Nine Women Receive Uterus Transplants in Sweden, Raising Ethical Questions

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News Maternity and Birthing

Nine Women Receive Uterus Transplants in Sweden, Raising Ethical Questions

Martha Kempner

Swedish doctors plan to implant embryos into the new wombs soon, though no one knows if the organs can support a growing fetus. Furthermore, some experts are concerned that the risks to the potential mother and child, not to mention the donor, far outweigh the possible benefits.

It’s been over 35 years since Louise Brown, the first “test tube” baby, was conceived through in vitro fertilization (IVF), and in the intervening decades there have been numerous reproductive technologies developed to help women facing infertility, as well as same-sex couples who want children, become biological parents. Now, researchers in Sweden are trying what might be considered the most radical idea yet: They have transplanted uteruses into nine infertile women who wish to give birth. 

Many of the women had intact fallopian tubes and ovaries that were able to produce eggs, but were either born without a uterus or had lost their uterus as a result of cervical cancer. (A condition known as MRKH that causes a fetus to develop ovaries but not a uterus is estimated to occur in about 1 in 4,500 newborn girls.) The donors were all living relatives, including mothers, of the women. The uteruses were transplanted into the women beginning in September 2012. Doctors did not attach the recipients’ fallopian tubes to the uterus, so spontaneous pregnancy is not possible. Instead, before the surgery, the doctors harvested the recipients’ own eggs and created embryos that have been frozen.

Within the next few months, doctors hope to implant the embryos and determine whether these women can become pregnant and carry a fetus to term using a donor uterus.

Thus far, according to the medical team, there have been signs of success, with few complications. Many of the women got their periods within six weeks of the surgery. One women had an infection in her new uterus, but it was cleared up easily, and others had “minor rejection episodes.” None of the women needed intensive care or further surgeries.

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They do, however, have to continue to take anti-rejection drugs, which can cause high blood pressure, swelling, diabetes, and increase the risk of certain cancers. For this reason, the doctors plan to remove the donor uteruses after a maximum of two pregnancies.

The researchers involved are hailing this as a potential breakthrough for women with no other options, while others worry that this approach is too radical. British fertility expert Richard Smith told The Province that he worries about the risk for the donors. In order to ensure enough blood vessels can be attached when the organ is transplanted, surgeons had to remove even more tissue from the donor than they would in a woman having a radical hysterectomy for medical reasons. Smith questions if this is ethical given that these donors are healthy and their donations, while generous, are not life-saving. He also is concerned that the implanted uteruses will not have enough blood flow to adequately nourish a growing fetus. Still, Smith and his team are attempting to raise money for uterus transplant experiments of their own, but say they will use organs only from dead or dying donors.

Medical teams in other parts of the world have also attempted to transplant uteruses from both living and deceased donors. In 2000, a Saudi Arabian woman received a uterus from a live donor but a blood clot meant doctors had to remove it a few months later. In April 2013, Turkish doctors announced that a 22-year-old woman who had received a cadaver uterus in 2011 was pregnant. A month later she miscarried.

In an editorial for Healthline, Dr. Kenneth Troffater, who has worked with kidney and liver transplant patients, argues that uterine transplants of any kind violate the oath of “first do no harm,” as the risks to the potential mother and child far outweigh the benefits. He writes:

[T]here are risks to the woman of transplant rejection, diabetes as a consequence of the immunosuppressive therapy, preeclampsia, early delivery, and potential risks to the fetus from all of these factors. But, apart from these other risks of organ transplants, we have no idea whether the vascular changes that are required to support a normal pregnant uterus, and the baby inside, can occur with a transplanted uterus, what the risks of transplant rejection of a uterus might be during a pregnancy to the woman, or the consequences of these events on a developing baby. To be the first woman with a transplanted uterus to take this chance on a baby is, in my opinion, a selfish and foolish proposition.

He adds that the physicians involved should “step back, take their egos out of the picture, and think about what they are doing more carefully.”

Rewire spoke to Dr. Alan Kaye, an expert in cervical cancer who had a different opinion. He cautions that this is still in the experimental stages, and we don’t yet know if it will ever be a really viable option for women. He also agrees that the risks to the donors need to be carefully assessed, but, he says, it may someday be a good option.

“The concept appears sound and is not much different in providing a person a transplanted kidney, even though they could live with dialysis,” said Kaye. “If a wholesome natural environment-like womb can be provided, for IVF, it can have a positive loving outcome for the mother and baby. That can be a blessing.”