Uterus Transplantation

• 10 Oct 2023

For Prelims: Uterus Transplantation, Artificial Uteri, In vitro fertilization

For Mains: Science and Technology- Developments and their Applications, Bio-technology.

Source: TH

Why in News?

Recently, the United Kingdom's first uterus transplant was conducted, providing new hope for women facing reproductive challenges.

• India is one of a few countries to have had a successful uterine transplant; others include Turkey, Sweden, and the U.S.
• Doctors now aim to reduce the surgery cost, currently at Rs 15-17 lakh in India, and develop a bioengineered artificial uterus to simplify transplants and eliminate live donors for ethical organ transplantation.

What is a Uterus Transplant?

• About:
  • Unlike heart or liver transplants, uterus transplants aren’t life-saving transplants. Instead, they are more like limb or skin transplants – which improve the quality of individuals’ lives.
  • Uterus transplants can help women who lack a uterus fulfill their reproductive needs.
  • The first live birth after a uterus transplant occurred in Sweden in 2014, marking a breakthrough in treating uterine factor infertility.
• Steps Involved in a Uterus Transplant:
  • The recipient undergoes thorough physical and mental health evaluations before the transplant.
  • The donor's uterus, whether from a live or deceased donor, is rigorously examined for viability.
    • Live donors undergo various tests, including gynaecological examinations and cancer screenings.
  • The procedure doesn’t connect the uterus to the fallopian tubes, which ensures the ovum from the ovaries moves to the uterus – so the individual can’t become pregnant through natural means.
    • Instead, doctors remove the recipient’s ova, create embryos using in vitro fertilization, and freeze them embryos (cryopreservation).
      • Once the newly transplanted uterus is ‘ready’, the doctors implant the embryos in the uterus.
  • Robot-assisted laparoscopy is used to precisely remove the donor's uterus, making the process less invasive.
  • After the transplantation procedure, the vital uterine vasculature(the network of vessels connecting the heart to other organs and tissues in the body) and other important linkages are methodically re-established.
• Post-Transplant Pregnancy:
  • Success is determined in three stages:
    • Monitoring graft viability in the first three months.
    • Assessing uterus function between six months to one year.
    • Attempting pregnancy with in vitro fertilization, but with higher risks like rejection or complications.
    • The final stage of success is a successful childbirth.
  • Frequent check-ups are essential due to potential risks like rejection, abortion, low birth weight, and premature birth.
• Considerations and Side Effects:
  • Immunosuppressant drugs are necessary to prevent rejection but may cause side effects.
  • Side effects include kidney and bone marrow toxicity and an increased risk of diabetes and cancer.
  • For these concerns, the uterus must be removed after successful childbirth and regular follow-ups for at least a decade are recommended after childbirth.

Artificial Uteri

• Researchers, at the University of Gothenburg, are working on bioengineered uteri. These are created using stem cells taken from a woman's blood or bone marrow as a foundation for a 3D scaffold.
  • Preliminary experiments with rats show promise.
• Artificial uteri could eliminate the need for live donors, addressing ethical concerns and reducing the potential risks to healthy donors.
• Artificial uteri could benefit women facing infertility issues as well as members of the LGBTQ+ community.
  • However, trans-women recipients may still need additional procedures, like castration(removing the testicles of a male animal or human) and hormone ftherapy.
  • Also, Ensuring consistent blood flow to support a developing fetus is a challenge in creating artificial uteri, as the male body lacks the necessary structures for uterine and fetal development.
• Future Possibilities:
  • Artificial uteri offer exciting possibilities for reproductive medicine but require further research and development before becoming a practical solution for human reproduction.