Gestational Carrier vs Uterine Transplant: Which one for a Infertile Patient?
Recently, a team of physicians in Cleveland, Ohio performed the first uterus transplant surgery in the United States.
Uterine Transplants Reaching New Grounds In USA
The procedure was successfully completed, but unfortunately, as is common for transplants as complex as this, the blood flow to the uterus was not able to be maintained, and the uterus had to be removed. Had the uterus survived, it would have been more than a year before knowing if the goal of the treatment—a healthy pregnancy--had been achieved.
Briefly, the surgery was performed for a 26 year old woman who was born without a uterus, a condition that is called Mullerian agenesis, a disorder that affects about 1 in 5000 women. When this disorder occurs, the ovaries are present and function normally with normal puberty, but menses never occur, and when evaluated, it is discovered that the uterus, cervix, and part of the upper vagina have never formed. Without a uterus, it is impossible to become pregnant or carry a pregnancy. During the transplant surgery, the uterus of a deceased organ donor was transplanted, with successful survival of the organ (and more importantly, the organ recipient.) For the next year, anti-rejection medications and hormonal manipulations will be necessary to prepare the uterus for a possible pregnancy, and if the transplanted uterus appears to function, then pregnancy can be attempted.
In 2014, the first birth following a uterine transplant was reported in Sweden, after many years of studying the technique in animal models. This birth was premature, but the child was otherwise healthy. Since that time, there have been three other births reported by the same Swedish team, demonstrating the potential successful use of uterine transplantation as a treatment for infertility due to severe uterine problems. In Sweden, the surgery has been performed with both deceased and live uterine donors. The surgery is technically more complex for live donors, and in some cases, a mother has donated her uterus to her daughter—a reproductively interesting situation in which a grandchild was born from the same uterus as the mother.
The surgery is far from being a standard procedure. Several other transplant attempts have resulted in failure of the uterus to survive or rejection of the new uterus requiring removal of the transplant. And others with a transplant have yet to have a successful pregnancy. The completion of the first U.S. transplant is exciting, but many hurdles remain before we know if this surgery was truly successful.
The Debate: Uterine Transplant Vs Gestational Carrier
An important question is whether a uterine transplant is even necessary with other treatments available for uterine issues. Currently, there is a very successful and less risky option for women with severe uterine problems-- even for those who are born without a uterus. Gestational surrogacy is a very successful option to help a woman have a child of her own without the risk of surgery. With gestational surrogacy, embryos created by a woman are transferred to the uterus of the surrogate mother, or gestational carrier, through techniques that have been used for over 30 years with in vitro fertilization. Thousands of children are born safely each year through gestational surrogacy in the United States. The use of gestational surrogacy, however, is not without ethical concerns. Arguments have been made that the compensation for carrying another’s pregnancy amounts to a “womb for rent”, exploiting the health of less advantaged women and being akin to selling organs for donation. There are countries (such as Sweden) where this procedure is prohibited by law, and in those countries, transplant surgery may be the only option available.
The future of uterus transplant surgery in the U.S. is unknown. Unless transplant surgery can be shown to be a safer and less costly alternative to what is currently available, it is unlikely to become widely available. And as this surgery is solely to treat the infertility resulting from uterine problems, coverage of the expenses for this procedure by the insurance industry is not likely. Nevertheless, the science and techniques developed to achieve this accomplishment remain impressive, and the hope remains that other previously “untreatable” fertility conditions may one day be overcome as well.
About Dr. Shaun Williams
Dr. Shaun C. Williams, who is board certified in both Reproductive Endocrinology and Obstetrics and Gynecology, is a staff physician and fertility specialist at Reproductive Medicine Associates of Connecticut. Dr. Williams, who has been named a “Best Doctor in America” and Fairfield County “Top Doc,” has been treating Connecticut infertility patients since 2005. His medical areas of interest include fertility preservation and reproductive surgeries, especially robotic surgery to treat conditions affecting a woman’s reproductive health. However, his true passion is caring for patients, which is why he makes himself available through email, phone and appointments. Because of his bedside manner, his patients have also named him “Most Compassionate Doctor” for the past four years.