British doctors have moved a step closer to carrying out what they hope will be the world’s first successful human womb transplant, giving hope to thousands of women who are unable to have children for medical reasons.
London-based surgeons and vets, working with medical teams in New York and Budapest, have performed the first long-term transplants of a uterus with a reliable blood supply in rabbits. If trials on larger animals are successful, the first woman could receive a viable uterus transplant from a deceased human donor within two years, the researchers say.
An estimated 15,000 women of childbearing age in Britain were born without a uterus or had it damaged or removed after illnesses such as cancer. The procedure could offer an alternative to surrogacy or adoption.
Richard Smith, a consultant gynaecological surgeon at Hammersmith Hospital, West London, said that his team had solved a key problem of how to maintain a regular blood supply to a womb transplanted from a donor rabbit into another, allowing it to survive long enough to carry a successful pregnancy. But the project has stalled due to scepticism from the wider medical community and a lack of funding from research bodies. An independent charity, Uterine Transplant UK, will be set up later this month to raise £250,000 to continue the research.
The first uterus transplant, carried out on a 26-year-old Saudi woman in 2000, failed when a blood vessel supplying the organ developed a clot, and it had to be removed after 99 days. Maintaining a reliable blood supply has been seen as crucial before the technique — which has also been tried on pigs, sheep, goats and monkeys — can be safely and successfully performed on humans.
The latest study, presented to the American Society for Reproductive Medicine in Atlanta, involved five donor rabbits and five recipients, who were operated on at the Royal Veterinary College in London. The recipient rabbits received a womb using a “vascular patch technique” that connected major blood vessels, including the aorta.
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Previous studies failed when animals died due to blood clots or excessive bleeding. But of the five, two rabbits lived for up to 10 months and examinations after death — from causes unrelated to the transplant — showed the surgery to have been a success. Although the surviving rabbits were mated, they did not become pregnant naturally. But further research will attempt to make rabbits pregnant by using embryos fertilised in the laboratory, Mr Smith said.
Women with a transplanted uterus would have to undergo in vitro fertilisation treatment to achieve pregnancy and give birth by Caesarean section in order to avoid complications such as ectopic pregnancy — a baby developing in the wrong place.
A successful transplant would also be temporary, to avoid the patient having to take immunosuppressant drugs for life, in order to avoid rejection of the womb. But a woman recipient might be given two to three years to conceive and carry a baby or babies before the womb was removed.
Surgeons in New York have already obtained permission to carry out a human trial, after demonstrating that a uterus from a donor can be preserved for up to 12 hours, long enough to perform surgery.
Tony Rutherford, chairman of the British Fertility Society, said there was “a big difference between demonstrating effectiveness in a rabbit and being able to do this in a larger animal or a human”.
Via Times Online