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Walter JR, Johannesson L, Falcone T, Putnam JM, Testa G, Richards EG, O'Neill KE. In Vitro Fertilization Practice in Patients with Absolute Uterine Factor Undergoing Uterus Transplant in the United States. Fertil Steril 2024:S0015-0282(24)00245-0. [PMID: 38631504 DOI: 10.1016/j.fertnstert.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Report detailed, pooled multicenter experiences and outcomes after IVF among patients undergoing uterus transplantation in the United States. DESIGN Cohort study SUBJECTS: Patients undergoing uterus transplant from the three longest running uterus transplant clinical trials in the United States. INTERVENTION In vitro fertilization among uterus transplant patients MAIN OUTCOME MEASURES: Reproductive outcomes pre- and post-transplant ovarian stimulation RESULTS: 31 uterus transplant recipients were included in this cohort (mean age at transplant was 31 years, standard deviation 4.7). Prior to transplant, recipients completed a mean of 2 oocyte retrievals (range 1-4), banking a mean of 8 untested embryos (range 3-24) or 6 euploid embryos (range 2-10). Post-transplant retrieval cycles were required in 19% of recipients (n=6/31): a total of 16 cycles (range 2-4 cycles per recipient). All post-transplant retrievals were performed vaginally without complication. Preimplantation genetic testing was used by 74% of subjects (n=23/31). 72 autologous single embryo transfers occurred in 23 patients who completed at least one embryo transfer. Two embryo transfers followed a fresh IVF cycle and the remainder were frozen embryo transfers (n=70). Endometrial preparation during was more commonly performed with programmed protocols (n=61) (exogenous administration of estrogen/progesterone) compared to natural cycle protocols (n=9). The overall live birth rate for this cohort was 35% (n=25/72) per embryo transfer. Among those patients who had an embryo transfer leading to a live birth (n=21), a mean of 2.2 embryo transfers was performed. The overall live birth rate after the first embryo transfer was 57% (n=13/23) and rose to 74% after a second embryo transfer (n=17/23). There was no difference in rate of preeclampsia, live birth, neonatal birth, or placental weights among programmed versus natural cycle frozen embryo transfers. There were no differences in the live birth rate between living or deceased donor uteri (37% versus 32%, p=0.6). CONCLUSIONS Post-transplant ovarian stimulation was required in 26% (n=6/23) of recipients undergoing at least one embryo transfer despite high rates of preimplantation genetic testing and pre-transplant embryo cryopreservation. Post-transplant retrievals were performed transvaginally, without complication. Future reporting of IVF experience will be essential to optimize reproductive outcomes after uterus transplant.
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Affiliation(s)
- Jessica R Walter
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Liza Johannesson
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH
| | - J Michael Putnam
- Fertility Center of Dallas, Baylor University Medical Center, Dallas, TX
| | - Giuliano Testa
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Elliott G Richards
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH
| | - Kathleen E O'Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA. kathleen.o'
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Janota J, Orlova E, Novackova M, Chmel R, Brabec R, Pastor Z, Chmel R. Three-year follow-up results of two children born from a transplanted uterus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:370-375. [PMID: 37901926 DOI: 10.5507/bp.2023.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Abstract
AIMS To evaluate the 3-year follow-up results of two children delivered at our institution in 2019 from mothers with a transplanted uterus. METHODS Observational data on pregnancy outcomes, neonatal course, and growth trajectory in two children born to mothers after uterus transplantation, including 3-year follow-up and neurodevelopmental status assessed using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). RESULTS Both children were born prematurely via uneventful caesarean sections, to mothers with Mayer-Rokitansky-Küster-Hauser syndrome and a transplanted uterus. An acute caesarean section was performed in one mother because of the onset of regular uterine contractions at 34 weeks and 6 days of pregnancy; in the other mother, an elective caesarean section was performed at 36 weeks and 2 days of gestation. The children were born healthy with no congenital malformations. They had an uneventful postnatal course and showed a normal growth trajectory during 3 years of follow-up. The Bayley-III neurodevelopmental scores of both children were within the normal ranges at ages 2 and 3 years. CONCLUSION Though pregnancy after uterus transplantation is associated with the risk of premature delivery, no abnormalities were observed in the neonatal course and 3-year follow-up results, including the neurodevelopmental status, of two children born prematurely to mothers with a transplanted uterus. This is the first report on neurodevelopmental outcomes in children born after uterus transplantation. More data on children born after this radical procedure of uterine factor infertility treatment are required to support our promising results.
