Uterine transplant
Encyclopedia
A uterine transplant is the transplantation of a uterus
in order to replace one which has undergone necrosis
or in Müllerian agenesis
. Though the procedure has significant potential, it has been performed only a few times.
in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform an animal autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus (Erslan et al. 1966). With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred (Confino et al. 1986).
In Saudi Arabia
in 2000, a uterine transplant was performed on a patient whose own uterus had hemorrhaged after childbirth
. The transplanted uterus functioned for 99 days, however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful. In 1931, Lili Elbe
died from organ rejection three months after receiving one of the world's earliest uterine transplants.
In 2000, a human uterine transplant was performed in Saudi Arabia by Dr. Wafa Fagee. Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea
; exploratory laparotomy
confirmed uterine necrosis. The procedure has raised some moral and ethical concerns.
The latest can be found in the March-April 2011 issue of the "Journal of Minimally Invasive Gynecology".
In this article, Edwin Ramirez M.D, his father Dr. Hugo A. Ramirez,(Pioneer), sister Doris Ramirez Nessetti M,D, Matthew Nessetti M.D, Masood Khatamee M.D, Marla R Wolfson MS, PhD, Thomas H Shaffer MSE, PhD and Viviana Zuluaga Ramirez DVM, demonstrated that a pregnancy can be carried for the First time in History in a transplanted uterus under the influence of immunosuppressive therapy in the sheep model. The Ramirez project initially started eleven years ago as a family project at UT Odessa, Tx and ended in Bogota, Colombia at the La Salle University.
in humans. Some concerns regarding genetics
, anatomy
and hormones
addressed below:
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
in order to replace one which has undergone necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
or in Müllerian agenesis
Mullerian agenesis
Müllerian agenesis is a congenital malformation in women characterised by a failure of the müllerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper portion of the vagina. It is the second most common cause of primary amenorrhea after...
. Though the procedure has significant potential, it has been performed only a few times.
History
In 1896, Knauer published the first study of ovarian transplantation and that lead to the investigation of uterine autotransplantationAutotransplantation
Autotransplantation is the transplantation of organs, tissues or even proteins from one part of the body to another in the same individual. Tissue transplanted by such "autologous" procedure is referred to as an autograft or autotransplant. It is contrasted with xenotransplantation and...
in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform an animal autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus (Erslan et al. 1966). With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred (Confino et al. 1986).
In Saudi Arabia
Saudi Arabia
The Kingdom of Saudi Arabia , commonly known in British English as Saudi Arabia and in Arabic as as-Sa‘ūdiyyah , is the largest state in Western Asia by land area, constituting the bulk of the Arabian Peninsula, and the second-largest in the Arab World...
in 2000, a uterine transplant was performed on a patient whose own uterus had hemorrhaged after childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. The transplanted uterus functioned for 99 days, however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful. In 1931, Lili Elbe
Lili Elbe
Lili Elbe was an Intersex person and one of the first identifiable recipients of male to female sex reassignment surgery. Elbe was born as a male in Denmark. Born as Einar Mogens Wegener, she identified as male for most of her life and was a successful artist with that name...
died from organ rejection three months after receiving one of the world's earliest uterine transplants.
In 2000, a human uterine transplant was performed in Saudi Arabia by Dr. Wafa Fagee. Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea
Amenorrhoea
Amenorrhoea , amenorrhea , or amenorrhœa, is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and lactation , the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method...
; exploratory laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
confirmed uterine necrosis. The procedure has raised some moral and ethical concerns.
The latest can be found in the March-April 2011 issue of the "Journal of Minimally Invasive Gynecology".
In this article, Edwin Ramirez M.D, his father Dr. Hugo A. Ramirez,(Pioneer), sister Doris Ramirez Nessetti M,D, Matthew Nessetti M.D, Masood Khatamee M.D, Marla R Wolfson MS, PhD, Thomas H Shaffer MSE, PhD and Viviana Zuluaga Ramirez DVM, demonstrated that a pregnancy can be carried for the First time in History in a transplanted uterus under the influence of immunosuppressive therapy in the sheep model. The Ramirez project initially started eleven years ago as a family project at UT Odessa, Tx and ended in Bogota, Colombia at the La Salle University.
Procedure
Uterus transplantation starts with uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates. It may need to be stored for e.g. transportation to the location of the donor. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h. The following insertion procedure, with vascular anastomosis, has not been fully developed in animal models, indicated by frequent thrombosis formation.Application on transgendered women
It may be possible for trans women to receive uteruses, which would effectively represent a step closer to a true sex changeSex change
Sex change is a term often used for gender reassignment therapy, that is, all medical procedures transgendered people can have, or specifically to sexual reassignment surgery, which usually refers to genitalia surgery only...
in humans. Some concerns regarding genetics
Sex-determination system
A sex-determination system is a biological system that determines the development of sexual characteristics in an organism. Most sexual organisms have two sexes. In many cases, sex determination is genetic: males and females have different alleles or even different genes that specify their sexual...
, anatomy
Sexual dimorphism
Sexual dimorphism is a phenotypic difference between males and females of the same species. Examples of such differences include differences in morphology, ornamentation, and behavior.-Examples:-Ornamentation / coloration:...
and hormones
Endocrine system
In physiology, the endocrine system is a system of glands, each of which secretes a type of hormone directly into the bloodstream to regulate the body. The endocrine system is in contrast to the exocrine system, which secretes its chemicals using ducts. It derives from the Greek words "endo"...
addressed below:
- Women with Swyer syndromeSwyer syndromeSwyer syndrome, or XY gonadal dysgenesis, is a type of hypogonadism in a person whose karyotype is 46,XY. The person is externally female with streak gonads, and left untreated, will not experience puberty...
have male genetics and lack ovaries, but have a uterus. Similarly to trans women, they need hormone replacement therapyHormone replacement therapy (male-to-female)Hormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the sex to which they were assigned, or later, if this assignment has proven to be incorrect...
to induce female puberty and maintain female secondary sex characteristics. Such women have had successful pregnancies, though obviously requiring egg donation and IVF. - In the case of most trans women who began HRTHormone replacement therapy (male-to-female)Hormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the sex to which they were assigned, or later, if this assignment has proven to be incorrect...
past male puberty, the pelvis has failed to develop femininely and broaden as it would've before or during puberty. However, as proven by Nadya SulemanNadya SulemanNadya Denise Doud-Suleman , known as Octomom in the media, is an American woman who came to international attention when she gave birth to octuplets in January 2009. The Suleman octuplets are only the second full set of octuplets to be born alive in the United States...
, Lina MedinaLina MedinaLina Medina is the youngest confirmed mother in medical history, giving birth at the age of five years, seven months and 17 days...
and Stacey Herald, a small pelvis is not an obstacle to gestation, even in extreme cases. Delivery would be via c-section.