FIRST LIVE BIRTH AFTER MOTHER-TO-DAUGHTER UTERUS TRANSPLANTATION, Andrei Rebarber, MD (Print, Digital)

By on September 15, 2016

Surgical advancements have made it possible to bring one uterus through three generations. The following describes the uterus transplantation surgery, In Vitro Fertilization (IVF) procedures and the pregnancy outcomes of this unique birth of a healthy baby boy. This birth also represents the second successful birth ever after human uterus transplantation.

Uterus Transplantation (UTx)

In this particular case, the uterus was transplanted from mother to a daughter born with uterine agenesis, which is an anomaly where there is a complete absence of uterine tissue above the vagina. Donor surgery entailed isolation of the uterus, not including the oviducts, together with major arteries, and major uterine veins.

The donor surgery lasted for 10 hours, while recipient surgery began before final graft procurement. This surgery initially involved dissections of the vaginal vault and external iliac vessels. The vagina was anastomosed end-to-end, and then the uterus was fixed to the pelvic ligaments. The duration of this recipient procedures was less than 5 hours and the hospital stay was one week.

In Vitro Fertilization (IVF)

After uterus transplantation, the daughter waited for 12 months for embryo transfer (ET), to avoid rejection occurrences that commonly happen during the first year after any transplantation. A pregnancy test was positive 20 days after a single blastocyst transfer, where an ultrasound four weeks later showed a fetal heartbeat.

Pregnancy & Delivery through Uterus Transplantation

Pregnancy was achieved for the woman after the first single embryo transfer, and the pregnancy proceeded uneventfully until a C-section was performed in week 34+ to relieve the patient from intense pruritus, secondary to cholestasis of pregnancy. With success, the baby boy has developed fully normal during the first year.

A hysterectomy was performed some months after delivery. Because of extensive adhesions, the hysterectomy was complicated and with a surgical duration similar to transplantation. It is important to understand that uterus transplantation does not only involve the primary surgery but always a subsequent hysterectomy and in the successful cases, also cesarean section. Although hysterectomy is associated with surgical risk, the graft removal enables discontinuation of immunosuppression, which avoids any associated long-term side effects.

Conclusion of Success of Uterus Transplantation

This second birth after uterus transplantation further points towards that uterus transplantation is a feasible and near-future treatment for absolute uterine factor infertility. Especially since this is the first case with the uterus donated from a close relative, or specifically the grandmother of the baby. Researchers recognized the duration of the surgical transplant, specifically the long operating time for the donor (10 hours). However, the length of the complex donor surgery is more likely to be substantially shortened in the future by surgical training and advancements.

Most importantly, the pregnancy was entirely healthy regarding fetal growth and umbilical blood flow. The repeated success of uterus transplantation shows that his is a feasible future treatment for women with infertility.

For more details about this specific case and the advancement of uterus transplantation, please visit the original research publication.  For more information regarding MFM or our services, visit the about us page.

Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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