Uterine Transplants (UTx)
Uterine Transplantation is a very recent breakthrough in the world of reproductive medicine and organ transplant, a boon for those girls who have not attained puberty in their life and are not having menstruation (medically called primary and secondary Amenorrhea). Absence of menstruation could be due to the underdeveloped or absence of the secondary reproductive organs. In certain cases, the periods may not start at all, despite the normal presence and functioning of secondary sexual organs in those hormonal evaluation and medical therapy can help to overcome the problem.
There are various causes that can lead to Amenorrhea including disorders of the outflow tract related to uterus, vagina, ovaries, anterior pituitary and even problems related to Central Nervous System.
One in 500 women suffer from absolute uterine factor infertility.
In around 20% of the cases, anatomical abnormalities can cause Amenorrhea while surgical correction and intervention would help them in achieving the desired results. In case of issues with the pituitary gland, hormonal therapy is suggested to get the desired results.
However, in severe cases like a patient diagnosed with rare Mullerian agenesis Mayer Rokitansky Küster Hauser Syndrome which affects 1 in every 4500 females during birth is a congenital disorder. These women are born without uterus and vagina, but ovaries are well developed and mostly normal ovulation occurs. Diagnosis is done through karyotyping and ultrasound. The treatment will start only after the patient attains the age of commencing sexual activity. Vaginoplasty is usual first line of treatment whereas non-surgical procedures like vaginal dilators can be done if there is enough vaginal length.
In such cases, uterine transplant remains the most viable option for having baby in which a healthy uterus from the donor can be transplanted into the patient’s body and the embryo is transferred to the transplanted uterus in a women. It is generally advised after marriage to facilitate conception. The women should be in legal relation with partner before going into such major program. The donor should be less than 55yrs, healthy and with no comorbidities. As of today relative Donor is encouraged. The program consists of following steps
- Evaluation of infertile couple
- IVF/ICSI to create an embryo and freeze the same
- Donor selection and evaluation
- Uterus transplantation
- Immune suppression therapy
- Embryo Transfer
- Follow up for rejection
This program is a lengthy process and takes at least 4 to six months min from IVF to go for embryo transfer. Women and family are given multiple counselling to understand and always adoption and surrogacy options were discussed.
Uterine transplant is also considered for women who have lost their uterus during delivery due to excessive postpartum bleeding, asherman syndrome where endometrium is scarred, and lost uterus for gynecological emergency or cancer.
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