American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion

Allyse, Megan; Amer, Hatem; Coutifaris, Christos; Famuyide, Abimbola O.; Flyckt, Rebecca; Gargiulo, Antonio R.; Heimbach, Julie K.; Johannesson, Liza; Jowsey‐Gregoire, Sheila G.; Khan, Zaraq; Langstraat, Carrie; Levin, S; McDiarmid, Sue V.; Miller, Charles M.; Mulligan, David C.; O’Neill, Kathleen; Pfeifer, Samantha M.; Porrett, Paige M.; Quintini, Cristiano; Rosen, Charles D.; Silasi, Dan‐Arin; Stewart, Edward T.; Testa, Giuliano; Tzakis, Andy; Tullius, Stefan G.; Penzias, Alan S.; Bendikson, Kristin; Falcone, Tommaso; Gitlin, Susan; Gracia, Clarisa R.; Hansen, Karl R.; Jindal, Sangita; Kalra, Suprita; Mersereau, Jennifer E.; Odem, Randall R.; Rebar, Robert W.; Reindollar, Richard H.; Rosen, Mitchell P.; Sandlow, Jay; Schlegel, Peter N.; Stovall, Dale W.

doi:10.1016/j.fertnstert.2018.06.017

Cited by 51 publications

(30 citation statements)

References 28 publications

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“…It is estimated that uterine-factor infertility affects 3%–5% of women worldwide. 3 Uterus transplant is still considered experimental, with approximately 40 cases performed worldwide at the time of this writing. The procedure is unique in several ways: it can be performed with living or deceased donors; it is a temporary transplant removed after successful delivery; and unlike other living-donor transplants, like kidney and liver, the uterus has exhausted its function in the living donor while still being perfectly functional for the recipient.…”

Section: Introductionmentioning

confidence: 99%

DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

et al. 2019

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Objective: Uterus transplantation is rapidly becoming a viable clinical option for women with uterine-factor infertility and a desire for parenthood. Radiological imaging plays a central role in selecting the optimal living donors for uterus transplantation and serves to exclude any pathology and evaluate the uterine vasculature. The latter is the most important variable in the ultimate technical success of the uterus transplant. In this first report of imaging in the setting of uterus transplantation, we report our experience with living-donor selection, and the evolution of the imaging techniques that ultimately allowed a significant improvement in donor selection and transplant outcome. We also suggest a framework for preoperative imaging in uterus transplantation. Methods: Between 2016 and 2018, 27 potential living donors were evaluated by imaging prior to uterine donation for uterus transplantation. Predonation imaging included a screening chest radiograph, dual-phase computed tomography (CT) angiograms of the abdomen and pelvis in the arterial and venous phases and pelvic sonography with Doppler. Seventeen potential donors additionally underwent multiphasic pelvic MR angiograms. The imaging performed was meant to display features of the vascular anatomy relevant for uterus transplantation. Results: Out of the 27 potential live donors who were evaluated by imaging, 9 eventually donated their uterus for transplantation. The most frequent reason for exclusion was suboptimal quality of the vessels (33%), including small uterine arteries, the presence of atherosclerosis or small size/poor quality of the uterine or utero-ovarian veins, or both. The next most common reason was voluntary patient withdrawal or failure to complete the evaluation process (28%). Three potential donors (16.6%) were rejected for uterine factors, fibroids, and/or adenomyosis. Other reasons for donor rejection included ABO incompatibility and unfavorable psychological evaluation. Conclusion: Diagnostic imaging plays a crucial role in selecting appropriate potential donors, screening prospective recipients, planning the graft procedure, and following up on any graft or nongraft-related complications in both the donor and recipient after the transplantation procedure is performed. Contrast-enhanced CT and MR angiographies have complementary roles, especially when evaluating the donor for adequacy of the arterial and venous supply to the uterine graft and the experience gained from our series indicates that the inclusion of both modalities contributed directly to successful uterus transplant graft survival by selecting patients with favorable arterial and venous vasculature.

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Section: Introductionmentioning

confidence: 99%

DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

et al. 2019

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“…There is at present no consensus as to the optimal or minimum number of banked embryos needed prior to the transplant procedure; recommended inclusion criteria by the American Society for Reproductive Medicine (ASRM) state only that recipients should have a "sufficient number of good quality embryos." 6 There is no standard definition of what constitutes a "good quality" embryo in the field of reproductive endocrinology. There is ongoing debate on whether and to whom aneuploidy screening through preimplantation genetic testing (PGT-A) should be offered with IVF.…”

Section: Introductionmentioning

confidence: 99%

“…18 The ASRM recommends a single embryo be transferred at a time in all uterus transplant patients. 6 Therefore, stringent protocols for embryo selection are of great importance. Morphology selection alone does not avoid the transfer of aneuploid embryos.…”

Section: Introductionmentioning

confidence: 99%

“…Uterus transplant recipients are women with restricted options for achieving motherhood who wish to achieve pregnancy and as such may be considered a vulnerable population. 6 Recipients are exposed to known and unknown risks as part of their participation in clinical trials and require significantly more resources than typical IVF patients. By the time they enter into IVF, potential transplant recipients have already undergone an exhaustive screening process and can anticipate undergoing treatment with immunosuppressive agents in addition to multiple surgeries for the goal of carrying and delivering a biological child.…”

Section: Introductionmentioning

confidence: 99%

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Preimplantation genetic testing for aneuploidy in uterus transplant patients

Chattopadhyay

Richards

Libby

et al. 2021

Clin Med�Insights�Reprod�Health

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Uterus transplantation is an emerging treatment for uterine factor infertility. In vitro fertilization with cryopreservation of embryos prior is required before a patient can be listed for transplant. Whether or not to perform universal preimplantation genetic testing for aneuploidy should be addressed by centers considering a uterus transplant program. The advantages and disadvantages of preimplantation genetic testing for aneuploidy in this unique population are presented. The available literature is reviewed to determine the utility of preimplantation genetic testing for aneuploidy in uterus transplantation protocols. Theoretical benefits of preimplantation genetic testing for aneuploidy include decreased time to pregnancy in a population that benefits from minimization of exposure to immunosuppressive agents and decreased chance of spontaneous abortion requiring a dilation and curettage. Drawbacks include increased cost per in vitro fertilization cycle, increased number of required in vitro fertilization cycles to achieve a suitable number of embryos prior to listing for transplant, and a questionable benefit to live birth rate in younger patients. Thoughtful consideration of whether or not to use preimplantation genetic testing for aneuploidy is necessary in uterus transplant trials. Age is likely a primary factor that can be useful in determining which uterus transplant recipients benefit from preimplantation genetic testing for aneuploidy.

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“…Harm minimization may be achieved through, for example: the promotion of alternatives to transplant such as surrogacy and adoption (where permitted) 37 ;the use of living donors who have already completed their families/are undergoing removal of healthy uteri as part of a wider gynecological procedure or gender affirmation surgery 38 ;expansion of the deceased donor pool to include increased/non-standard risk donors 39 ; and/or, supporting research into future advances in ART which may render the use of living donors obsolete such as the bioengineered uterus 34 …”

Section: Introductionmentioning

confidence: 99%

Ethical and policy issues raised by uterus transplants

O’Donovan

Williams

Wilkinson

2019

British Medical Bulletin

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Abstract Introduction In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide. Sources of data This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx. Areas of agreement There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry. Areas of controversy There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment. Growing points UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide. Areas timely for developing research Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law.

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American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion

Cited by 51 publications

References 28 publications

DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

Preimplantation genetic testing for aneuploidy in uterus transplant patients

Ethical and policy issues raised by uterus transplants

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