(Photo Credit: gabi_menashe via photopin cc)

It’s been a busy week for fertility science. This past weekend, the world welcomed the first baby born from a transplanted womb and on Monday, it was announced that another two women are set to give birth using their mothers’ wombs.

Why are these developments so important to the fertility field?

There are many causes for infertility, but one of the most challenging causes is Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome, a congenital defect which occurs in 1 in 4,500 women where they are born without a uterus. This condition, and other conditions such as Asherman’s syndrome (an acquired uterine condition characterized by scar tissue formation inside the uterus and/or the cervix), can benefit from uterus transplants as a potential treatment for infertility. Previously, these conditions have had few to no options for treatment without the involvement of gestational carriers or resorting to adoption.

Is transplantation worth it?

In Canada, the Assisted Human Reproductive Act prohibits the payment of gestational carriers, which makes finding a woman who is willing to carry a child for free very difficult. For MRKH patients who do not have the option of surrogacy, womb transplants could be the answer.

Additionally, having the mother carry her own child bypasses some legal complexities involving gestational carriers. In Canada, contracts are usually put together to show the “intent of the parties,” acting as guidelines for gestational carriers and the intended couples on many issues that may or could occur during the relationship. At present, there has been no precedence of these contracts being challenged in court.

However, current Canadian laws state that the gestational carrier has rights over the unborn child until the time of birth. Say, for instance, it is discovered that the carried baby has Down syndrome. If the gestational carrier does not wish to continue with the pregnancy but the intended parents would like to have the child, the gestational carrier has the legal right to terminate the pregnancy regardless of the parents’ wishes. This type of ethical dilemma would be avoided if the intended mother were to carry the baby herself.

Should uterine transplant procedures become the new norm?

Although there’s no quantifying the joy that families experience when they give birth to a baby after experiencing infertility, uterine transplants are experimental procedures with biological and ethical implications which should be considered:

Biological

• Of nine women who had uterine transplants from the Swedish team in 2013, two had to receive hysterectomies post-procedure due to severe infection and arterial blood clots in the uterus.
• Only one gave birth at 31 weeks after severe pre-eclampsia and the baby’s heart rate became abnormal (the baby has since been declared healthy).
• Since this procedure is still in its early stages of development, there are still many questions about whether it can be performed repeatedly, reliably and safely.
• The drugs that prevent the womb from being rejected could be damaging in the long term. Side effects include high blood pressure, diabetes and possible increased risk of some types of cancers. This means that the transplant wombs will be removed after a maximum of two pregnancies so the women can stop taking the anti-rejection drugs. In addition, since the baby will have to be born via caesarian section, couples must undergo a few months of observation before knowing whether the mother can keep the uterus for a second pregnancy or have the womb removed.

Ethical

• Some ethics specialists have argued that since effective womb transplants have been made at the risk of a live donor as opposed to a post-mortem donor, the entire procedure might not be ethical, especially since the transplant is not a life-saving procedure.

In order to avoid the above situations, we generally limit gestational carriers to sisters or family members with perfect medical histories. However, as more and more women want to have children at an older age when pregnancies may be complicated by chromosomal abnormalities, we should be open to remarkable advances in infertility treatment.

It’s important to note that the leader of the uterus transplantation team, Professor Mats Brannstrom, has admitted that this procedure won’t be a routine surgery “until many years yet”.

For example Advances such as comprehensive chromosomal screening may help maximize the chances of a chromosomally normal embryo being transferred into a carrier and that may help to at least limit some of the above dilemma.  It does not limit if a carrier becomes emotionally attached to a child and wants to keep the child or if there are other complications in pregnancy that arise for which difficult decisions need to be made.