A plastinated fetus is seen during the exhibition "Body Worlds" by Gunther von Hagen in Rome.
(photo credit: REUTERS)
Encouraged by successful deliveries of babies following uterine transplants in Sweden and the US, Israel Transplant hopes “within two years” to begin such transplants for young women born without a uterus or who underwent hysterectomies after contracting uterine cancer, The Jerusalem Post has learned.
Israel Transplant director Dr. Tamar Ashkenazi said the process was initiated by a team at Ziv Medical Center in Safed. Israel is a very baby-oriented society; in 1996, it adopted the world’s first law that allowed married women to have babies through surrogate mothers.
Uterine transplants would offer hope to childless couples to conceive their own child together and reduce the need for surrogacy.
Last month, a woman born without a uterus gave birth to a healthy baby boy a year after undergoing an experimental uterine transplant at Baylor University Medical Center in Texas. The success, the first of its kind in the US, was announced last week; her identify is being kept private.
In the last three years, Sahlgrenska University Hospital in Sweden made possible the birth of eight infants following successful uterine transplants; the fact that the feat was reproducible in the US created much interest in transplant centers around the world.
Gynecologists estimate that in the US alone, 50,000 women might be candidates for transplants of a uterus donated by a live donor. There have even been cases where the mother of a childless woman has donated her uterus to make it possible for her daughter to give birth.
About one in 4,500 women is born without a uterus; losing a uterus due to cancer is much more common.
The transplant is not simple or cheap; it involves complex connections of blood vessels and nerves in addition to the muscular sac itself, and requires the woman to take anti-rejection drugs for as long as the uterus remains in the her body. The organ would remain only as long as it is intended to carry fetuses; when the woman is finished having a family, the uterus would be removed so that she would no longer have to take immune-suppression drugs, which can cause complications.
Since the process of impregnation would not be able to be achieved naturally, each recipient undergoes in-vitro fertilization (IVF) to produce embryos that are implanted in the “new” uterus.
The five-hour transplant operation, which is performed about a year before the couple intends to begin IVF, presents a risk of rejection by the recipient as well as infection in the donor whose uterus has been removed. All babies gestated this way are delivered by Cesarean section – about a month or so before the full-term of 40 weeks – to minimize stress on the donated sac.
Prof. Eliezer Shalev, chairman of the Health Ministry’s National Council for Obstetrics and Gynecology, a senior gynecologist at the Rappaport Faculty of Medicine of Haifa’s Technion-Israel Institute of Technology and one of the leading experts in his field, told the Post that he is “in favor of any medical procedure that will be good for patients. If I were an active obstetrician today, I would go to Baylor to learn how it was done so it can be adopted here,” he added.
“One must first examine the success rate and decide if it is possible here and would be included in the basket of health service. I am sure there will be a demand for it,” said Shalev.
The possibility of uterine transplantation was first investigated in 1918, 24 years after a Viennese doctor performed ovarian auto-transplantation – the extraction and storage of ovarian material and subsequent transplantation back into the same female – in a rabbit. In 1931, a transgender woman from Denmark died in Germany from organ rejection after undergoing one of the world’s first transplantations of a uterus.
When IVF was successfully introduced in 1978, uterine transplant research was halted; in the last two decades, however, it has been revived due to demand from women.
Currently, Israeli law allows only heterosexual married couples to create surrogacy arrangements, but this has come under protest from MK and former health minister Yael German. It is likely that once uterine transplants become routine, both unmarried and lesbian women lacking a uterus – as well as transsexual women who were physically originally men – would demand the right to have uterine transplants as well.