Ten years after the first operation, also followed by IVF, Swedish doctors (who are international leaders in this field) have seen positive results. However, some ethical issues remain.
On 15th September 2012, gynaecological surgeons at the Sahlgrenska University Hospital in Gothenburg, Sweden, led by Mats Brännström, performed the first uterus transplant in their history (and one of the first in the world), which was a great success and was followed by eight more operations in the following months. In most cases, the donors were the patients' mothers and in other cases close relatives or friends. The recipients were women who did not have a uterus, or had a malfunctioning one, due to congenital diseases or a hysterectomy because of a tumour.
In Spring 2014, the first child of one of the women who had undergone in vitro fertilisation (IVF) after the transplant was born. In the meantime, two of the transplant patients had to give up the new uterus, which had to be removed due to various problems. In the other seven women, however, menstruation resumed about two months after the transplant. This was considered a very positive result.
Uterus transplant and in vitro fertilisation: the results 10 years on
Ten years later, it is time to take stock and see how these women are doing, how many of them have become mothers, and how their children are doing. This is why the specialists involved, who have continued to closely monitor the physical and psychological conditions of the patients, have published one of the most comprehensive reports ever written on the subject in the scientific journal Fertility & Sterility with their observations.
Of the seven women who kept the uterus, six (86% of the total) underwent IVF, became pregnant and had one or more children. Among these the fertilisation success rate for each attempt was 33%, similar to that of non-transplanted women. Three of them had twins, bringing the number of children born to nine.
According to Swedish doctors, there were no significant physical or psychological problems: none of the women had to resort to drugs or mood therapies (e.g. for anxiety or depression), and the same was true of the recipients.
On the contrary, four years after the transplant, the quality of life of all the women involved was above average, according to researchers. This is probably due to an awareness of having recovered from a condition that was thought impossible to live with and, as far as the donors were concerned, of having been the reason for this.
The children, who continue to be studied, also showed no abnormalities after two years. This led Mats Brännström to say that the outcome of the transplants was better than expected.
A new robotic technique
Although this is a small case study, the data and information gathered is crucial and often brand-new, given that these transplants only began a few years ago. By the end of 2021, around 90 women worldwide had received a uterus transplant and become mothers of some 50 children. Twenty of those surgeries were performed in Sweden, which in 2017 adopted a new robotic surgical technique that allows for a much less invasive operation than traditional donor surgery.
Sweden's leading role in this approach to infertility is also confirmed by the fact that it was Swedish specialists who set up an international register, under the auspices of the International Society of Uterus Transplantation (ISUTx), to share all data and continue to improve a technique that has greatly changed the outlook for women without a uterus.
Concerns in Switzerland
Outside Sweden, however, several ethical concerns remain about this type of procedure, which is fairly complex and expensive, and - unlike other transplants - is not performed to save a life. The question many are asking is whether it is right to resort to such extreme measures to make pregnancy possible.
The consequences for donors who, in some cases, are still of childbearing age, must also be considered. There is also the problem of anti-rejection drugs, which are needed after the transplant and are not usually a recommended treatment during pregnancy. The National Ethics Commission for Medicine (CNE) in Switzerland has been expressing doubts about this type of technique since 2014.
