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Happy babies: Thanks To Someone’s Uterus

Pregnant woman with a baby bump

More than half of US women who received a uterus through a transplant went on to have successful pregnancies. But uterine transplants are not without controversy.

If women are born without a uterus, they do not necessarily have to do without children of their own. It is not uncommon for women to born without a uterus or to have their uterus removed prematurely. However, uterine transplants are still very rare. The procedure has been performed around 100 times worldwide. Therefore, the number of cases examined is very limited.

But the results so far give many women hope: Between 2016 and 2021, 33 women in the US received a uterus transplant, and since then 19 of them, or 58 percent, have given birth to a total of 21 babies.

Artificial insemination after successful transplantation

After a transplant, women must wait around a year until the uterus is fully functional and menstruation starts regularly. Then a pregnancy by means of artificial insemination is fundamentally conceivable. Natural fertilization is not possible because women do not have fallopian tubes.

In 74 percent of the recipients examined, the uterus was still functional one year after the transplant. In this group, 83 percent had children who were all alive, the researchers reported in the journal JAMA Surgery

The babies were all delivered by cesarean section, an average of 14 months after the uterine transplant. All of the women had to take medications that suppress the immune system to prevent rejection after the transplant.

For this reason, the transplanted uterus was removed from the woman after the birth in order to avoid taking immunosuppressive drugs for life, as these sometimes have strong side effects.

3d Illustration - Female Reproductive System
3D illustration of the female reproductive system

Organ donation is possible for women without a uterus
Most of the examined recipients of a uterus transplant had no uterus from birth (Mayer-Rokitansky-Küster-Hauser syndrome).

In the US alone, more than a million women could potentially benefit from a uterine transplant, according to study leader Dr. Liza Johannesson of Baylor University Medical Center in Dallas .

About 15,000 women are affected in Germany. Before uterus transplants existed, the only way to have children was to adopt or foster a child or have another woman surrogate them, which is illegal in Germany.

Donor organs should come from living women

However, uterine transplants are not without controversy, not only because they are very complex and expensive, but also because of ethical concerns. The procedure is also not without risk for the donor, because transplantation is most promising when the uterus of a living donor is used.

This was the case for two-thirds of transplants in the United States. About one in four of these donors experienced a complication after the procedure.

“Reducing the risk for living donors should be a goal when the pool of deceased donors is insufficient,” emphasize Rachel Forbes and Seth Karp of Vanderbilt University in Nashville in an accompanying editorial on the study.

Ultrasound examination of an expectant mother
A woman who wants to have children can be helped by a uterus donation. However, the procedure is also not without risk for the donor.

Dispute over cost assumption

The new study is also likely to rekindle the debate as to whether uterine transplantation should be seen as a standard of care in women without a uterus. “Uterine transplantation should be considered a clinical reality in the United States,” the study states.

But who bears the costs? The affected woman who wants to have children or the health insurance companies? Because the complex operation costs around 50,000 euros and actually a uterus transplant – in contrast to a heart transplant – is not a vital intervention that the solidarity community has to take over.

“A uterus transplant is a de facto fertility treatment,” and some insurance companies may refuse to cover the cost, according to coauthor Giuliano Testa of Baylor University Medical Center in Dallas. At the same time, the fulfillment of a long-cherished desire to have children is of enormous psychological importance for the women concerned.

It will probably take a long time before the money dispute is resolved. It is possible that more women will opt for a uterus transplant in the future – also thanks to the encouraging results of the US study. So far, however, such an operation has only been possible for very few women anyway, also because there are so far only very few donors.

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