First Uterus Transplant Performed in U.S.

There's exciting medical news this week for women who want to give birth but don't have a uterus -- needed to become pregnant and give birth -- because it was removed due to illness or they were born without one. According to estimates, approximately 50,000 American women may be candidates for the uterine transplant just performed in the U.S.

The Cleveland Clinic announced they successfully performed the nine-hour surgery on a 26-year-old woman on Feb. 24th, marking the first time it has been performed in the US. Before now, uterine transplants have only been successfully completed at one place, the University of Gothenburg. in Sweden. Nine women have had the surgery there using a uterus from a live donor with five women having babies, the first in 2014. All were born premature, but healthy.

To prepare for the ground-breaking operation here, Dr. Andreas G. Tzakis, head of the Cleveland Clinic surgical team, travelled to Sweden to work with the doctors at the University. Dr. Tzakis' prior experience includes 4,000 to 5,000 transplants of kidneys, livers and other abdominal organs.

The transplant surgery is considered high risk and the fetus will be exposed to anti-rejection drugs and develop inside the uterus from a deceased donor. Dr. Tzakis states the drugs are safe given how many women take them while pregnant after undergoing kidney or liver transplants. And, the drugs are taken by the patients only while the uterus remains, not for the rest of their life.

The patient must wait a year before trying to get pregnant -- this allows time to heal from the surgery and to establish the right amount of medication needed to make sure the organ is not rejected. Once healed, and if the transplant has worked, the couple will need to use in vitro fertilization (IVF) to get pregnant.

Before undergoing surgery, this patient had her eggs removed, fertilized with her husband's sperm and then frozen. When ready, the embryos will be transferred into her new uterus. If she is able to get pregnant and give birth, delivery will need to be done through a C-section. Also, the transplant is temporary so once the woman has had one or two children, the uterus will be removed so she can stop taking the powerful anti-rejection drugs.

While the Cleveland Clinic is celebrating the very first U.S. transplant of a uterus, they have permission from their ethics panel to perform ten procedures as part of a clinical trial. The clinic is continuing to screen women with uterine factor infertility (UFI) those born without a uterus or with uterine abnormalities that block pregnancy. They will discuss both the first surgery and their program in an upcoming press conference. For now, they have stated only that the patient is in stable condition.

When the New York Times wrote last November about hospitals in the U.S. and the United Kingdom getting ready to perform their own transplants, they called uterine transplantation "a new frontier, one that pairs specialists from two fields known for innovation and for pushing limits, medically and ethically -- reproductive medicine and transplant surgery."

After all ten transplants, the Cleveland Clinic will make a decision about whether to continue with uterine transplants and as standard procedure. Other U.S. and UK hospitals are said to be getting ready to perform their own transplants.

Having any organ transplant is a major undertaking and this one is combined with IVF and eventual removal of the uterus. Still, Dr. Tzakis says he understands why this new procedure may be an option worth considering for couples who want to be parents as surrogacy and adoption are not always alternatives for personal reasons including culture or religion.

The woman who just became the first U.S. recipient of a uterine transplant was interviewed when she was still being screened as a candidate. In explaining why she wanted to be selected she said "I crave that experience, I want the morning sickness, the backaches, the feet swelling. I want to feel the baby move. That is something I've wanted for as long as I can remember." A lot of other women feel that way, too, and for those who need a new uterus to help, instead of thinking it was impossible, there's hope.

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