From Rabbits to Humans: Transplanting Wombs

SarahBlennerBy Sarah Blenner, JD, MPH

In 2000, the first human womb transplant was attempted in Saudi Arabia.  The transplant failed when the 26 year old woman developed a blood clot and the transplanted uterus had to be removed.  But now scientists believe that they are close to perfecting a reproductive technology that could solve some women’s infertility: transplanting a womb into a woman who lacks a functioning uterus. 

Infertility affects one in six women.  Some women are unable to get pregnant because they either do not have a uterus or do not have a properly functioning uterus.  At least 15,000 women in Britain alone are infertile because of a condition associated with uterine function.  A woman may lack a uterus because she has had a hysterectomy or may not have a properly functioning uterus because of a medical condition, such as intrauterine adhesions, also known as Asherman’s syndrome.  Currently, if women without a properly functioning uterus wish to have children, they must either adopt or turn to surrogacy.  Despite the availability of these alternatives, some women want to bear their own children and are willing to undergo surgery to achieve pregnancy. 

One hurdle to successful womb transplants has been ensuring the womb receives an adequate supply of blood.  However, a 2009 study using a new technique appears to overcome this difficulty in rabbit womb transplants, by allowing the rabbit’s body to supply enough blood to the womb.  The transplant was considered a success, despite the fact that the rabbits did not get pregnant.  Researchers who participated in this study are optimistic that the techniques used in their research will be ready for human use in as early as two years from now

But critics are skeptical that the technology will be available any time soon.  Tony Rutherford, chairman of the British Fertility Society, stated that there is “a big difference between demonstrating effectiveness in a rabbit and being able to do this in a larger animal or human.”  Others are concerned that the technology may be applied to humans too early.  The International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women’s Health has cautioned that ambition on the part of the infertile women may put “pressure on researchers to move prematurely to human application.

Beyond potential unknown risks, there are risks that affect the donor (if living), the recipient, and the potential fetus.  Additionally, as with any organ transplant, the body may reject the organ.  As a result, women who receive the organ transplant will have to remain on immunosuppressants while the womb is in her body.  According to the FDA, the use of some immunosuppressants may carry an additional risk during pregnancy.

Further, women who have a womb transplant may be at increased risk for ectopic pregnancies, which are life-threatening and occur when the embryo implants outside of the uterus.  To avoid this, women who receive the womb transplant will have the additional cost of undergoing in-vitro fertilization. 
Womb transplants also raise a host of ethical issues.  Some of these issues were addressed in 2008 by the FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health issued guidelines regarding uterine transplantation.  The Committee stated that currently the uterine transplantation is “ethically inappropriate” because of there is not enough data on safety and potential harm and more studies should be done on animal models before any clinical experimentation on humans occurs.  Additionally, the committee raises the ethical question of whether young, healthy women with potential to bear children should be permitted to donate their uteruses.  

Is an operation for a non-life-threatening condition, such as infertility, worth all of the risks? Clare Lewis-Jones from Infertility Network UK stated: “Before this treatment could be made available, a great deal of thought and discussion on all the issues including the ethical ramifications and need for counseling would be required.”

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