Throughout her early childhood Sara Ottosson appeared perfectly healthy. It was only when she reached her teenage years and failed to menstruate that they suspected something was wrong. It turned out that Sara had a disease called Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome: even though she looked perfectly normal, her reproductive organs had failed to develop. She was born without a uterus. The cause of MRKH syndrome is not known, although it is suspected to result from a combination of genetic and environmental factors. It affects approximately 1 in 4,500 newborn girls worldwide.
Led by Dr. Mats Brännström, a team of surgeons at the University of Gothenburg in Sweden are giving Sara, now 25-years old, hope that she may one day fulfill her dream of giving birth to a baby. The uterus will come from a very special donor: Eva Ottosson, Sara’s mother. Sara’s operation will mark only the second time transplantation of a uterus has been attempted in humans, and the first time between a mother and daughter.
The only previous attempt was performed in 2002 by surgeons in Saudi Arabia. The uterus from a 46-year-old woman was transplanted into a 26-year-old woman after the younger woman hemorrhaged following childbirth. She still wished to have another baby. The transplanted uterus stayed healthy for a while, but eventually developed blood clots that cut off blood flow to the uterus. It was removed after 99 days. The transplanted uterus was meant to be temporary, to be removed following childbirth. Immunosuppressant drugs that the 26-year-old had to take to prevent rejection of the donated uterus could cause serious side effects.
Following the initial operation, experts in the field asked if it was ethical to subject a patient to the risks of a transplant if the organ is not lifesaving. Members of the country’s medical community commented that uterus transplants would be particularly useful in Saudi and other Muslim countries where using surrogate mothers is prohibited by Islamic law.
So too in Sweden are surrogate mothers illegal. And as far as Sara is concerned, the chance to give birth to a child is worth the risk of the operation. Speaking with The Telegraph, she said, “It would mean the world to me for this to work and to have children. At the moment I am trying not to get my hopes up so that I am not disappointed. But we have also been thinking about adoption for a long time and if the transplant fails then we will try to adopt.” Eva talks about giving her daughter the chance at motherhood in the following video.
When confronted with the inevitable question of what it will be like to recieve the same womb from which she was born, the 25-year-old invokes austere scientific logic: “I haven’t really thought about that. I’m a biology teacher and it’s just an organ like any other organ,” she told The Telegraph. “But my mum did ask me about this. She said ‘isn’t it weird?’ And my answer is no. I’m more worried that my mum is going to have a big operation.”
Both Sara and her mom have reason to worry.
According to Dr. Brännström, transplanting a uterus is more difficult than transplanting a kidney or liver–it’s even more difficult than transplanting a heart. The uterus needs more blood than those other organs to function. Thus, the amount of blood vessels that need to be connected to the uterus is greater. Dr. Brännström also cites the uterus’s inconvenient anatomical location. He likens working deep within the pelvis to “working in a funnel.”
Even more worrisome than making sure all the blood vessels are in place and working, the unprecedented nature of human uterus transplants means a standard immunological strategy has not been worked out. As with all transplant operations, a major risk is that the host’s immune system will reject the donor organ. To minimize rejection, hosts are routinely given immunosuppresive drugs. But, as Brännström and colleagues reported in a recent paper, human data is extremely limited: “A handful of studies on immunosuppression to prevent rejection after uterus transplantation have been published. However, no treatment protocol, successful in terms of long-term survival and functionality of the graft, has been presented. It is obvious that detailed studies addressing this issue and high success rates are needed before another human uterus transplantation attempt.”
The paper was published in November of 2009. I’m rather skeptical that a whole lot of “detailed studies” with “high success rates” have been reported since its publication.
But the uterus becomes a whole new bag of marbles once it’s pregnant. During pregnancy, the uterus activates a physiological program that makes it more tolerated by the host. This is where Sara’s boyfriend comes in.
As soon as the new uterus has healed, the doctors are going to take sperm from Sara’s boyfriend and try to impregnate her with it. The sooner she gets pregnant, the better chance she has of avoiding complications due to rejection.
Dr. Brännström and his colleages–as well as Sara and Eva Ottosson–stand at a precipice that is half a century in the making. In the time since the initial experiments began in the sixties, researchers have successfully transplanted wombs among rats, mice, dogs, pigs, sheep, rabbits, non-human primates, and–for 99 days–between two humans. So many unknowns will follow Sara and her mother into the operating room when they undergo the surgeries next year. So much trust will they be putting into science and into the hands of their surgeons. For their sake, and for the sake of all women hoping to undergo the same procedure, I hope that trust is well-placed.