Only three years ago, on 4 September 2014, birth in Sweden of first baby born of a grafted uterus was greeted with immense hope by couples suffering from uterine infertility. Since n, prowess has been repeated: seven or infants have been born in service of Dr Mats Brännström in Gonburg and two births are expected in Sweden and Brazil. No less than 38 uterine grafts have already been carried out in world, and number of teams embarking on adventure continues to increase.
The very young international learned Society of uterine graft (ISUTX) held its first congress in mid-September to take stock of this medical revolution which, in Europe alone, could meet needs of some 200,000 women afflicted of uterine infertility. For se women suffering from a congenital absence of uterus related to syndrome of Mayer-Rokitansky-Küster-Hauser (100 to 200 per year in France), or a ablation as a result of cancer or hemorrhage of deliverance, pregnancy was so far Impossible. “The results presented at Congress go well beyond our initial expectations,” excites Prof. Tristan Gauthier (CHU de Limoges), one of pioneers of subject in France. The results are extraordinary. When we embarked on adventure in 2010, people took us for fools. “But recently speech has changed.”
“We were contacted by 200 couples!”
These successes must not, however, make m forget some difficulties. “Anor 25% of grafts are explanted, mainly as a result of thrombosis or infection,” says Dr. Gauthier. This shows that we are still in experimental stage. Out of a total of 38 registries recorded worldwide at conference, 28 involved a living gift and 10 a levy on a deceased patient. The transplant is considered successful when rules appear within six months after operation, final goal remains birth of a child. Until now, only transplants from live donations have allowed couples to become parents. “But this number is not enough to conclude wher transplant from a living donor works better than brain death gift,” says Tristan Gauthier.
His team received green light from drug agency to carry out 8 grafts from deceased donors. “We were contacted by 200 couples!” he recalls. Half a dozen patients have already completed first stage of protocol, obtaining an embryo through in vitro fertilization. No grafting has yet been carried out because donation after cerebral death has its own constraints: expectation of a compatible graft from a deceased between 18 and 50 years.
Risk, hemorrhage, thrombosis, or even serious complications, are real
For teams having chosen to graft a uterus from a living donor, that of Prof. Jean-Marc Ayoubi and René Frydman (Hôpital Foch, Suresne) For example, only French team to work on subject, sampling operation is long (10 to 13 hours) and delicate. The risks, hemorrhage, thrombosis, or even serious complications, are real, even though, says Tristan Gauthier, “since very first transplant in 2002, no deaths have fortunately been regretted in donors as in recipients”.
The team at Foch Hospital, which has long been collaborating with Gonburg to train, received in March approval of drug Agency to practice 10 grafts from living and related donors (friends or family of patient). The time is still to identify potential patients who need to be diagnosed with MRKH syndrome. They must be prepared to undergo a heavy immunosuppressive treatment, but, and that is peculiarity of uterine graft, for a limited time. The graft will be removed once pregnancy project has been completed as immunosuppressive drugs increase risk of certain cancers. But same grafted uterus can withstand several pregnancies: in Sweden, 2 patients have already carried 2 children. Deliveries are always carried out by caesarean section.
With respect to babies, 60-year decline of physicians on women’s pregnancies under immunosuppressants (for anor transplant) did not reveal a teratogenic risk, noted medical Academy in a report in 2015. Of eight Swedish births, three babies were born prematurely due to preeclampsia, probably favored by mor’s MRKH syndrome. “They are all doing well today,” says Prof. Brännström. They will be followed on a medical and psychological level for several years. If Professor Brännström already anticipates that uterus transplant is out of field of experimentation within five years, his French counterparts are more cautious. “It is still very premature to talk about it as a potential treatment for infertility,” warns Tristan Gauthier.
