Transplantation: The end of absolute uterine-factor infertility?

AAGL attendees are normally reserved, but on Wednesday they got on their feet to give an ovation to the doctor who engineered the first pregnancy in a woman with a transplanted uterus.

At the Jordan M Phillips, MD Keynote Address, Mats Brännström, MD, PhD, told a rapt audience about the decade of research behind the pregnancy, which resulted in a healthy baby born in September.

Dr. Brännström is Professor and Chairman, Department of Obstetrics and Gynecology at the Sahlgrenska Academy, University of Gothenburg, Sweden. He was introduced by Arnold P. Advincula, MD, AAGL Scientific Program Chair, who noted that Dr. Brännström’s success was an example of years of grit and perseverance.

Dr. Brännström told the large audience that the possibility of uterus transplantation was first posed to him in the 1990s by a 27-year-old patient who needed hysterectomy and asked if this procedure was possible.

Dr. Brännström’s  group began transplant research on animals in 1999, when they implanted second uteruses in mice. The overall pregnancy rates were similar among mice with native and transplanted uteruses. The researchers moved on to rat and baboon studies, then in 2012 and 2013, 7 Swedish women received uterus transplants from living relatives (most often their mothers; notably, the oldest donor was 60). The recipients were told that the transplants were part of a research effort and that pregnancy was not guaranteed.

The transplant surgeries took 10–12 hours, rather than 3–4 hours, as was first projected. None of the transplant recipients required blood transfusions or ICU stays. Their hospital stays ranged from 3 to 9 days.

Two transplanted uteruses have had to be removed. There have also been some rejection episodes, which were asymptomatic and detected by cervical biopsy.  These were reversed with cortisone therapy.

The first live birth, in September, was by cesarean delivery at 31 weeks’ gestation due to the mother’s preeclampsia. Two other women with transplanted uteruses are currently more than 25 weeks into their pregnancies.

A case for and against mesh use in vaginal surgery

Dr. Brännström called these breakthroughs “the rebirth of reproductive surgery” and boldly predicted that they may mark the beginning of the end of absolute uterine-factor infertility (AUFI). 

To get weekly advice for today's Ob/Gyn, subscribe to the Contemporary OB/GYN Special Delivery.