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Affiliation(s)
- Jan Janota
- Department of Neonatology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ekaterina Orlova
- Department of Neonatology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marta Novackova
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Radim Brabec
- Department of Neonatology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Georgevsky D, Ying L, Krishnan S, Laurence J, Robinson D, Campbell N, Wyburn K, Marinelli T, Davis R, Narayan R, Lutz T, Chan A, Heaney SA, Kitzing YX, Anderson L, Liyanagama K, Robson J, Carter J, Testa G, Johannesson L, Marren A. First uterine transplant case at the Royal Prince Alfred Hospital. Aust N Z J Obstet Gynaecol 2023; 63:599-602. [PMID: 37200477 DOI: 10.1111/ajo.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
Uterine transplantation (UT) is an emerging medical treatment for women affected by absolute uterine factor infertility (AUFI). To date there have been over 90 documented cases of UT performed worldwide, with over 50 live births. UT allows women affected by AUFI the opportunity to carry and deliver a childd. The Royal Prince Alfred Hospital (RPAH) introduced a UT study in 2019; however, due to the impacts of the COVID pandemic the study was placed on hold for two years. In February 2023, RPAH performed the centre's first UT from a living unrelated donor to a 25-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. The donor and recipient surgeries were uncomplicated and both are recovering well in the early post-operative period.
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Affiliation(s)
- Dana Georgevsky
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Li Ying
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Surya Krishnan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jerome Laurence
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - David Robinson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Neil Campbell
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tina Marinelli
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rajit Narayan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Agnes Chan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sally-Ann Heaney
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Yu Xuan Kitzing
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lyndal Anderson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Keith Liyanagama
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Jonathan Carter
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre, Dallas, Texas, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre, Dallas, Texas, USA
| | - Anthony Marren
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Deans R, Pittman J, Gerstl B, Haghighi K, Pleass H, KÄhler PD, Kvarnström N, Hseih W, Keung K, Luxton G, Yong K, Caldas R, Byun L, Loo C, Tippett J, Caponas G, Moses D, Wan KM, Arulpragasam K, Kiely N, Brännström M, Abbott J. The first Australian uterus transplantation procedure: A result of a long-term Australian-Swedish research collaboration. Aust N Z J Obstet Gynaecol 2023. [PMID: 37029932 DOI: 10.1111/ajo.13678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
AIMS The aim is to report the results of Australia's first uterus transplantation (UTx). METHODS Following long-standing collaboration between the Swedish and Australian teams, Human Research Ethics approval was obtained to perform six UTx procedures in a collaborative multi-site research study (Western Sydney Local District Health 2019/ETH13038), including Royal Hospital for Women, Prince of Wales Hospital, and Westmead Hospital in New Souh Wales. Surgeries were approved in both the live donor (LD) and deceased donor models in collaboration with the inaugural Swedish UTx team. RESULTS This is the first UTx procedure to occur in Australia, involving a mother donating her uterus to her daughter. The total operative time for the donor was 9 h 54 min. Concurrently, recipient surgery was synchronised to minimise graft ischaemic time, and the total operative time for the recipient was 6 h 12 min. Surgery was by laparotomy in the LD and recipient. The total warm ischaemic time of the graft was 1 h 53 min, and the cold ischaemic time was 2 h 17 min (total ischaemic time 4 h 10 min). The patient's first menstruation occurred 33 days after the UTx procedure. CONCLUSION Twenty-five years of Swedish and Australian collaboration has led to Australia's first successfully performed UTx surgery at The Royal Hospital for Women, Sydney, Australia.
