Transplanting a Uterus: Teamwork Required

 Innovation is more than having a great idea; it’s having the expertise and wherewithal to transform the idea into a reality. On Feb. 24, a team of Cleveland Clinic caregivers perfectly illustrated that concept by performing the United States’ first uterus transplant.

The teamwork required to make this effort a success cannot be understated. In all, about 70 Cleveland Clinic caregivers have been part of the uterus transplant process, including transplant specialists, obstetricians and gynecologists, bioethicists, psychiatrists, nurses and social workers, among others.

Before the clinical trial went forward, Cleveland Clinic’s Institutional Review Board – which reviews and monitors all human-related research projects – examined the proposal for more than a year.

Transplant surgeons and gynecological surgeons – who had little reason to work together in the past – spent the past 10 years researching, studying and practicing uterus transplants, including side-by-side involvement with the Swedish transplant team that has performed nine uterus transplants.

It is truly a remarkable surgical feat, but we still haven’t reached our goal – a successful pregnancy and a healthy baby. That will likely take another two years, as the uterus needs about a year to heal and stabilize before implanting an embryo.

Today, though, there is new hope for women who are infertile due to an absent or non-functioning uterus, an irreversible condition known as uterine factor infertility. For the first time, they can envision a future that includes pregnancy and childbirth.

Our first patient, Lindsey (whose last name is being withheld to protect her privacy), was 16 when her OB-GYN told her she had been born without a uterus. In that moment, her whole world changed. Her dreams of motherhood seemed to vanish. Eventually, she and her husband, Blake, adopted three “beautiful little boys” through foster care. Still, she prayed that one day she might be able to conceive, carry and deliver a child.

As the first woman in the United States to undergo a uterus transplant, Lindsey took the first step toward making her hope a reality – not just for herself but also for the 3 percent to 5 percent of reproductive-aged women worldwide with uterine factor infertility.

The transplant doesn’t come without questions, however. Some wonder about the necessity of the procedure, considering that adoption and surrogacy are viable options. In many societies, though, adoption and surrogacy are impermissible due to ethical, cultural or religious objections, leaving women with no option for motherhood.

Others wonder whether the surgical risk to the woman is acceptable, considering that she is not suffering from a life-threatening illness. While it’s true that this is not a life-saving procedure, it has the potential to be a life-affirming procedure for hundreds of thousands of women worldwide, including Lindsey.

For more information about Cleveland Clinic’s uterine transplant program, visit https://www.clevelandclinic.org/lp/uterus-transplant/index.html. Details of the clinical trial can be found at https://clinicaltrials.gov/ct2/show/NCT02573415.