on immunosuppressant medications who have had babies.  I don’t know what the research says, but I figure if there was a concern for significant adverse outcomes in the children, then they would not allow this to occur.  Given the complexity of uterine functions that occur with supporting a pregnancy, though, this an entirely different level than a kidney transplant.

It did make me wonder why women would want to undergo the risks of having a transplant, and expose their babies to immunosuppressant medications in order to have a child.  After all, there is the option of surrogacy.  That is what Kim Kardashian is doing for her third child, since she had complications with her previous pregnancies.  With surrogacy, the child would still be genetically yours, but the difference is that another woman would be carrying the child.  So you wouldn’t be able to experience the pregnancy for yourself, but on the upside you would not have the transplant risks.

What says a lot are the statements from the physicians involved in this study.  One says, “We do transplants all day long.  This is not the same thing. I totally underestimated what this type of transplant does for these women. What I’ve learned emotionally, I do not have the words to describe.”  Another says, “A lot of people underestimate the impact that infertility can have on a person’s wellbeing.  It can have such a profound impact.”  The article goes on to say that uterine transplant is not a replacement for the options of surrogacy and adoption, but rather another option for couples.

Reading the statements above made me think about my own feelings.  Experiencing infertility myself has given me a deeper understanding of the feelings related to pregnancy and childbirth.  I understood the heartache of wanting children and not being able to.  But going into it, I didn’t think I’d be bothered so much by it since I’d already had a child.  And certainly, the feeling is different than for those who don’t have any children.  But I underestimated how disappointed I’d feel, and how I’d feel like my body was failing me.

The other thoughts that come up regarding these transplants is how important it is for many women to not only have a child that is genetically theirs, but to also want to experience the pregnancy for themselves.  As an obstetrician who sees the worst symptoms of pregnancy, I feel like pregnancy is often pretty miserable for many women.  And how often do I hear my patients, pregnant or not, say how good men have it.  After all, we women have to deal with periods, pregnancy, delivery, breastfeeding, and menopause.  And for the most part, the responsibility of contraception falls on us.

Despite all of that, the above goes to show how special it is to be able to carry one’s own child.  It’s not something that every woman wants, or should be expected to do.  But for those who do want to, it can be deeply disappointing to have that option taken away.  For the women who are candidates, it’s a remarkable achievement to now have the option to have a baby using a uterine transplant.

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