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Affiliation(s)
- Rebecca Deans
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Jana Pittman
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Brigitte Gerstl
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Koroush Haghighi
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Henry Pleass
- Department of Gynaecology, Westmead Hospital, New South Wales, Sydney, Australia
- Department of Gynaecology, Sydney University, New South Wales, Sydney, Australia
| | - Pernilla Dahm KÄhler
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg, Sweden
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Niclas Kvarnström
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Wayne Hseih
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Karen Keung
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Grant Luxton
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Kenneth Yong
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - Rita Caldas
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Lily Byun
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Christine Loo
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
- Department of Clinical Pathology, South-Eastern Area Laboratory Services, New South Wales, Sydney, Australia
| | - John Tippett
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - George Caponas
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Daniel Moses
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
- Department of Gynaecology, Prince of Wales Hospital, New South Wales, Sydney, Australia
| | - King-Man Wan
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Kaushalya Arulpragasam
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
| | - Neill Kiely
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
| | - Mats Brännström
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg, Sweden
- The Faculty of Medicine, University of Gothenburg, Sweden, Gothenburg, Sweden
| | - Jason Abbott
- Department of Gynaecology, Royal Hospital for Women, New South Wales, Sydney, Australia
- Department of Gynaecology, University of New South Wales, New South Wales, Sydney, Australia
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Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
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Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
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Herrera Cappelletti E, Humann J, Torrejón R, Gambadauro P. Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis. Hum Reprod Update 2021; 28:282-295. [PMID: 34935045 PMCID: PMC8888991 DOI: 10.1093/humupd/dmab041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Endometrial cancer is common and usually occurs after menopause, but the number of women diagnosed during reproductive age is increasing. The standard treatment including hysterectomy is effective but causes absolute uterine factor infertility. In order to avoid or postpone surgery, conservative management of endometrial cancer (CMEC) has been proposed for younger women who want to retain their fertility. OBJECTIVE AND RATIONALE The main objective of this study was to estimate the chances of pregnancy and live birth for women with early-stage endometrial cancer (EEC) who are managed conservatively for fertility preservation. SEARCH METHODS The PRISMA recommendations for systematic reviews and meta-analyses were followed. Structured searches were performed in PubMed, Embase and the Cochrane Library, from inception until 13 June 2021. Inclusion was based on the following criteria: group or subgroup of women with Clinical Stage IA, well-differentiated, endometrioid endometrial cancer (from now on, EEC); CMEC for fertility preservation; and reported frequencies of women achieving pregnancy and/or live birth after CMEC. The following exclusion criteria applied: impossibility to isolate/extract outcome data of interest; second-line CMEC for persistent/recurrent disease; CMEC in the presence of synchronous tumours; case reports; non-original or duplicated data; and articles not in English. Qualitative synthesis was performed by means of tabulation and narrative review of the study characteristics. Study quality was assessed with an ad hoc instrument and several moderator and sensitivity analyses were performed. OUTCOMES Out of 1275 unique records, 133 were assessed in full-text and 46 studies were included in the review. Data from 861 women with EEC undergoing CMEC were available. Progestin-based treatment was reported in all but three studies (93.5%; 836 women). Complete response to treatment was achieved in 79.7% of women, with 35.3% of them having a disease recurrence during follow-up. Of 286 pregnancies obtained after CMEC; 69.4% led to live birth (9% of them multiple births) and 66.7% were achieved through fertility treatment. Based on random-effects meta-analyses, women treated with progestin-based CMEC have a 26.7% chance of achieving pregnancy (95% CI 21.3-32.3; I2 = 53.7%; 42 studies, 826 women) and a 20.5% chance to achieve a live birth (95% CI 15.7-25.8; I2 = 40.2%; 39 studies, 650 women). Sample size, average age, publication year, study design and quality score were not associated with the outcomes of progestin-based CMEC in moderator analyses with meta-regression. However, mean follow-up length (in months) was positively associated with the chances of pregnancy (regression coefficient [B] = 0.003; 95% CI 0.001-0.005; P = 0.006) and live birth (B = 0.005; 95% CI 0.003-0.007; P < 0.001). In sensitivity analyses, the highest chances of live birth were estimated in subsets of studies including only women of age 35 or younger (30.7%), the combination of progestins with hysteroscopic resection (30.7%), or at least 3 years of follow-up (42.4%). WIDER IMPLICATIONS Progestin-based CMEC is viable for women with well-differentiated, Clinical Stage 1A, endometrioid endometrial cancer who want to preserve their fertility, but there is room for improvement as only one-fifth of them are estimated to achieve live birth according to this meta-analysis. Further investigations on prognosis-driven selection, hysteroscopic resection and long-term surveillance are arguably needed to improve the reproductive outcomes of CMEC.
