A uterine transplant is the transplantation of a uterus in order to replace one which has undergone necrosis or in Müllerian agenesis. Though the procedure has significant potential, it has been performed only a few times.
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In 1896, Knauer published the first study of ovarian transplantation and that lead to the investigation of uterine autotransplantation in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform an animal autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus (Erslan et al. 1966). With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred (Confino et al. 1986).
In Saudi Arabia in 2000, a uterine transplant was performed on a patient[1] whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days, however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful.[2] In 1931, Lili Elbe died from organ rejection three months after receiving one of the world's earliest uterine transplants.[3]
In 2000, a human uterine transplant was performed in Saudi Arabia by Dr. Wafa Fagee. Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns.
The latest can be found in the March-April 2011 issue of the "Journal of Minimally Invasive Gynecology".[4]
In this article, Edwin Ramirez M.D, his father Dr. Hugo A. Ramirez,(Pioneer), sister Doris Ramirez Nessetti M,D, Matthew Nessetti M.D, Masood Khatamee M.D, Marla R Wolfson MS, PhD, Thomas H Shaffer MSE, PhD and Viviana Zuluaga Ramirez DVM, demonstrated that a pregnancy can be carried for the First time in History in a transplanted uterus under the influence of immunosuppressive therapy in the sheep model. The Ramirez project initially started eleven years ago as a family project at UT Odessa, Tx and ended in Bogota, Colombia at the La Salle University.
Derya Sert, who was born without a uterus, has become the first woman in the world to receive a womb from a deceased donor. The operation, performed on 9th August 2011 by doctors from Akdeniz University Hospital in southern Turkey, has been a success. However, the Turkish team is still cautious about declaring the operation a complete success. “The surgery was a success… But we will be successful when she has her baby,” Ozkan said. “For now, we are happy that the tissue is living.”[5][6]
Uterus transplantation starts with uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates.[7] It may need to be stored for e.g. transportation to the location of the donor. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h.[7] The following insertion procedure, with vascular anastomosis, has not been fully developed in animal models, indicated by frequent thrombosis formation.[7]
It may be possible for trans women to receive uteruses, which would effectively represent a step closer to a true sex change in humans. Some concerns regarding genetics, anatomy and hormones addressed below:
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