Friday, July 5, 2019

A womb of mother and daughter

Bringing a child to life through the womb of his mother is the unique experience that two young Swedish women are about to experience. Aged about thirty years, they want to become a mother but can not because they have no uterus. One had her uterus removed because she had cancer of the cervix, and the other was born without a uterus, a victim of a rare disease called Rokitanski's syndrome.
 For them, all the advances in medically assisted procreation have not changed anything in their lives. The only way out of being a mother was adoption.
Researchers from the University of Gothenburg have just given them hope to one day bring their child. Indeed, these two young people have just undergone a uterine transplant. And for the first time in the world, the donor is the mother of the recipient! This feat is the culmination of more than ten years of research. And no less than ten surgeons - who have been training for several years - practiced this procedure.

How was the transplant done? 
The Swedish doctors first of all paid particular attention to the choice of the donor-recipient couple. They evaluated the mother's uterus to see if she could accommodate an embryo and promote its development. The quality of the links between mother and daughter has also been studied. Then, in vitro fertilizations were performed, and the embryos were frozen. All that remained was to take the mother's uterus and implant it in the girl's room.
A few days after the transplant, it is therefore too early to talk about success. In 2002, a woman had been operated in Saudi Arabia. Three months after the operation, the graft was rejected. So it will take another year before we can implant the embryos in the two young Swedish transplant patients and a few months before we can say that the pregnancy is a success. One of the issues is the impact on the fetus of immunosuppressive therapy, which is inherent in any transplant. Moreover, to expose the recipient as little as possible to the side effects of these treatments, the uterus will be removed as soon as the woman has been able to give birth to one or two children, according to the wishes of the couple.

Is such an intervention possible? For the moment, we are at the research stage. Experiments were conducted in the sheep by the team of the CHU Limoges, to assess the feasibility of uterine removal. But already, Pascal Pivert does not quite agree with his Swedish colleagues who have used live donors.
Using samples from deceased donors is therefore the preferred route for the French. It remains to be seen if after having taken a heart, a liver and then kidneys, it is technically possible to also take a uterus
 
The question is central because the ethical debate is not quite the same when it comes to living or deceased donors. The use of a living donor for a kidney or liver transplant seems more acceptable since the life of the recipient is at stake. Of course, for women without a uterus, the work of Swedish doctors is a real hope. In France, one in 4500 girls is affected by Rokitanski's syndrome, and is born in the world without a uterus. As for hysterectomies, there are about 70,000 per year, but the majority concern women who are no longer of childbearing age. 

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