Earlier this month, a woman successfully delivered a healthy baby boy following a uterus transplant. This is the first for the United States, and the birth took place at the Baylor University Medical Center in Dallas. The mother, who chose to remain anonymous, was born without a uterus. The woman, along with all the women in Baylor’s uterus transplant clinical trial, suffer from uterine factor infertility (AUI). This means that they were born with a non-functioning uterus or are completely missing one.
Most of the women in the trial have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, which falls under AUI. This woman, and the others part of the trial, never expected to be able to carry their own children. But with this new clinical trial, these women have a new-found hope.
While this is a first for the United States, a uterus transplant has already yielded successful births abroad. The first birth following a uterus transplant happened was part of a trial at the Sahlgrenska University Hospital in Gothenburg, Sweden. Since that first delivery, the medical team successfully delivered seven more infants.
“We were very proud of the first birth in Sweden,” said Dr. Liza Johannesson, who was part of the original Swedish team but has now moved to Dallas to work on Baylor’s clinical trial. “But this birth is what’s going to make the field grow, because this is the first time this has been replicated anywhere else. This step is equally, if not even more important.”
In February 2016, a team of surgeons in Ohio at the Cleveland Clinic performed the first-ever uterus transplant in the United States. The patient was 26-year-old Lindsey McFarland. The uterus was taken from a deceased donor and transplanted into McFarland in a surgery that took about nine hours to complete.
Sadly, it was not successful. Shortly after the procedure, Dr. Andreas Tzakis, a lead surgeon on the trial, said that the uterus had to be removed. McFarland developed a yeast infection, which ultimately comprised the blood supply to the new uterus, as well as one of McFarland’s legs. The doctors were thankfully able to save her leg, but ultimately it was a horrible loss for McFarland and the team.
The Swedish trial that yielded eight healthy births used live-donors. This first U.S. uterus transplant birth was made possible by a selfless live-donor as well. Taylor Siler, a 36-year-old RN from Dallas, donated her uterus to the woman. After having two children of her own, she decided she didn’t want anymore kids, but she had heard about the program and wanted to give someone else a chance to carry a child. After learning about the successful birth, Siler was understandably emotional. “I’ve just been crying and getting teary thinking about it,” she said. “I think about her every day and I probably will for the rest of my life.”
The procedure took five hours to remove her uterus, and another five to transplant it into the woman. Following the procedure, Siler was in for 12 weeks of recovery. Prior to the transplant, the anonymous patient was first given fertility drugs to harvest her eggs, which were then fertilized and frozen. After the surgery, the patient was given immunosuppressant drugs so that her body wouldn’t reject the new organ. Then the patient must wait about a year for the frozen embryos to be transplanted into the new uterus. If all goes well, the patient will become pregnant and carry her baby to term, as it happily happened in this case.
The birth proved to be an emotional experience for the entire medial team. “We do transplants all day long,” said Dr. Giuliano Testa, the head of the Baylor trial, and surgery chief of abdominal transplant at Baylor. “This is not the same thing. I totally underestimated what this type of transplant does for these women. What I’ve learned emotionally, I do not have the words to describe.”
Dr. Robert Gunby, the obstetrician who performed the C-section and delivered the baby echoed that sentiment. “I’ve delivered a lot of babies, but this one was special,” he said. “When I started my career, we didn’t even have sonograms. Now we are putting in uteruses from someone else and getting a baby.” Dr. Johannesson said that she had tears in her eyes when the baby was delivered.
As of right now, the team at Baylor has completed 8 uterus transplants. Five of them took, while the rest had to be removed. The Baylor trial is unlike any uterus transplant trial before in that they are using uteruses from both live and deceased donors. The trial aims to complete 10 uterus transplants in total. The hospital told Time that another woman part of the trial is pregnant from a live-donor uterus.
Baylor covered the costs for the 10 patients part of their first clinical trial, but they are now looking for funding. They are estimating the cost of a uterus transplant at $500,000. It’s also unlikely that this will covered by insurance, as infertility treatments and procedures rarely are. “The reality is that it’s going to be very difficult for many women to afford this,” said. Dr.Testa.
But, many women are still very excited about the news and are asking their doctors about it. Some of the women who’ve shown great interest weren’t born with female genitalia, let alone a uterus.
Cecile Unger, a specialist in female pelvic medicine at Cleveland Clinic said that about 40 of her transgender female patients asked about uterus transplants. While a uterus transplant into a natural-born female was proven possible, the same seems impossible into a biologically male body. However, in theory it can work.
“It’s doable, it just hasn’t been done,” said Dr. Karine Chung, director of the fertility preservation program at the University of Southern California’s Keck School of medicine. “… My guess is five, 10 years away, maybe sooner.” She also pointed out that male and female anatomy isn’t all that different. Theoretically, transwomen could take female hormones to prepare a donor uterus. They can have their pelvic inlets widened. Although biological males lack necessary vasculature that females have in the pelvic, the donor uterus can be attached to the internal iliac vessel.
Theoretically, it’s possible, and many transwomen have expressed a lot of interest in uterus transplants following the success of this first U.S. uterus transplant birth.
For example, trans model Leyna Bloom shared a link to the Time story on her Twitter account. “5 years from now I will have a baby #TransisBeautiful #LeynaBloom #ProLove,” she captioned the tweet.
“I bet just about every transgender person who is female will want to do it, if it were covered by insurance,” said Dr. Christine McGinn, a transwoman plastic surgeon who performs sex reassignment surgeries. “The human drive to be a mother for a woman is a very serious thing. Transgender women are no different.”
But, since donor uteruses are scare, it’s likely that biological-females suffering from AUI will be prioritized. “Are people going to want to do it? Yes,” said Dr. Arthur Caplan, head of medical ethics at the NYU School of Medicine. “But I don’t see making this a priority. In terms of making the best use of scarce resources, this won’t get over the threshold.”
The procedure is far too expensive also, and many transwomen find themselves economically marginalized. Gender aside, without funding, it will be nearly impossible for anyone to afford. But, this first U.S. uterus transplant birth is a ray of hope for many women who were told they would never be able to get pregnant, to finally be able to give birth to a child.