It was announced last week that the UK Womb Transplant team are ready to perform the UK's first series of womb transplants. Ethical approval has recently been granted for a clinical trial, which will see 10 women who do not have a viable womb, undergo a womb transplant operation. This will offer them the unique chance of carrying their own child.
The team is lead by Mr Richard Smith, consultant Gynaecological Surgeon at Queen Charlotte's Hospital, London, and head of UK Womb Transplant who has been pioneering research in this area for almost two decades. He has worked closely with the Swedish team who have already performed 9 uterine transplants and had a successful pregnancy. He said "This operation is clearly a viable option for those women who otherwise have absolutely no chance of carrying their own baby, which is the case for around 50,000 women in the UK."
The concept of womb transplantation is not new, originally put forward in the 1960s as a possible cure for infertility. The success of IVF treatment in the 1970s, however, saw the idea of womb transplantation disappear, and the field move in the direction of life-saving surgery, such as lung, heart and kidney transplantation. The prospect of womb transplantation later re-emerged, following the advent of fertility-sparing surgeries for gynaecological cancers and the success of ovarian transplantation. Eventually in 2000 a team in Saudi Arabia performed the first womb transplantation, though it failed after 99 days. This attempt came on the back of minimal background research and work mainly by the Swedish and UK teams over the past 12 years has looked at causes of failure, and ways to improve the chances of future success in the field.
Dr Srdjan Saso, principle investigator of the human trial which will be based at Imperial College London and The Lister Hospital has invested several years of his research career working with UK Womb Transplant and wrote his PhD on fertility preservation and womb transplantation. He said "Ninety-five percent of the literature in this field comes from our group and the Swedish team, with whom we work closely and who have paved the way forward with the first ever pregnancy following a womb transplant. Our research has focused on the immunological, surgical, obstetrics and fertility aspects that are required to ensure the venture is a success. We aim to perform five transplants in 2016 and a further five in 2017. Each woman will be a monitored for at least 12 months before an embryo transfer is performed, and thus we would expect to see the first baby born to our cohort towards the end of 2017. Unlike the Swedish team we will use wombs donated by deceased donors, which removes the risk of potential complication to the donor. We still have a great deal of money to raise (about £450,000) but that will not stop us from going ahead with the planning, preparation and recruitment" I asked Dr Saso how he would respond to those who are skeptical about the need for the procedure and research in this area. He responded "There is a question that needs answering: "Is uterine (womb) transplantation a safe and viable option for women do not have a viable uterus"?? At present, the two options are adoption or surrogacy. Surrogacy in particular, brings it own legal and ethical dilemmas, and as such only 167 children were born through surrogacy in the UK in 2013. We hope to offer these women a third option, and given the number of couples who have contacted our team already, we know this is an acceptable concept for patients.
These women have a medical condition, which prevents them from bearing children, and although the transplantation is not life-saving, one cannot underestimate the positive impact this may have on their lives. Infertility has a significant psychological impact, which is often unspoken and underappreciated, with 50% of women describing it as 'the most upsetting experience of their lives' and 17% suffering a depressive episode. Furthermore, our research has had many spin-offs which will improve techniques in fertility-preserving surgery for cancer. For example, surgical treatment of early stage cervical cancers and placental site trophoblastic tumours, rare types of ectopic pregnancies, as well as novel engineering techniques looking at womb perfusion that can be extrapolated to other fields within gynaecology and beyond."
Eppur si muove... And so despite the cash-strapped field of UK academia, British scientists continue to produce cutting edge research and move the boundaries and what was once deemed pure science fiction, with an aim to offer couples a choice they never thought possible.