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The chance to carry a child is a deeply emotional experience, but the journey could be physically and mentally challenging. You’ll undergo thorough medical evaluations, a major surgical procedure, and need to take immunosuppressive medications to reduce the risk of organ rejection. Pregnancy after a uterine transplant is considered high-risk and needs constant medical attention. In most cases, the uterus is removed after childbirth to lower the need for long-term medication.
It is important to seek accurate information if you are considering a uterine transplant. The emotional weight of this decision might feel heavy, but remember you are not alone. There are doctors and counsellors who will guide you through every step.
Understanding Uterine Transplantation
Uterine transplantation involves surgically placing a healthy uterus into a woman’s body. This allows her to potentially carry and deliver a baby. It’s mainly for people with absolute uterine factor infertility (AUFI). This means you either don’t have a uterus or your uterus cannot support a pregnancy. AUFI is believed to affect around one in every 500 women.In uterus transplantation, success is measured by the proper functioning of the organ and the birth of a healthy baby. After the transplant, it is recommended to wait at least 12 months before attempting pregnancy.
Causes of AUFI
- Congenital absence of the uterus, also known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is a condition where a woman is born without a uterus.
- Other congenital malformations besides MRKH can cause different levels of infertility. They also increase the chances of complications during pregnancy, like miscarriage or very early preterm births.
- Hysterectomies are the most common gynaecological surgery, and more than 40 per cent of women who undergo the procedure are under 44 years old.
- A dysfunctional uterus can prevent embryo implantation or the completion of pregnancy. This can be caused by factors like radiation damage, myoma, adenomyosis, or intrauterine adhesions.
Who Might Consider Uterine Transplantation
You may want to consider a uterine transplantation if:- You were born without a uterus (MRKH syndrome).
- Your uterus was removed due to cancer, fibroids, or other conditions.
- Your uterus cannot sustain a pregnancy because of damage or abnormalities.
Process of Uterine Transplantation
The process involves multiple carefully planned steps for a successful transplantation:Evaluation and Preparation
Before the transplant, the doctor will perform IVF to create embryos. This involves collecting your eggs and fertilising them with sperm in a lab. Once fertilised, the embryos are frozen and stored for future use.
Donor Selection
The uterus must be evaluated for its ability to support a pregnancy. For living donors, a comprehensive gynaecological exam is required, along with pre-surgery imaging of the uterus using CT and MRI scans. Screening for uterine cancer is also essential, which includes tests for human papillomavirus (HPV), Papanicolaou smear, and an endometrial biopsy. Hormonal priming for several months may be done for postmenopausal living donors.
3. Donor Surgery
Removing the uterus involves a delicate surgical procedure. Although improvements in surgical techniques and the use of robotic-assisted laparoscopy have made the operation much less invasive for the donor.- Living donor: The surgery takes 10 to 13 hours. Surgeons delicately remove the uterus, preserving blood vessels. The donor’s ovaries are left intact to avoid immediate menopause. Recovery takes 7 to 10 days in the hospital.
- Deceased donor: The uterus is procured soon after the donor’s death, often within 18 to 90 minutes, to avoid tissue damage.
4. Transplant Surgery
The donor uterus will be surgically placed into your body. This surgery lasts 6 to 9 hours. Surgeons will connect the uterus to your blood vessels for proper blood flow.5. Immunosuppression
After surgery, you will need to take medications to prevent your body from rejecting the new uterus. You need to take them as long as the uterus remains in your body.The side effects of immunosuppression include nephrotoxicity, bone marrow toxicity, diabetes, and a higher risk of cancers.
6. Healing
Your body will adjust to the new uterus during the healing process. You will need regular checkups to monitor blood flow to the uterus using ultrasounds.If the surgery is successful, you may begin menstruating within a few months. This is a positive sign that the uterus is functioning as it should.
7. Embryo Transfer
Embryo transfer typically happens 6 to 12 months after the transplant, once doctors confirm the uterus is healthy.The frozen embryos created before the transplant are thawed. A fertility specialist then places one or two embryos into your uterus. About 2 weeks later, a blood test checks if you’re pregnant. If the attempt is unsuccessful, you may try again in a future cycle.
8. Pregnancy and Delivery
Pregnancy with a transplanted uterus is considered high-risk. You will have frequent ultrasounds and doctor visits to closely monitor the baby, uterus, and your health. Delivery after a uterus transplant is almost always done through a caesarean section.9. Hysterectomy or Uterus Removal
You may keep the uterus for another pregnancy attempt if you want more children. But remember that this requires ongoing immunosuppression treatment. After you have the desired number of children, the uterus is often removed. This reduces the need for long-term immunosuppression or any other risks.Follow-up care for the recipient should continue even after the hysterectomy of the transplanted uterus. This monitoring should last for at least ten years and ideally be maintained for life.
Pregnancy Complications After Uterine Transplantation
People with a transplanted uterus are at higher risk for pregnancy complications like:- Low birth weight
- Preterm birth
- Preeclampsia
- Rejection episodes
- Spontaneous abortion
- Intrauterine death
Uterine transplantation is a hopeful option for people who face uterine factor infertility. The process requires careful monitoring and emotional support. After childbirth, the transplanted uterus is removed to limit the need for long-term immunosuppressive medication. Make sure to speak with well-reputed medical professionals and counsellors if you are considering this procedure. It’s important to fully understand the risks and prepare for the physical and emotional challenges along the way.
FAQs
- What is uterine transplantation?
Uterine transplantation is a procedure where a healthy uterus is transplanted into a woman’s body to allow her to carry a pregnancy. It’s for people who cannot carry a pregnancy due to uterine factor infertility. - Is pregnancy after a uterine transplant safe?
Pregnancy following uterine transplant is high-risk. Regular medical monitoring is important for the mother and the baby.