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Affiliation(s)
- Erica Herrera Cappelletti
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Area of Obstetrics and Gynaecology, University of Cádiz, Cádiz, Spain
| | - Jonas Humann
- Area of Obstetrics and Gynaecology, University of Cádiz, Cádiz, Spain
| | - Rafael Torrejón
- Area of Obstetrics and Gynaecology, University of Cádiz, Cádiz, Spain
| | - Pietro Gambadauro
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Area of Obstetrics and Gynaecology, University of Cádiz, Cádiz, Spain,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden,Res Medica Sweden, Uppsala, Sweden,Correspondence address. E-mail: ; ; https://orcid.org/0000-0003-1568-4575
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Wall AE, Johannesson L, Sok M, Warren AM, Gordon EJ, Testa G. The journey from infertility to uterus transplantation: A qualitative study of the perspectives of participants in the Dallas Uterus Transplant Study. BJOG 2021; 129:1095-1102. [PMID: 34889028 DOI: 10.1111/1471-0528.17052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess how absolute uterine factor infertility affects women who undergo uterus transplantation, how uterus transplantation impacts women with absolute uterine factor infertility and how uterus transplant recipients view uterus transplantation in terms of their reproductive autonomy. DESIGN Qualitative semi-structured interview study. SETTING Uterus transplant programme in a large academic medical centre in the USA. POPULATION/SAMPLE Twenty one uterus transplant recipients. METHODS A medical chart review was conducted to collect patient demographic information and clinical outcomes. Semi-structured interviews collected information regarding participants' experience. MAIN OUTCOME MEASURE(S) The outcomes of interest were participants' experience of infertility, experience with uterus transplantation and general perceptions of uterus transplantation. RESULTS Six participants were pregnant (one with a second child), six had experienced early graft failure and removal, five had delivered a healthy baby, and four had a viable graft and were awaiting embryo transfer. The primary themes identified were: the negative impact of absolute uterine factor infertility diagnosis on psychological wellbeing, relationships and female identity; the positive impact of uterus transplantation on healing the emotional scars of absolute uterine factor infertility, female identity and value of research trial participation and the perception of uterus transplantation as an expansion of reproductive autonomy. All participants reported that uterus transplantation was worthwhile, regardless of individual outcome. CONCLUSION Absolute uterine factor infertility has a negative impact on women from a young age, affects multiple relationships and challenges female identity. Uterus transplantation helps to reverse this impact, transforming women's life narrative of infertility and enhancing female identity. TWEETABLE ABSTRACT Absolute uterine factor infertility (AUFI) adversely affects women. Uterus transplantation helps mitigate the negative impact of AUFI, by transforming women's life narratives of infertility and enhancing female identity.
