World's first womb transplant
LONDON. England (CNN) -- The world's first human womb transplant has taken place on a 26-year-old woman in Saudi Arabia, it has been revealed.
The transplanted human uterus produced two menstrual periods before it failed after three months and had to be removed.
The experiment showed a womb transplant is technically achievable -- and was immediately hailed as a breakthrough bringing hope to tens of thousands of childless couples whose only chance of a baby at the moment is through surrogacy.
Surrogacy is not acceptable on religious grounds to Muslims.
The date of the operation -- April 2000 -- gave rise to speculation that similar operations, not yet documented in medical journals -- might have taken place in the two years since.
But some experts warned such surgery is highly risky and raised ethical issues. Some say it wil not be acceptable until less toxic anti-rejection drugs become available.
The idea of uterus transplants was first explored in the 1950s.
But after 20 years of failed experiments on dogs and baboons, many scientists considered it impossible because of the complex blood vessels that must be connected and because of fears that anti-rejection drugs could harm a foetus.
Dr. Wafa Fageeh, a professor at Abdulaziz University who performed the transplant with her team at King Fahad Hospital and Research Centre in Jeddah, Saudi Arabia, called the operation "a good start."
An editorial in the International Journal of Gynecology and Obstetrics, which revealed the operation, praised the breakthrough.
The editorial, by Dr. Louis G. Keith of Northwestern University medical school, Chicago, and Giuseppe Del Priore of New York University medical center said the Saudi team had crossed one of the last frontiers of transplant surgery.
Although uterine transplants did not save lives, their importance to many women should not be underestimated, they said.
"To some individuals, childbearing is the greatest event of a lifetime. To such persons, transplantation of organs of reproduction would not be considered frivolous or unnecessary, even though these organs do not sustain life."
"You have to give them credit. They took a concept that everybody thought was undoable and they did it," Keith, an obstetrician and gynecologist who was not involved in the research, told AP.
"It brought enough blood to the uterus for the uterus to survive 99 days and function as a uterus is supposed to function -- which is to menstruate," said Keith.
Other experts were more cautious.
"It is technically feasible, theoretically desirable, but presently unsafe," Roger Gosden, a fertility pioneer at Eastern Virginia Medical School in Norfolk, Virginia, told the Associated Press.
"Their results reveal the risks and this procedure awaits the development of safe immunosuppression.
"A transplant to save life is an acceptable risk, but not one for fertility, when there are alternatives," he said. "This is why we would never be given ethical clearance to try this in the United States" for the foreseeable future.
The operation failed because a blood vessel supplying the uterus developed a clot, which cut off the blood supply.
The transplant, using the womb of a 46-year-old post-menopausal woman who had to have a hysterectomy, was performed April 6, 2000, on a 26-year-old Saudi woman who had lost her uterus because of excessive bleeding after childbirth.
The recipient was given anti-rejection pills, but nine days after the operation the body rejected the womb. However, doctors were able to control it with drugs.
Hormone treatment was given to thicken the womb's lining and it grew to 18 millimetres thick, indicating that hormones were getting through and that blood supply was good, the researchers reported.
Menstrual periods happen when the lining of the womb, prompted by hormones, reaches a certain thickness to accommodate a fertilised egg but sheds because fertilisation has not occurred.
The hormone treatment was given for 21 days, then stopped for a week before being restarted.
"She had two menstrual periods after stopping the hormones each time," Fageeh said.
On the 99th day, scans revealed a blockage in one of the grafted vessels which cut off blood supply to the uterus, and it had to be removed. The clot did not endanger the woman's life.
Some experts believe that non-vital transplants aimed at improving quality of life rather than saving it -- such as transplants of the hand, voice-box or uterus -- are not worth the risks.
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International Journal of Gynaecology and Obstetrics
American Society for Reproductive Medicine
The New England Journal of Medicine
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