The opportunity to conceive, carry and give birth to a biologically related child is a deep desire for many women. The lack of a functioning uterus has kept that opportunity out of reach. This includes the congenital condition called Mayer-Rokitansky-Küster-Hauser syndrome and those who had a hysterectomy for medical reasons. Starting next year uterus transplants are being trialed in Australia. The procedure involves a donated uterus is surgically removed from a suitable donor and transplanted into an eligible recipient. Hormones are used to stimulate menstruation in the recipient, and once the uterus is functioning normally, an IVF-created embryo is transferred into the woman’s uterus. After completing a successful implantation and healthy development, the baby is delivered by caesarean section. The reason is because a uterus transplant pregnancy is regarded as high risk, and the woman may not be able to feel contractions. Women with the congenital absence of a uterus will not be able to deliver vaginally. The uterus recipient is prescribed immunosuppression medication to prevent rejection of the donor organ. These drugs are administered at levels deemed safe for the developing fetus along with close monitoring. Immunosuppression continues until the delivery of up to two healthy babies or five years after the transplant, whichever is first. Uterus transplantation is an ephemeral transplant: a non-life-saving temporary transplant, aimed solely at enabling reproduction. These features make it medically and ethically distinct from other transplants. Currently, only pre-menopausal women can be uterus donors, and living donors need to have had a successful pregnancy to be eligible to donate. The risks for recipients are organ rejection, infection, and blood clots or thrombosis, as well as risks arising from the surgery duration (average 5 hours) such as blood clots (including in the lung) and from immunosuppression. The procedure is new and donor organs are in short supply, however the future of uterus transplants will be another tool for women to conceive.
