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Uterus transplant may enable pregnancy
2007-01-15
A New York hospital is taking steps to offer the nation's first uterus transplant, a radical experiment that might allow women whose wombs were removed or are defective to bear children. Muzi.com News 10032503-0 (muzi.com)The wombs would come from dead donors, just as most other organs do, and would be removed after the recipient gives birth so she would not need anti-rejection drugs her whole life. Muzi.com News 10032503-1 (muzi.com) The hospital's ethics board has conditionally approved the plans, although the hospital's president warned women not to get false hopes because a transplant is not expected "any time in the near future." Muzi.com News 10032503-2 (muzi.com) Several experts cautioned that much more research must be done, and one declared this bold concept "not really ready for prime time." Muzi.com News 10032503-3 (muzi.com) The New York doctors just did a six-month trial run, showing that wombs could be obtained from organ donors, and now are screening potential recipients. Muzi.com News 10032503-4 (muzi.com) "I believe it's technically possible to do," said lead physician Dr. Giuseppe Del Priore. Muzi.com News 10032503-5 (muzi.com) However, even some scientists involved think they should produce more healthy offspring in animals before trying women. Muzi.com News 10032503-6 (muzi.com) Others note that about a thousand women already have become pregnant after kidney, heart and other transplants, with generally good results. They view uterus transplants as a way to help women whose only option now for a biological child is through a surrogate mom. Muzi.com News 10032503-7 (muzi.com) "If this is a passionate desire for a woman who's had surgical removal of a uterus, I would think this would be something she'd really want to pursue," although the risks would have to be carefully weighed, said Julia Rowland, director of the National Cancer Institute's Office of Cancer Survivorship. Muzi.com News 10032503-8 (muzi.com) The transplant project is being led by Del Priore, a cancer specialist, and Dr. Jeanetta Stega, a gynecologic surgeon, at the New York Downtown Hospital, part of the New York-Presbyterian Health Care system. Muzi.com News 10032503-9 (muzi.com) Organ transplants usually are performed to save lives, but increasingly they are being done to improve quality of life. Hand transplants and the recent partial face transplant in France are examples. Muzi.com News 10032503-10 (muzi.com) Besides surgical complications that can prove fatal, the main risk in such operations is the need for lifelong immune-suppressing drugs to prevent organ rejection. Muzi.com News 10032503-11 (muzi.com) However, if a uterus had to be removed, it would be serious but probably not life-threatening like loss of a liver or heart, proponents say. Muzi.com News 10032503-12 (muzi.com) A uterus transplant has only been attempted once -- in Saudi Arabia in 2000. That womb came from a live donor and had to be removed three months later because of a blood clot. Stega thinks that transplanting more blood vessels and using better anti-clotting drugs would lessen this risk. Muzi.com News 10032503-13 (muzi.com) Doctors in London and Hungary want to offer such transplants and several are working with Del Priore and Stega. Potential candidates include women born without a uterus, those with abnormal tissue growth called endometriosis, and women who lost a womb to non-cancerous tumors called fibroids. Muzi.com News 10032503-14 (muzi.com) Del Priore is interested in fertility preservation for cancer survivors. Muzi.com News 10032503-15 (muzi.com) "Patients ask, 'Can anything else be done?'" he said. Muzi.com News 10032503-16 (muzi.com) Margaret Cieprisz was one. The Manhattan woman was diagnosed with ovarian cancer at age 38, a few months after she was married. Muzi.com News 10032503-17 (muzi.com) "The fact that I wasn't going to be able to have children, it was an unbearable thought to have to accept," she said. Muzi.com News 10032503-18 (muzi.com) She delayed a hysterectomy to create embryos that later were implanted in her sister, a surrogate mom for her 2 1/2-year-old daughter, Natalie. If a uterus transplant were possible, "I would have wanted to consider it," she said. "I'm so happy that I have a child, but I kind of missed out on something." Muzi.com News 10032503-19 (muzi.com) To be transplant candidates, women must have frozen embryos