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Affiliation(s)
- Anji E Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Monica Sok
- Division of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas, USA
| | - Ann Marie Warren
- Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, and Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Castro F, Ejzenberg D, Pinheiro RS, Ducatti L, Arantes RM, Nacif L, Waisberg D, Martino RB, Santos VR, Soares JM, Baracat EC, D'Albuquerque LAC, Andraus W, Canaval H, Canaval G, Rico JM, Vanin A. Uterus procurement from deceased donor for transplantation. Transpl Int 2021; 34:2570-2577. [PMID: 34668605 DOI: 10.1111/tri.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Women with absolute uterine factor infertility cannot get pregnant. The current experience in uterine transplantation is limited and the use of a deceased donor uterus in this area is incipient after some initial unsuccessful attempts. The birth of healthy babies through this modality in four different centers has given a new impetus to the use of this transplantation technique. We aimed to develop a technique for uterus procurement and preparation for transplantation from a brain dead donor. Fifteen uteri were retrieved from multi-organ donor patients, 10 of these were used in bench surgeries with the proposed technique. All procedures were performed after obtaining family's consent. This study allowed the clinical use of two of the 15 organs that were procured for transplantation. One of these organs resulted in the first live birth worldwide using a uterus transplanted from a deceased donor, a landmark in reproductive medicine. Another outcome was the optimization of the surgical technique involving less manipulation of the uterine vascular pedicles. The success of this novel technique suggests that the proposed model can be replicated and optimized further to facilitate the transplantation of uterus from deceased donors.
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Affiliation(s)
- Felipe Castro
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia.,Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
| | - Dani Ejzenberg
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rafael S Pinheiro
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Liliana Ducatti
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rubens M Arantes
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Nacif
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Waisberg
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rodrigo B Martino
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Vinicius R Santos
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose Maria Soares
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wellington Andraus
- Department of Liver and Digestive Tract Organ Transplantation, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Hoover Canaval
- Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia
| | - Gustavo Canaval
- Department of Gynecology and Obstetrics, Clinica Imbanaco, Cali, Colombia
| | - Juan Manuel Rico
- Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
| | - Anabel Vanin
- Department of Liver Transplantation, Clinica Imbanaco, Cali, Colombia
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9
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Georgevsky D, Li Y, Pather S, Tejada-Berges T, Robinson D, Laurence J, Campbell N, Wyburn K, Liyanagama K, Narayan R, Lutz T, Chan A, Heaney SA, Kitzing YX, Anderson L, Testa G, Johannesson L, Marren A. Uterus transplantation and pregnancy induction: Approved protocol at the Royal Prince Alfred Hospital. Aust N Z J Obstet Gynaecol 2021; 61:621-624. [PMID: 33956989 DOI: 10.1111/ajo.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 12/21/2022]
Abstract
Absolute uterine factor infertility (AUFI) is defined as the absence of a uterus or the presence of a non-functional uterus. Before the first live birth from a uterus transplant in 2014, the only fertility options for women with AUFI were surrogacy and adoption. In November 2019, our team was granted approval for the first uterus transplant trial in Australia using known living donors. Our program is based on that of our overseas collaborators in Dallas, Texas; this team will also be proctoring us for our first two cases.
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Affiliation(s)
- Dana Georgevsky
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Ying Li
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Selvan Pather
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Trevor Tejada-Berges
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - David Robinson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Jerome Laurence
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Neil Campbell
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Keith Liyanagama
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rajit Narayan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Agnes Chan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sally-Ann Heaney
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Yu Xuan Kitzing
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lyndal Anderson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre Dallas, Dallas, Texas, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre Dallas, Dallas, Texas, USA
| | - Anthony Marren
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, New South Wales, Australia.,Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
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10
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Chmel R, Nováčková M, Čekal M, Chmel R, Pastor Z. Current ethical aspects of absolute uterine factor infertility treatment using uterus transplantation. Ceska Gynekol 2021; 86:40-45. [PMID: 33752408 DOI: 10.48095/cccg202140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE An analysis of ethical studies related to uterus transplantation in the treatment of absolute uterine factor infertility. METHODS Literary research using the Web of Science, Google Scholar and Pubmed databases with the following keywords: absolute uterine factor infertility, ethics, deceased donor, living donor, and uterus transplantation. An analysis of articles published in impact and reviewed journals between 2000-2021. RESULTS Uterus transplantation is a promising treatment method for women with absolute uterine factor infertility. In the experimental studies, an ultimate goal of this complex treatment was repeatedly achieved: childbirth through a caesarean section. An important milestone towards the application of uterus transplantation in human was the Montreal criteria of its ethical feasibility, published in 2012-2013. In 2012, the first uterus transplant study from a living donor started in Sweden and, in 2016, further studies were initiated worldwide. The first childbirth from the transplanted uterus in 2014 increased the interest of ethicists in various aspects of this experimental treatment, and this trend continues. Current ethical analyzes are focused particularly on the comparison of advantages and disadvantages related to the utilization of living and deceased donors of uterus; comparing ethical aspects of gestational surrogacy and uterus transplantation; uterus transplantation as an extremely radical form of assisted reproduction; its impact on adoptions; uterus transplantation in trans-gender women; the importance of establishing an international registry for uterus transplants; and other important ethical issues associated with this complex form of assisted reproduction. CONCLUSION Uterus transplantation is still in an experimental stage. The ethical analysis of the individual steps of this comprehensive method in the treatment of female infertility should be carried out continuously, in connection with the gradually presented outcomes of ongoing scientific research studies.
