Womb transplants give hope to women born without a uterus

Womb transplant babies

Hopeful mothers who are born without wombs or have lost their wombs due to cancer or disease are hailing a new procedure

Women who are diagnosed with a uterus that is congenitally absent and those who have undergone a hysterectomy are considered to be “unconditionally infertile”-or described as having a form of infertility known as AUFI (absolute uterine factor infertility).

The only two options these women have to parent a baby are surrogacy or adoption. Now, though, women are able to choose a remarkable third option: the transplantation of the womb of another female to become fertile again.

The world’s first womb-transplant baby

The world’s first womb-transplant baby, Vincent, was born in October last year to a 36 year old Swedish woman who discovered at age 15 she was born without a womb; a condition known as Rokitansky syndrome. A 61 year old close family friend, who had already gone through menopause, donated her womb to the 36 year old.

According to the medical journal, The Lancet, the 36 year old recipient underwent in-vitro fertilization one year after her uterine transplant. She became pregnant after her first single embryo transfer. After developing pre-eclampsia during her pregnancy, the 36 year old recipient delivered a premature but healthy baby boy, named Vincent, by caesarian section.

The uterine transplant procedure performed by Dr. Mats Brannstrom, a Swedish physician and professor from the University of Gotenborg, has been compared in stature and significance to the world’s first heart transplant.

The successful procedure gave Dr. Brannstrom hope to go one step further by using the wombs of dead donors, as reported by the Daily Mail. Dr. Brannstrom plans on stripping the wombs of their cells and then regenerating them by coating them with live stem cells from the recipient’s body.

Using stem cells from the mother, an exact match, would be a significant step. It would reduce or eliminate the need for long-term immune-suppressing drugs, currently needed to prevent rejection of the live donor’s womb.

As reported by James Gallagher with BBC News, the birth was a joyous moment for Dr. Brannstrom:

“That was a fantastic happiness for me and the whole team, but it was an unreal sensation also because we really could not believe we had reached this moment.”

“Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility.”

Researchers have made great leaps into the science of regenerative medicine with many different types of organs. According to Smithsonian, it won’t be long before full organ transplants, such as livers, lungs and hearts, will be grown in a laboratory, made to order.

Mother-daughter womb swap

One month later, two more women delivered healthy babies from the transplanted wombs of their mothers, donated to allow their daughters to become fertile. The impact of a mother-daughter womb transplant is significant.

One womb will link three generations together. To a woman who has lost her uterus due to cancer or disease – or if it is congenitally absent – her child can be born from a womb that has been handed down through a generation, a womb that has carried its very own mother.

Risks of uterine transplant

Uterine transplant is not without its risks and complications. One hurdle is determining who qualifies as a good candidate for the procedure. To be a good candidate for uterine transplantation, the woman should be of childbearing age, without a uterus and in good health. The patient must have a stable immune system, especially because she will be taking anti-rejection drugs once the transfer occurs and throughout the pregnancy.

Anti-rejection drugs are taken to avoid rejection of the uterus.  But according to Dr. Brannstrom, as reported by Popular Science, they are only meant to be temporary since the powerful drugs can suppress the immune system, making the recipient prone to illness and infections.

The 36 year old Swedish recipient took triple anti-rejection drugs throughout her pregnancy to prevent rejection. Although three episodes of mild rejection occurred, they were successfully reversed with corticosteroids.

The pregnancy of a uterine transplant recipient is treated as a high risk pregnancy with organ rejection a strong possibility. There are also surgical risks to the donor, who can be any age as long as she has a healthy uterus. And the surgery is complicated.

Dr. Antonio Gargiulo, a specialist in infertility and reproductive surgery at Brigham and Women’s Hospital, told the Boston Globe, “A live donor would have to undergo a radical hysterectomy, which would remove a larger portion of the tissues surrounding the uterus than in a typical hysterectomy, so that those tissues could be connected with tissues of the recipient.”

“Such a surgery could cause excessive bleeding or injury to the bowel or the ureters, and could lead to an infection that could develop into sepsis,” he said.

Costs involved

For women who long to “naturally” carry their own child, the cost of a uterine transplant is stunning. Dr. Gargiulo estimates the costs of a uterine transplant could be as high as $300,000 in the U.S. Surrogacy is a major cost factor, ranging from $10,000-30,000, not including physician fees and vitamins.

However, surrogacy costs are just one part of the entire procedure. Although, that may soon change. In the future physicians may be using “refurbished” wombs from cadavers, which may cut down on costs of the procedure.

The other options for a woman with AUFI are adoption or surrogacy. Adoption of a newborn from a non-profit agency can cost $10,000-$25,000. Using a private adoption through an attorney can range even higher, costing from $8,000-$40,000. Compare that to surrogacy which can range from $10,000-30,000.

