An absent, damaged or diseased uterus prevents embryo implantation and a successful pregnancy. However, the advent of viable uterus transplants raises searching questions about its impact on the future of infertility, fertility treatment and surrogacy.
One in 5,000 women are born without a womb in the UK. Hysterectomy is still often used to treat women with cervical or uterine cancer, many of whom have not yet had children or completed their family. In the UK around 1,000 women undergo hysterectomies every year in the 15 to 24- year old age group due to cancer and other conditions. One or two women in every hundred who deliver a baby have their womb removed to prevent life-threatening bleeds (post-partum haemorrhage). Women also undergo hysterectomies as a result of severe fibroids.
The number of women with compromised uterine function includes those with: intra-uterine adhesions, malformed uterus, damage caused by radiation and fibroids.
History
In the early and mid-twentieth century, medics and scientists undertook research on uterus transplantation. In the 1960’s, scientists successfully achieved a uterus transplant, pregnancy and birth in a dog. However, this research was deferred following the availability of IVF and the arrival of the first IVF baby in the UK in 1978.
Sweden
Fast forward forty years and in October 2014, the British Medical Journal announced that a baby boy had been born in Sweden following a uterus transplant. The Swedish mother, aged 36, had undergone a uterus transplant in 2013, receiving the uterus from a living 61-year old friend. The Swedish mother had been born without a uterus, although she had healthy ovaries. Her eggs had been harvested, and used to create embryos with her husband’s sperm. An embryo was then transferred into her transplanted uterus. She took a range of immunosuppressant drugs and although three mild rejection episodes occurred during the pregnancy, these were successfully controlled with drugs.
The US
In November 2017, a second baby was born in the US following a uterus transplant from a living donor. The baby was born at Baylor University Medical Center in Dallas, Texas.
The UK
On 5 June 2018, the UK Womb Transplant Research Team announced it is expanding its research in this developing area. In 2015 it secured permission to perform 10 uterus transplants from brain dead donors and it now has authority to perform another 5, using uteri from live donors. It hopes to start the programme and perform the first operation of its kind in the UK later this year, led by Mr Richard Smith in collaboration with the team from Dallas. Mr Richard Smith has an international reputation for the development of fertility sparing surgical procedures and is a Consultant Gynaecologist at the West London Gynaecologist Cancer Centre, Queen Charlotte’s & Chelsea Hospital, Imperial College London.
This follows hundreds of hours of work by the UK Womb Transplant team in 2017 and into 2018 into research, trials, development of protocols and training and reports to regulators to gain permission to begin this groundbreaking programme. Around 750 women have approached the team for a uterus transplant and after preliminary selection the team has contacted around 50 of them. The women will undergo clinical and psychological assessment along with potential living donors. A living donor is likely to be the recipient’s mother or sister. The recipient will need to take immunosuppressant medication and create and store embryos ready for implantation. A delivery will take place by caesarean section between 35-37 weeks’ gestation and the women will be offered the chance to try for two pregnancies. The costs of these procedures will be paid for by the UK Womb Transplant Research Team.
Mr Smith hopes to develop a sustainable national programme by 2020. He anticipates around 10 suitable organ donors will be available in the London area every year and he hopes to perform 5 uterus transplants annually. As such, womb transplants could in future provide a fertility solution for women without a womb or with compromised uterine function.
Medical issues
It is believed that 42 women worldwide have received uterus transplants, producing 11 babies up to May 2017. These womb transplants have been carried out in 10 countries: Saudi Arabia, Turkey, Sweden, US, China, Czech Republic, Brazil, Germany, Serbia and India.
However, a uterus transplant is still viewed as experimental. It is expensive, invasive and requires specialist medical surgery which is only performed in a small number of places. The procedure carries many of the same risks associated with other organ transplants. It is only intended to be temporary, to avoid the need to take immunosuppressant medication for life, with a hysterectomy after the recipient has successfully given birth.
There is ongoing debate about best practice in the developing field of uterus transplantation. There are calls for screening of donors and recipients to ensure they are in good health, with no infection or cancer. Some teams require an upper age limit of 35-40 for women undergoing uterus transplantation and an upper age of 55-65 for donors. Other medical complications reported in recipients include urinary tract complications, thrombosis, infection and preeclampsia in pregnancy.
Legal issues
Deciding to build a family through innovative reproductive technology and assisted conception is a big step. Modern family building creates increasingly complex medical, legal and practical issues. Expectations and wishes can outpace understanding of law and policy and this carries additional risks which can leave individuals and their much wanted children without legal protection. This makes it important to invest time, energy and financial resources wisely and secure expert medical and legal help at the outset to maximise success.
If you are considering assisted conception, or even a womb transplant, it is important to obtain expert fertility, parenting and family law advice to include specialist:
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Family building law advice to discuss your conception options and the legal issues arising whether this includes: fertility treatment, fertility preservation and maximisation, conception with donor eggs/sperm/embryos, surrogacy, a co-parent, a known donor or innovative reproductive technology.
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Fertility law advice to help you provide informed legal consent to fertility treatment at a UK fertility clinic to include: assistance with completion of consent forms, storage and use of eggs, sperm and embryos.
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Fertility and family law advice to give a firm legal basis for modern family building and life to include: a known donor agreement, a co-parenting agreement, a parenting agreement, specialist legal advice on surrogacy or a ‘family proof’ Will.
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Fertility and family law advice if you experience difficulties in building your family or encounter difficulties about legal status or rights for a child (including disputes with a parent, co-parent, donor, surrogate).