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11
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Chmel R, Novackova M, Pastor Z. Lessons learned from the Czech uterus transplant trial related to surgical technique that may affect reproductive success. Aust N Z J Obstet Gynaecol 2020; 60:625-627. [PMID: 32573763 DOI: 10.1111/ajo.13184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022]
Abstract
Uterus transplantation is an experimental method in the treatment of infertility in women with congenital or acquired absence of uterus. The majority of uterus transplants worldwide have been performed in women with Mayer-Rokitansky-Küster-Hauser syndrome, with neovagina and absent uterus. We report two aspects affecting reproductive success related to the surgical technique of transplantation. The first is the stenosis of vaginal-neovaginal anastomosis between the graft's vaginal rim and the recipient's neovagina. The second is a firm fixation of the uterus close to the pubic symphysis. Both these aspects contribute to the technical difficulty of embryo transfer to the transplanted uterus.
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Affiliation(s)
- Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marta Novackova
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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12
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Peters HE, Juffermans LJM, Lambalk CB, Dekker JJML, Fernhout T, Groenman FA, de Groot CJM, Hoksbergen AWJ, Huirne JAF, de Leeuw RA, van Mello NM, Nederhoed JH, Schats R, Verhoeven MO, Hehenkamp WJK. Feasibility study for performing uterus transplantation in the Netherlands. Hum Reprod Open 2020; 2020:hoz032. [PMID: 32128452 PMCID: PMC7048682 DOI: 10.1093/hropen/hoz032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/10/2019] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Is it feasible to perform uterus transplantations (UTx) in a tertiary centre in the Netherlands? SUMMARY ANSWER Considering all ethical principles, surgical risks and financial aspects, we have concluded that at this time, it is not feasible to establish the UTx procedure at our hospital. WHAT IS KNOWN ALREADY UTx is a promising treatment for absolute uterine factor infertility. It is currently being investigated within several clinical trials worldwide and has resulted in the live birth of 19 children so far. Most UTx procedures are performed in women with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a congenital disorder characterized by absence of the uterus. In the Netherlands, the only possible option for these women for having children is adoption or surrogacy. STUDY DESIGN SIZE DURATION We performed a feasibility study to search for ethical, medical and financial support for performing UTx at the Amsterdam UMC, location VUmc. PARTICIPANTS/MATERIALS SETTING METHODS For this feasibility study, we created a special interest group, including gynaecologists, transplant surgeons, researchers and a financial advisor. Also, in collaboration with the patients' association for women with MRKH, a questionnaire study was performed to research the decision-making in possible recipients. In this paper, we present an overview of current practices and literature on UTx and discuss the results of our feasibility study. MAIN RESULTS AND THE ROLE OF CHANCE A high level of interest from the possible recipients became apparent from our questionnaire amongst women with MRKH. The majority (64.8%) positively considered UTx with a live donor, with 69.6% having a potential donor available. However, this 'non-life-saving transplantation' requires careful balancing of risks and benefits. The UTx procedure includes two complex surgeries and unknown consequences for the unborn child. The costs for one UTx are calculated to be around €100 000 and will not be compensated by medical insurance. The Clinical Ethics Committee places great emphasis on the principle of non-maleficence and the 'fair distribution of health services'. LIMITATIONS REASONS FOR CAUTION In the Netherlands, alternatives for having children are available and future collaboration with experienced foreign clinics that offer the procedure is a possibility not yet investigated. WIDER IMPLICATIONS OF THE FINDINGS The final assessment of this feasibility study is that that there are not enough grounds to support this procedure at our hospital at this point in time. We will closely follow the developments and will re-evaluate the feasibility in the future. STUDY FUNDING/COMPETING INTERESTS This feasibility study was funded by the VU Medical Center (Innovation grant 2017). No conflicts of interest have been reported relevant to the subject of all authors. TRIAL REGISTRATION NUMBER n.a.