Insurance coverage is highly unlikely given the voluntary nature and the risks and complexity of the procedure. Especially, when surrogacy is a much less costly and safer option, where it is legal, that is- such as in the U.S.

The solutions are complex

Not all medical specialists willingly perform uterine transplants. Dr. James Grifo of New York University Medical School, sympathizes with women who might want a uterine transplant, as reported by NPR – yet he has decided to follow other less risky priorities, he said in an interview.

“I don’t think it’s a simple discussion by any stretch,” Grifo told NPR. “You know, when you’re the patient, then you fully understand the issues. When you’re just theoretically discussing these things, unless it actually hits home, I think you don’t really fully understand it.”

Dr. Liza Johannesson, of Sahlgrenska University Hospital in Gothenburg, said: “It is also really exciting to have your mother as a donor. It is a very nice gift to give to your daughter.”

Ultimately, womb transplants are not without their controversies. The hearts of hopeful mothers will always ache to carry their own children – and those who have mothers willing to donate are the lucky ones.

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Tick-Tock: The fertility war on women over 35

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Top fertility experts staunchly at odds with delaying parenthood-warning of the fertility risks and reliability of IVF in older women

Geeta Nargund, Britain’s top fertility specialist, is staunchly at odds with women over 30 delaying parenthood. Have children too late, and you could miss out completely is the message Professor Nargund recently conveyed.

Professor Nargund’s no-nonsense position that women should “start trying for a baby before 30 – or risk never having children” was conveyed in a frank letter addressed to education secretary Nicky Morgan. In the letter, which was published on Daily Mail, Professor Nargund demanded that teenagers be taught the “dangers of delaying parenthood because of the spiraling cost to the taxpayer of IVF for women in their late 30s and 40s.”

Professor Nargund is the Medical Director of CREATE Fertility. She is also a Senior Consultant Gynecologist and Lead Consultant for Reproductive Medicine services at St George’s Hospital, London.

Her letter cited the devastation and regret by women who realize they are too late to start a family. She also argued that many young people were poorly informed about the impact of age on fertility.

When is a woman’s “best” reproductive age?

According to a 2012 guide on age and fertility by the American Society for Reproductive Medicine, a women’s best reproductive years are in her 20’s. Fertility gradually declines in the 30’s, particularly until 35 – after which point it sharply declines.

“Each month that she tries, a healthy fertile 30 year old women has a 20% chance of getting pregnant per cycle, by age 40 a women’s chance is less than 5% per cycle,” the guide states.

These percentages are true if conception occurs by natural conception, fertility treatments or IVF. “Fertility does not last until menopause,” the guide makes clear. “The average age of menopause is 51 but most women become unable to have successful pregnancies sometime in their mid-40’s.”

How reliable is IVF in older women?

Dr. Marta Devasa, gynecologist at Dexeus Women’s Health, recently presented her research on IVF fertility rates in older women at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE).

The data came from a Spanish clinic that treated 4,195 women and 5,841 cycles with IVF. The clinic calculated the cumulative live birth rate using one fresh and any subsequent frozen embryo transfers over 12 years.

The study showcased the difficulty of getting pregnant through In-Vitro-Fertilization (IVF) for women over 44 using their own ovules, with a treatment success rate for IVF cycles of only 1.3%.

The results demonstrated that fertility begins to significantly drop after 38. The rate of live births after IVF using their own ovules, is 23.6% for women between 38 and 39 years, 15.6% aged 40-41 and dropping as low as 6.6% in those between 42 and 43 years.

The conclusion drawn from the study was that by the age of 35, women should be urged to freeze their eggs and women over 44 should choose donated oocytes in order to increase their success rate as the “chances of success with their own ones are scarce.”

“And it is true”, Dr. Devasa argued, “Pregnancies in older women and celebrities don’t help us because many people don’t know that most of the time they have gone for egg donation.”

The dangers of “fertility security”

An increasing amount of young women may be being lulled into a false sense of “fertility security”. A study published in the journal Human Reproduction found entrenched fertility myths among University Israeli students.

According to the authors, these myths included in particular “the false belief in the possibility of late (beyond 35 years) and very late genetic motherhood. This can be explained by the technological ‘hype’ and favorable media coverage of very late pregnancies.”

Perhaps, the media’s infatuation with celebrity baby bumps may have become a “raison d’être” for delaying parenting. The media has” glamorized the “40 is the new 30” frenzy of celebrities with children, including Salma Hayak, age 41, Halle Barre, age 42, Kelley Preston with her third child at age 47, and Laura Linny welcoming her first child at age 49.

