Event Review: The First Human Womb Transplant

After two decades of dedicated research, the UK's first human womb transplant was successfully performed in early 2023 between two sisters (see BioNews 1204). Co-led by teams from Imperial College Healthcare NHS Trust and Oxford University Hospitals NHS Foundation Trust, this landmark 18-hour procedure offered new hope for motherhood to the one-in-5000 UK women facing uterine infertility, including those who have undergone hysterectomies. This achievement marked the UK's entry into a global effort that has seen around 100 transplants and 50 babies born since 2013.

The first human womb transplant represents a monumental achievement in reproductive medicine, a field continuously evolving to address infertility challenges. Richard Smith, lead gynaecological surgeon at Hammersmith Hospital, Imperial College NHS Trust, and Isabel Quiroga co-lead surgeon at Oxford University Hospital, presented their pioneering surgery at the Royal Institution. Their talk shed light on the scientific intricacies of the procedure and its ethical considerations.

Smith began by outlining the current landscape in the UK, where approximately 50,000 women are diagnosed with absolute uterine factor infertility, a condition where the uterus is either absent or dysfunctional. Traditional treatments like surrogacy or adoption do not fulfill the desire of some women to experience pregnancy and childbirth firsthand. I was especially impressed with how Smith introduced the topic, portraying his and Quiroga's work as a potential solution for women unable to carry their own children, making the presentation both engaging and informative. He proceeded to delve into the specific surgical procedures used and relevant aspects of the female pelvic anatomy, although the technical details, while fascinating, may have been overly complex for the Royal Institution's lay audience.

While the medical achievements are impressive, the ethical implications of womb transplantation are complex and multifaceted. Smith addressed the sensitive ethical topic of eligibility criteria, discussed previously in BioNews (see BioNews 1205). He explained that eligible candidates must be diagnosed with absolute uterine factor infertility, have created embryos through IVF, be aged 24 to 42, have a healthy BMI, be in remission for over five years if post-oncological, and have no ongoing medical conditions.

While this rigorous selection process ensures medical suitability and minimises risks, they also raise concern in equity in access to the procedure. For instance, the requirement for pre-existing IVF embryos imposes a financial burden that may exclude women from lower socioeconomic backgrounds, and specifying an age range and health conditions can be seen as discriminatory. Smith's focus on the medical aspects was understandable, but I would have liked to hear more about the ethical dimensions balancing innovation with safety, fairness, and accessibility.

Smith also briefly discussed the 2010 Gender Equality Act, which mandates equal treatment for cisgender and transgender women in surgical procedures, like those involving vaginas for transgender women. He claimed microbiome discrepancies would exist between natural vaginas and those created for trans women, alongside heightened risks of miscarriage, would make trans women ineligible for uterine transplant. He underscored the ethical responsibilities placed on surgeons and the potential for raising false hopes in the transgender community.

This discussion further highlights the complexities and challenges inherent in ensuring equitable healthcare outcomes while navigating the delicate balance between medical advancements and patient expectations.

Quiroga complemented the discussion with a detailed history and statistics of successful organ transplants, highlighting their profound impact on medical science. She emphasised that, unlike other organ transplants which are life-saving, uterus transplants are uniquely life-transforming and life-generating. I appreciated that, by drawing this distinction, Quiroga wants to stress the transformative potential of uterus transplants, not just in extending life but in creating new life and profoundly changing the lives of women with uterine factor infertility.

She then provided details on surgical technique and offered a thorough explanation of all the ethical assessment bodies and consent forms required to proceed with the procedure, given its relatively higher failure rate compared to other organ transplants. While her speech was comprehensive, I found it less informative and slightly boring compared to Smith's. It lacked engaging insights and the valuable points for discussion of Smith's, focusing more on procedural details that failed to captivate me.

It is evident that Smith and Quiroga's work opens doors for further research and improvements in transplantation techniques. As the procedure becomes more refined, the hope is that it will become more accessible and safer for a larger number of women. Moreover, this advancement paves the way for exploring similar procedures in other areas of reproductive medicine, potentially offering new solutions to a variety of infertility issues.

Overall, the presentation provided a fascinating exploration of the medical advancement, covering essential aspects, considerations, and necessary knowledge to appreciate its importance and exceptionality. Smith proved to be a compelling speaker, effectively conveying key points and engaging the audience. However, Quiroga's segment, focused heavily on technical details, felt less engaging to me. Nonetheless, amidst the overall positivity, there remains a hint of bittersweetness; the non-medical implications of this breakthrough were not really discussed, leaving an intriguing avenue for future discussions and considerations.