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Affiliation(s)
- H E Peters
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - L J M Juffermans
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - C B Lambalk
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - J J M L Dekker
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - T Fernhout
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - F A Groenman
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - A W J Hoksbergen
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - J A F Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - R A de Leeuw
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - N M van Mello
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - J H Nederhoed
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - R Schats
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - M O Verhoeven
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - W J K Hehenkamp
- Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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13
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Richards EG, Flyckt R, Tzakis A, Falcone T. Uterus transplantation: organ procurement in a deceased donor model. Fertil Steril 2018; 110:183. [PMID: 29980257 DOI: 10.1016/j.fertnstert.2018.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To demonstrate our technique of uterine procurement from a deceased donor. DESIGN This video uses live action footage from surgery and detailed illustrations to review the steps and techniques involved in deceased donor procurement surgery. SETTING Academic medical center. PATIENT(S) A deceased multiorgan donor. INTERVENTION(S) Trial organ procurement of a viable uterus from a deceased donor. MAIN OUTCOME MEASURE(S) Procurement time and associated features of suitability of dissected specimen. RESULT(S) This video article describes the advantages of a deceased donor model over a live donor model, including eliminating the risk of surgical complications to a living donor, avoidance of ethical issues inherent in live donation, easier access to generous vascular pedicles for anastomosis, and faster procurement time. This video also outlines the key steps to a successful uterine procurement using illustrations and live action footage from a trial organ procurement. CONCLUSION(S) Uterine transplantation is an emerging surgical treatment for patients with absolute uterine factor infertility. Continued practice is essential in preparing for a deceased donor uterine procurement. The process continues to be refined and adapted as new information becomes available toward the goal of safe, efficient, ethical, and effective surgical treatment of absolute uterine factor infertility.
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14
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Matoba Y, Kisu I, Sera A, Yanokura M, Banno K, Aoki D. Current status of uterine regenerative medicine for absolute uterine factor infertility. Biomed Rep 2019; 10:79-86. [PMID: 30675350 PMCID: PMC6341411 DOI: 10.3892/br.2019.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022] Open
Abstract
Though assisted reproduction technology has been developed, a treatment for absolute uterine factor infertility (AUFI), such as defects in the uterus, has not yet been established. Regenerative medicine has been developed and applied clinically over recent years; however, whole solid organs still cannot be produced. Though uterine regeneration has the potential to be a treatment for AUFI, there have been only a few studies on uterine regeneration involving the myometrium in vivo. In the present report, those relevant articles are reviewed. A literature search was conducted in PubMed with a combination of key words, and 10 articles were found, including nine in rat models and one in a mouse model. Of these studies, eight used scaffolds and two were performed without scaffolds. In four of these studies, scaffolds were re-cellularized with various cells. In the remaining four studies, scaffolds were transplanted alone, or other structures were used. Though the methods differed, the injured uterus recovered well, morphologically and functionally, in every study. Only 10 articles were relevant to our investigation, but the results were favorable, if limited to partial regeneration. Recently, uterus transplantation (UTx) has been investigated as a treatment for AUFI. However, UTx has many problems in the medical, ethical and social fields. Though the artificial uterus was also researched and some improvements in this technology were reported, it will take long time for this to reach a clinically applicable stage. Though the results of uterine regeneration studies were promising, these studies were conducted using animal models, so further human studies and trials are needed.