Other scholars such Elizabeth Gregory, author of “Ready, Why Women Are Embracing the Later Motherhood”, argue “the national media have tended to focus on the individual and on the negative, leaving us with a skewed sense of what’s going on or what’s at stake.”

In an opinion piece for The New York Times, Gregory, who is also director of women’s studies at the University of Houston and research fellow on the Council on Contemporary Families, pointed out that women are delaying conception globally.

“The ‘experts’ are just catching up to explain why. Women figured out early that delay provides a shadow benefits system in our family-unfriendly world: higher salaries, more flexibility and higher marriage rates, as well as more interest in staying home at night,” she wrote.

“Along with personal benefits, delay has been an engine of feminist social change because it allows women – who for millennia were kept busy, uneducated and out of decision-making circles by early and unending fertility – to begin to have a voice in policy. Change creates pushback, as today’s harsh fertility politics demonstrate,” Gregory added.

Her work has explored why so many women are making this choice and what the effects are for fertility, the individual women involved and on society at large.

Costly fertility treatments

And for women who intentionally delay pregnancies or marriage to pursue their education, careers or other personal goals, insuring their fertility can be cost prohibitive.

Egg donation costs around $10,000 per egg freezing cycle and $500 per year to maintain frozen eggs – such costs can be prohibitive, if not out of the question financially for some women or couples. Plus, there’s no guarantee that they will result in viable pregnancies.

Perhaps the best message is that women need to weigh up the benefits and risks of having children later in life themselves and be responsible for their choices. We can fight the fertility war without the media’s constant “tick tock” narrative.

Does acetaminophen use in pregnancy lower testosterone in the male fetus?

Ultrasound of fetus larger sizeRecent research has suggested that taking Paracetamol (acetaminophen) during pregnancy for long periods of time may lower testosterone production in the male fetus – potentially increasing the risk for undescended testes and adverse reproductive health effects later in life.

The animal study published in the journal Science Translational Medicine (STM) investigated the effects of Paracetamol exposure on fetal testosterone levels. The researchers, from the University of Edinburgh, used host mice grafted with human fetal testicular tissue to study the effects of Paracetamol on testosterone production. The grafted testicular tissue simulated the developing testes during pregnancy.
The researchers found a 45% decline in plasma testosterone levels after 7 days of exposure to a typical dose of acetaminophen. However, after one day of exposure to a typical dose there was no change in testosterone levels.
A 2010 study published in the journal Epidemiology linked protracted use of Paracetamol during pregnancy to undescended testes (cryptorchidism) in males; however, the University of Edinburgh study was the first to demonstrate the effects of the drug on testosterone levels.
“These results are of clinical importance as there is growing evidence that most common male reproductive disorders, which can affect 1 in 6 men, may be attributed to sub-optimal testosterone exposure during fetal life,” the authors wrote.
What is testosterone?
Testosterone, a sex hormone, is produced by the testes in approximately the 7th or 8th week of pregnancy. Testosterone has key effects on sex drive, bone mass, the growth of body hair, fat distribution, muscle strength, brain function, metabolism, the vasculature and the production of sperm.
Testosterone is important to the developing fetus because it determines the sex of the newborn as well as future reproductive health.
Health implications of lowered testosterone in the womb
Researchers have suggested that reduced levels of testosterone in the womb may have implications later in life.
According to the authors of a reproductive health study published in the journal Proceeding of the National Academy of Science, during the period of fetal masculinization, testosterone exposure can (re) program fetal stem cells which later develop into testosterone producing adult Leydig cells. A lower testosterone exposure in the fetus can lead to lower
testosterone levels in the adult male which can ultimately impact fertility, erectile function, and sex drive.
Past research has previously linked low testosterone in adult males to an increased risk of other health issues such as obesity, depression and type 2 diabetes.
Paracetamol (acetaminophen) safety during pregnancy
According to the authors of an American Family Physician journal article, acetaminophen has a good safety record and is widely used during pregnancy with a paucity of adverse effects documented; hence, why acetaminophen has been validated as the pain reliever of choice during pregnancy.
An article published in the journal JAMA Pediatrics, suggests the safety record is less clear. The authors associated the use of acetaminophen during pregnancy to a higher risk of ADHD and other hyperactivity behavior disorders in children, with the risk stronger for maternal acetaminophen use in more than 1 trimester.
As both an over the counter and prescribed medication, Paracetamol is one of the most commonly used analgesic (pain) and fever medications used during pregnancy
A 2005 study published in the American Journal of Obstetrics and Gynecology reported at least 65% of women had used acetaminophen at one point or another during their pregnancy.
Planning a pregnancy?
This recent study also highlights the public health relevance of medication effects during pregnancy. Women who are planning a pregnancy or have just learned they are pregnant should consult with their physicians prior to taking any prescribed or over-the-counter medications.