When people think of organ transplantation it is usually in the setting of a life or death matter. It becomes obvious that it is necessary to incur the risks of organ transplantation to save a life, but is it worth the same risks to carry a child?
As many have recently read, this past week the Cleveland Clinic held a press conference announcing the first uterine transplant in the United States as a success and then unfortunately, days after they had to share the news that the patient had experienced a sudden complication leading to the removal of her transplanted uterus.
Reproductive medicine has been very successful during the past few decades, with the introduction of in vitro fertilization (IVF) in the late 1970s and intracytoplasmic sperm injection (ICSI) in the early 1990s, but it hasn’t found a good solution for women that are infertile due to a problem with or absence of their uterus.
Approximately 1 in 500 women suffer from uterine infertility. So far the option for these women to become a mother has been to either adopt a child or to find a surrogate mother. In 2014, the report of the first live birth following human uterus transplantation was published, showing that uterine factor infertility had a possible treatment.
Since then, besides the Cleveland Clinic case, eleven other cases of human uterus transplantations have been reported worldwide, conducted in three different countries. The outcomes have varied and the procedure is not without risks.
There is a risk of bleeding, infection and organ rejection. Rejection of an organ following transplantation is a common risk. The frequency of rejection typically depends on which organ is transplanted. For instance, the highest incidence of rejection is shown after lung, heart, and intestinal transplantation (~35%–40%, 30%–45%, and 55%, respectively). On the other hand, liver and kidney transplantation generally shows less frequent episodes of immediate rejection, with incidences of 13%–30% and 12%–14%.
In order to try to combat this rejection, doctors must give patients medications to suppress their immune system. This is also not without risk. These medications often increase the risk of infection and also have their own side effects. This process also becomes trickier in a patient that is soon going to become pregnant. We don’t know the long term pregnancy associated complications that may result from uterine transplantation. We do have evidence that women that have undergone transplantation of different organs and have had subsequent pregnancies have had an increased risk of obstetric complications including; ectopic pregnancy, hypertension, preeclampsia, miscarriage, premature delivery, low birth weight, stillbirth, and neonatal death.
As an OB GYN, I of course see the magic and beauty of gestation, but I also question if that experience is worth the risks of transplantation? It is wonderful to find new treatments for diseases. I marvel at the advancement of medicine and in this case within my own field, but I also cannot turn a blind eye to the many risks involved. Risks that may decrease as time goes on and more cases are performed, but may also not.
In this instance, as a professional, I do not feel completely equipped to give the answer. I have no idea what it feels like to want to have a child and not be able to do so. I also have never felt what it feels like to carry a child or to give birth. I hope that someday I am able to and if I cannot I will have to weigh the risks and benefits of the options available for me to do so. I only ask that all women in that situation carefully do the same.
Source: Uterus transplantation: current progress and future prospects. Int J Womens Health. 2016; 8: 43–51.Published online 2016 Feb 5