One uterus bridging three generations: first live birth after mother-to-daughter uterus transplantation

We discuss how a uterus from the mother of a woman with absolute uterine factor infertility can be transplanted to daughter and carry a pregnancy with delivery of a healthy child.

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Volume 106, Issue 2, Pages 261-266

Authors:

Mats Brännström, M.D., Ph.D., Hans Bokström, M.D., Ph.D., Pernilla Dahm-Kähler, M.D., Ph.D., Cesar Diaz-Garcia, M.D., Ph.D., Jana Ekberg, M.D., Ph.D., Anders Enskog, M.D., Ph.D., Henrik Hagberg, M.D., Ph.D., Liza Johannesson, M.D., Ph.D., Niclas Kvarnström, M.D., Johan Mölne, M.D., Ph.D., Michael Olausson, M.D., Ph.D., Jan I. Olofsson, M.D., Ph.D., Kenny Rodriguez-Wallberg, M.D., Ph.D.

Abstract:

Objective

To determine whether a uterus from the mother of a woman with absolute uterine factor infertility can be transplanted to daughter and carry a pregnancy with delivery of a healthy child.

Design

Part of an observational study.

Setting

University teaching hospital.

Patient(s)

Twenty eight-year-old woman with uterine agenesis, her male partner, and her 50-year-old mother.

Intervention(s)

In vitro fertilization with embryo cryopreservation before live donor uterus transplantation (UTx). Induction immunosuppression. Embryo transfer 12 months after UTx, pregnancy controls, delivery, and hysterectomy.

Main Outcome Measure(s)

Results of IVF-ET, parameters of pregnancy/birth, and surgical data of transplantation/cesarean section/hysterectomy.

Result(s)

Two IVF cycles before UTx resulted in 10 cryopreserved embryos. Donor surgery included hysterectomy with vascular pedicles of uterine vessels and proximal vessels up to and including parts of internal iliacs. Recipient surgery was by bilateral vascular connections to external iliacs, vaginal–vaginal anastomosis, and uterine fixation. Pregnancy occurred at the first single ET, and the pregnancy proceeded uneventfully until gestational week 34, when the patient developed cholestasis with intense pruritus. Cesarean section was performed at 34+6, with delivery of a healthy boy (weight 2,335 g). Hysterectomy was performed 3.5 months after delivery. The weight of the healthy child at 12 months was 9.3 kg. Grandmother (uterus donor) and mother are in good health 3 years after UTx.

Conclusion(s)

This is the first report of a live birth after mother-to-daughter UTx, and it also represents the second birth ever after human UTx.

Clinical Trial Registration

NCT01844362.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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