The latest in a series of innovative fertility treatments has made some amazing headway. Towards the end of 2015, the announcement was made that clinical trials for womb transplantation are officially slated to proceed. Ten transplants are scheduled to be performed during this proceeding, which will begin during the spring of 2016. We may see the first UK birth of a child grown in a transplanted womb in as few as two to three years following. The overall atmosphere surrounding the possibility is one of hopeful anticipation.
“Childlessness can be a disaster for couples,” says Dr. Richard Smith, the lead on the transplant team. Dr. Smith has been involved with the uterine transplant project in the UK for the last nineteen years, during which time he has also served as a visiting professor and a consultant throughout the UK and the United States. A graduate of the University of Glasgow, Dr. Smith is currently attached to Queen Charlotte's and Chelsea hospital in London, as a consultant gynecologist. “This technique offers hope for those whose only other recourse is surrogacy or adoption.”
Surrogacy is an option for couples who wish to have children, but are unable to conceive for medical reasons. There are other factors involved, however. Many women find themselves unable to deny the desire to carry their own children to term.
At the time of this writing, Laura Bartley is 28 years old. Laura was born with mayer-rokitansky-kuster-hauser syndrome, which in her case involves the absence of a womb. Others with the same condition may have an underdeveloped uterus, leaving them likewise unable to bear children. “I have ovaries and my own eggs,” Laura explains, “but other bits of my reproductive system are missing.” Because she still has her ovaries, Laura's body is able to produce various hormones that are important to her overall health, but bearing children was never a possibility.
This is something about which she was unaware throughout her life, until she met Chris, the man with whom she wanted to start a family. She had previously visited her GP to try and determine why her periods had never started, and she received the bad news when she and Chris were five months into their relationship. “Chris wanted a baby as much as I did,” Laura recalls. “It would have been easy for him to walk away. This is something that no woman ever wants to hear.”
Thankfully, Chris stuck around; the couple were engaged in 2009, and married two years later.
Conditions which result in absent or underdeveloped reproductive organs are a part of life for one in every 5000 women in the United Kingdom. As many as fifty thousand women of childbearing age are missing a womb. In addition to affecting the reproductive system, disorders such as MRKH often involve difficulties elsewhere in the body – such as kidney problems, bone-related health issues, and hearing impairment.
In addition to those who are missing a womb naturally, some women of childbearing age have had their uterus removed during treatment for conditions such as cancer. The possibility of a womb transplant would offer new hope to women in this situation as well.
Currently, Laura Bartley is on the list of 104 women being considered for the ten transplants to be undertaken. That is out of more than 300 who applied, but strictly imposed entry guidelines disqualified many from participation:
Laura entered the public eye earlier this month, when she began working to raise money herself in order to help fund the clinical trials, which are not being funded by the NHS. A charitable organization, Womb Transplant UK, has been created to help pay for the estimated 500,000 pounds needed to cover all ten procedures from start to finish.
Embryos will be created from each woman's eggs, using her own partner's sperm, ahead of the study's beginning. These embryos will be frozen for implantation later.
Once a donor uterus has been obtained, the procedure to implant it within the recipient takes approximately six hours. Donors are deceased individuals who have been classified as braindead. Their vital functions are maintained artificially until such time as their organs are removed for transplantation into their intended recipients. By current estimates, five wombs may be provided through this method on an annual basis within the UK. The legal specifics of how a woman might indicate her willingness to donate her womb – as per an organ donor card, for example – are very much a work in progress.
“Donor retrieval is a bigger operation than transplanting the uterus into the recipient,” Dr. Smith explained. “We don’t want to subject a live donor to that operation.” Previously, a live donor was used to provide the womb for an anonymous 36-year-old Swedish woman, who in October of 2014 became the first woman to give birth to a child carried in a transplanted womb. The donor was identified as a 61-year-old family friend.
As with any organ donation, each recipient will need to take a daily regimen of immunosuppressant drugs to prevent their body from rejecting the donor organ. For the purposes of these clinical trials, each participant's health will be closely monitored for twelve months following transplantation. After that step is completed, if no problems arise, she will be implanted with her own embryo.
The plan is to allow each participant to try for two pregnancies, if they so desire, before the transplanted womb is removed. The removal of the womb will prevent its former recipient from having to remain on immunosuppressant drugs for the rest of her life.
There is a great deal of work that remains to be done, but those involved suggest that current advancements are extremely promising. The details of how a woman might signal her willingness to donate her womb are still being ironed out, but the process is happening. Research continues into ways to make the treatment more affordable. Fertility groups within the UK are embracing the possibility of transplanted wombs with open arms.
Professor Adam Balen is the chairman of the British Fertility Society, and is widely acknowledged as being one of the world's foremost thinkers on reproductive medicine. He welcomed the news of these clinical trials, stating that they “open up the possibility for many women to carry their own pregnancy.” He added, “The UK team have been working on this for many years. It is very exciting that they have been given the go ahead to move into clinical practice.”
All Things Conceivable is a blog dedicated to sharing the knowledge and expert opinions of the dedicated team at ConceiveAbilities, a Chicago-based egg donation and surrogacy agency.