so there is no fertility issue complicating the chances of success, Del Priore said. Muzi.com News 10032503-20 (muzi.com) Here is how the process might work: Muzi.com News 10032503-21 (muzi.com) People donating a loved one's organs would be asked to donate the uterus, too. In the six-month experiment with the New York Organ Donor Network, nine out of 150 families agreed and eight wombs were successfully removed. Muzi.com News 10032503-22 (muzi.com) A uterus stays viable for about 12 hours, so the recipient would need to be ready for surgery once the retrieval begins. Muzi.com News 10032503-23 (muzi.com) The transplant would be through a vertical cut about 6 inches long, from the belly button to the pubic bone. The woman would need to be stable on anti-rejection drugs for at least three months before pregnancy would be attempted. Muzi.com News 10032503-24 (muzi.com) Then, previously frozen embryos would be transferred to the new womb in the usual manner through the vagina. (Doctors do not want the woman to have vaginal sex soon after the transplant because of an added risk of infection.) Muzi.com News 10032503-25 (muzi.com) The baby would be delivered by Caesarean section to avoid other risks involving the transplanted uterus. After the birth -- or two years after the transplant if no pregnancy is achieved -- the uterus would be removed to minimize the risks of anti-rejection drugs to the woman. Muzi.com News 10032503-26 (muzi.com) The drugs generally are not dangerous to a fetus although certain ones should be avoided, said Dr. Vincent Armenti, kidney transplant chief at Temple University School of Medicine in Philadelphia. He keeps a registry of pregnancies in transplant recipients throughout North America. Muzi.com News 10032503-27 (muzi.com) As of mid-2005, 990 women had had 1,547 pregnancies with results not much worse than the general population. Of the 772 pregnancies in kidney recipients, 590 births resulted (the rest miscarried or chose abortion). About half of babies were born prematurely -- most only slightly -- and much of this was due to the mothers' high blood pressure, not the transplant. Muzi.com News 10032503-28 (muzi.com) Only six babies died within a month of birth, and 4 percent had birth defects, some of them mild and fixable with surgery. Muzi.com News 10032503-29 (muzi.com) "The consensus of the community, supported by registry data, is that pregnancy can be safe in this population," Armenti said. Muzi.com News 10032503-30 (muzi.com) But some are wary. Muzi.com News 10032503-31 (muzi.com) "I think we have to learn quite a few things" before proceeding, said Stefan Schlatt, a researcher at the University of Pittsburgh, where a failed uterus transplant recently was done in a Rhesus monkey. Scientists are preparing to try again. Others have been done in mice, rats, rabbits and pigs, with offspring only in rodents. Muzi.com News 10032503-32 (muzi.com) "The whole thing is complicated. I think it's not really ready for prime time," said Dr. James Grifo, an infertility expert at New York University, who gave Del Priore a grant for rat research years ago. Muzi.com News 10032503-33 (muzi.com) The president of Del Priore's hospital, Dr. Bruce Logan, called the research "exciting and promising," but warned: "Every step in this long research process must be handled in a measured, prudent manner. Our first concern is always the safety of our patients." Muzi.com News 10032503-34 (muzi.com) The ethics board has approved the plans with the understanding it will reconsider once a patient is chosen. Muzi.com News 10032503-35 (muzi.com) "We want them to approve the actual patient, not just the process," Stega said. Muzi.com News 10032503-36 (muzi.com) The cost is unknown but could top $500,000, including two weeks of hospitalization, Del Priore said. He expects it to be shared by the hospital, charities that support infertility research, the patient, and insurers who cover the embryo creation part. Muzi.com News 10032503-37 (muzi.com) Some outsiders question whether it's right to take a uterus unless a donor agrees before death. Muzi.com News 10032503-38 (muzi.com) "Before anybody gets to use a reproductive organ ... should the donor not have the right to control that?" asked Arthur Caplan, bioethics chief at the University of Pennsylvania. "It's got symbolic importance that's far different from a pancreas or a liver." Muzi.com News 10032503-39 (muzi.com)
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