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Affiliation(s)
- Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Asako Sera
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Megumi Yanokura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan
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15
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Chmel R, Pastor Z, Mužík M, Brtnický T, Nováčková M. Syndrome Mayer-Rokitansky-Küster-Hauser - uterine and vaginal agenesis: current knowledge and therapeutic options. Ceska Gynekol 2019; 84:386-392. [PMID: 31826637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Evaluation of existing knowledge of etiopathogenesis, clinical manifestations and treatment options to increase quality of life in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). DESIGN Review article. SETTING Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS Literature search using the Web of Science, Google Scholar and Medline databases with keywords (absolute uterine infertility factor, AUFI, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH, uterine transplantation) and analysis of articles published in impact and reviewed journals. RESULTS MRKH syndrome is defined as congenital agenesis of the upper two-thirds of vagina and uterus in women with normal secondary sexual characteristics and female karyotype (46, XX). The incidence of the syndrome is 1 : 4500 births of female sex children. It is the second most common cause of primary amenorrhea. Recent research has focused on elucidating the genetic origin of the disease, focusing on the research of candidate genes that could be participating in the genesis of Müllerian ducts and their derivatives. CONCLUSION MRKH syndrome now appears as a multifactorial congenital developmental defect based on a combination of genetic predisposition and environmental factors. Modern medicine can help girls with MRKH syndrome to a quality sexual life. It is also able to offer different possibilities of achieving motherhood. In the future, however, further research is needed, in particular on the etiology and pathogenesis of this syndrome to detect a possible genetic basis of the disease.
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16
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O’Donovan L. Pushing the boundaries: Uterine transplantation and the limits of reproductive autonomy. Bioethics 2018; 32:489-498. [PMID: 30318618 PMCID: PMC6221006 DOI: 10.1111/bioe.12531] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 06/08/2023]
Abstract
Over the course of recent years, various scientific advances in the realm of reproduction have changed the reproductive landscape, enhancing women's procreative rights and the choices available to them. Uterus transplants (UTx) are the latest of such medical innovations aimed at restoring fertility in women suffering from absolute uterine factor infertility, providing them with the possibility not only of conceiving a genetically related child but also of gestating their own pregnancies. This paper critically examines the primacy of reproductive liberty in the context of uterus transplantation. It questions whether and to what extent we should respect the reproductive autonomy of a woman who chooses UTx, given the significant risks that attach to the procedure and existing concerns that UTx may perpetuate potentially troubling gendered norms surrounding pregnancy and the role of women's bodies in reproduction, which may place undue reproductive pressures on women.
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Chmel R, Nováčková M, Pastor Z, Matěcha J, Čekal M, Froněk J. [Ethical aspects of uterus transplantation]. Cas Lek Cesk 2017; 156:36-42. [PMID: 28264580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Uterus transplantation is an experimental treatment method with an ambition to become accepted treatment modality for women with absolute uterine factor infertility. The only legal alternative for these women to get parenthood is adoption which is accepted by most world societies and countries. Surrogate pregnancy is connected with many medical, ethical, legal, religious and social controversies in the great part of the world.Donors (in living donation), recipients, partners and also unborn children must be incorporated into the analysis of ethical risks and benefits of uterus transplantation. The main ethical risks for the recipient are surgery, immunosuppression, pregnancy and delivery. All the potential recipients have to be advised about further ethical issues like organ rejection, infection, side effects of the drugs, unsatisfactory fertilization and different complications during pregnancy.Uterus procurement in donor takes longer time than in standard hysterectomy due to preparation of uterine arteries and veins. Vessels with 2 mm diameter and their anatomical collision with ureter are connected with higher peroperative risk of uneventful surgical complications. Ethical issues might be connected with the uterus procurement in dead brain donors identically.The deliveries after uterus transplantation are fruitful but the risk of preterm delivery and immaturity of the newborns cannot be underestimated as well.
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