First live birth after uterus transplantation in the Middle East

Abstract

Background The first live birth after uterus transplantation took place in Sweden in 2014. It was the first ever cure for absolute uterine factor infertility. We report the surgery, assisted reproduction, and pregnancy behind the first live birth after uterus transplantation in the Middle East, North Africa, and Turkey (MENAT) region. A 24-year old woman with congenital absence of the uterus underwent transplantation of the uterus donated by her 50-year-old multiparous mother. In vitro fertilization was performed to cryopreserve embryos. Both graft retrieval and transplantation were performed by laparotomy. Donor surgery included isolation of the uterus, together with major uterine arteries and veins on segments of the internal iliac vessels bilaterally, the round ligaments, and the sacrouterine ligaments, as well as with bladder peritoneum. Recipient surgery included preparation of the vaginal vault, end-to-side anastomosis to the external iliac arteries and veins on each side, and then fixation of the uterus. Results One in vitro fertilization cycle prior to transplantation resulted in 11 cryopreserved embryos. Surgical time of the donor was 608 min, and blood loss was 900 mL. Cold ischemia time was 85 min. Recipient surgical time was 363 min, and blood loss was 700 mL. Anastomosis time was 105 min. Hospital stay was 7 days for both patients. Ten months after the transplantation, one previously cryopreserved blastocyst was transferred which resulted in viable pregnancy, which proceeded normally (except for one episode of minor vaginal bleeding in the 1st trimester) until cesarean section at 35 + 1 weeks due to premature contractions and shortened cervix. A healthy girl (Apgar 9-10-10) weighing 2620 g was born in January 2020, and her development has been normal during the first 6 months. Conclusions This is the first report of a healthy live birth after uterus transplantation in the MENAT region. We hope that this will motivate further progress and additional clinical trials in this area in the Middle East Region, where the first uterus transplantation attempt ever, however unsuccessful, was performed already three decades ago.

Decellularization protocol‐dependent damage‐associated molecular patterns in rat uterus scaffolds differentially affect the immune response after transplantation

“…Considering the ethical and legal controversies surrounding gestational surrogacy, UTx was widely recognized when the world's first live‐birth was born after this procedure at our center (Brännström et al., 2015). There are now 11 babies born from this fertility treatment in Sweden, and several more births reported from other centers around the world (Akouri et al., 2020; Brännström et al., 2016; Castellon et al., 2017; Ejzenberg et al., 2019; Jones et al., 2019; Testa et al., 2018). As with any organ transplant, UTx is dependent on an allogenic donor source and a carefully balanced immunosuppression to avoid graft rejection.…”

A New Approach for Treatment of Woman With Absolute Uterine Factor Infertility: A Traditional Review of Safety and Efficacy Outcomes in the First 65 Recipients of Uterus Transplantation

“…Both uterus retrieval and transplantation were performed by laparotomy. Donor's uterus was isolated with uterine arteries and veins, round ligaments, sacro-uterine ligaments, and bladder peritoneum [42].…”

“…Maintenance immunosuppression was by daily administration of tacrolimus and azathioprine to maintain adequate immunosuppression. Mycamine was given as antifungal prophylaxis, daily valganciclovir for six months was used as CMV prophylaxis, and trimethoprim/sulfamethoxazole for prevention of Pneumocystis jirovecci pneumonia was given for three months [42].…”

“…The patient developed vaginal stenosis, which required manual dilations three times. Due to persistent anemia, the patient received erythropoietin two times a week and oral ferrous sulfate with vitamin B12 three months before embryo transfer due to low hemoglobin levels [42].…”

“…Cesarean section was performed at 35 weeks gestation due to short uterus cervix and premature contractions registered on cardiotocography (CTG). A healthy female fetus was delivered 15 min after the skin incision [42].…”