Pregnancy hope for womb transplant patient

A womb transplant recipient is set to become pregnant after doctors successfully transferred an embryo into the transplanted uterus. If the embryo embeds and the pregnancy is successful, the baby will become the first child born following a womb transplant.

The woman, who is affected by MRKH syndrome and was born without a womb, received a uterus donated by her mother. She was one of nine patients to receive uteruses donated by living relatives in an ongoing trial being performed in Sweden (reported in BioNews 738).

'A success would be an important proof of principle that a procedure is now available to cure uterine infertility', said Dr Mats Brännström of the University of Gothenburg, who is leading the trial.

Although a pregnancy has been achieved from a womb transplant before, there have been no children born using donated uteruses. In 2011 a Turkish woman received a uterus from an unrelated deceased donor and later became pregnant. However, the pregnancy was terminated after eight weeks when an examination revealed no embryo heartbeat (reported in BioNews 705). In 2000 a woman in Saudi Arabia underwent a womb transplant using a uterus from a living donor but it had to be removed after a clot developed due to poor blood flow.

Some doctors believe that deceased donors are more suitable, as extra supportive tissue and vasculature can be transplanted along with the uterus, in addition to preventing healthy people from undergoing serious unnecessary procedures. The Swedish trial uses living donors, however, as the researchers involved believe this ensures that the uterus is in a good condition and is a better immunological match.

Dr Richard Smith of the charity Womb Transplant UK, which is raising money to perform womb transplants in the UK using deceased donors (reported in BioNews 665), said the 'principal concern for me is if the baby will get enough nourishment from the placenta and if the blood flow is good enough'.

As the woman has intact ovaries, doctors were able to create an embryo using her own eggs, which were cryopreserved before the transplant. About a year later they were fertilised in vitro and an embryo was transferred into the uterus. If the pregnancy is successful, the doctors plan to deliver the baby by caesarean section. The patient may then be allowed one more attempted pregnancy, following which the transplanted uterus will be removed.

Stina Järvholm, the psychologist working with Dr Brännström's team, is expecting months of challenging work to come. 'It's the gap between hope and despair', she said.