Moving swiftly after announcing the start of the clinical trial
in November of 2015, the Cleveland Clinic has recently performed the first uterus transplant in the United States. Doctors hope the 9-hour surgery will fulfill the dreams of their 26-year-old patient to carry and give birth to her own child.
This first uterine transplant is one of 10 that Cleveland Clinic will perform as part of their clinical trial. The procedure is specifically for healthy women who suffer from uterine factor infertility (UFI), meaning "they were born without a uterus, have lost their uterus, or have a uterus that no longer functions." To remove donor-related complications, only uteri from deceased donors will be transplanted.
While the transplant marked a critical step, there are still many more hurdles to overcome. It will take another 12 months for the donated uterus to completely heal inside the recipient’s body. After this period, her previously frozen fertilized eggs are thawed and implanted, one at a time, into the donated uterus until she becomes pregnant.
If pregnancy occurs, a high-risk obstetrics team will monitor the mother-to-be closely throughout pregnancy up to delivery. In addition to taking immunosuppressant drugs to prevent organ rejection, she will also undergo monthly cervical biopsies to confirm the organ is still intact. The birth of the baby is strategically carried out via a scheduled cesarean section to prevent labor strains to the transplanted uterus.
With so many big steps ahead, the team is cautiously optimistic. So far the University of Gothenburg in Sweden has the claim on the only successful births resulting from uterine transplants. Of nine women who underwent the procedure, four gave births to healthy but premature babies, while two transplants failed and necessitated removal.
Importantly, the transplanted uterus is not intended to last a lifetime. Rather, the transplanted organ will be removed via a hysterectomy or be allowed to wither away after the patient has delivered one or two children.
While revolutionary, some experts question whether this transplant procedure is the best use of resources, given available options for surrogacy and adoption. However, “There are women who won’t adopt or have surrogates, for reasons that are personal, cultural or religious,” said Dr. Andreas G. Tzakis, lead investigator of the trial. Furthermore, the uterine transplant is the only option that would allow a woman with UFI to biologically experience pregnancy, labor, and delivery.
"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," said one hopeful trial candidate.