very modern medicine

Everything We Know About the Country’s First Uterus Transplant

Photo: Jetta Productions/Getty Images

On February 24, surgeons at the Cleveland Clinic performed the first uterus transplant in the United States, a procedure they hope will allow a 26-year-old woman without a functioning uterus to give birth via cesarean section. Doctors in Sweden have already done this surgery nine times, but those transplants involved living donors — and in five cases, the donor was the recipient’s mother. For this clinical trial, the uteruses will come from deceased organ donors of childbearing age.

The notion of carrying your child inside the womb of a dead woman implanted in your body is enough to make your head spin. Why would someone go through all of this when adoption and surrogacy exist? This morning, the Cleveland Clinic team held a press conference to explain more details about the procedure. Here’s what we know.

Who is eligible?
Cisgender women ages 21 to 39 with uterine factor infertility (UFI), meaning those who don’t have a uterus because they’ve had a hysterectomy or were born without one, or women who have a uterine abnormality that would make carrying a pregnancy difficult. They need to have functioning ovaries (more on that later). Experts estimate that 50,000 women in the U.S. might be candidates.

What’s the process like?
The Cleveland Clinic screens candidates to see if they are in a stable relationship, could cope with a recovery process that includes taking anti-rejection drugs, and would be willing to relocate to Cleveland temporarily. Then, a candidate would undergo in vitro fertilization to collect ten eggs and have them fertilized with their partner’s sperm and frozen. Once a woman has banked six to ten mature-stage embryos called blastocysts, she’d be put on the transplant list.

What about the donors?
Pre-menopausal women who are organ donors and have matching blood and tissue types would be considered matches, but doctors would obtain explicit permission from the donor’s family to use the uterus. Doctors would examine the uterus to make sure it’s viable and then they have six to eight hours to do the transplant, hence women needing to live in the area.

Why aren’t they living donors like in Sweden?
Some of those women had complications, so the Cleveland Clinic team considers the surgery to be an unnecessary risk to an otherwise healthy person. But they are looking into making the procedure safer for a living donor.

What exactly happens during the surgery?
Doctors put the uterus, cervix, and the uppermost part of the vagina into the recipient’s pelvis and connect the blood vessels, then the vaginal canals. Remnant fallopian tubes are not connected, which is why IVF is needed. Sex won’t result in pregnancy.

When could women start implanting embryos?
Uterus recipients will need to wait a full year before trying to get pregnant, (a) so they can heal from the invasive surgery and (b) so that doctors can find the lowest effective dose of anti-rejection drugs, which weaken the immune system. (The drugs are considered safe to take during pregnancy because women with donated livers or kidneys have given birth to healthy babies.) Embryos will be implanted one at a time until one results in pregnancy. Patients would have a monthly cervical biopsy to rule out organ rejection and will be closely monitored since the pregnancy is considered high-risk. Doctors hope to wait until 37 weeks to have the C-section.

Why does it have to be a C-section?
The team doesn’t know if a transplanted uterus would respond to the normal signals of labor, or if it could handle vaginal delivery. Women in the study can have one or two babies via C-section (at least 1.5 years apart) and after that the uterus will be removed so they can stop taking the anti-rejection drugs.

This sounds rough. Who would want to do it?
Although adoption and surrogacy are options for couples facing infertility, Cleveland Clinic bioethicist Ruth Farrell, M.D., explained that “these options are not available to all women and families because of legal, cultural, religious, and other very personal reasons.” If successful, Dr. Farrell says uterine transplants would also allow women to make decisions about the health and well-being of the pregnancy, which isn’t possible with adoption and surrogacy.

Is this going to be a common thing now?
The hospital’s ethics panel says it can try the surgery ten times and then decide whether to offer it as a standard procedure. The second patient has embryos frozen and is awaiting a donor. If the study is successful it might be an option but, again, with 50,000 estimated candidates it wouldn’t be all that common.

Can transgender women have this surgery?
In theory it would work, but they would first need to have surgery to create a vagina and reconstruct the pelvic area, then wait a year to recover before having a uterus transplant. The Cleveland Clinic team isn’t including trans women in this first-of-its-kind study.

Who is the first recipient?
A 26-year-old woman named Lindsey was at the press conference with her husband, Blake. She was born without a uterus and is the mother to three adopted boys. The couple wanted to share their story but they also asked for privacy.

Lindsey read a prepared statement:

“First and foremost, I would like to take a moment to express the immense gratitude I feel toward my donor’s family. They have provided me with a gift that I will never be able to repay and I am beyond thankful for them. However, the reason I chose to speak today is that I want to be open and honest and to share my story. That being, when I was 16 I was told I would never have children. From that moment on I have prayed that God would allow me the opportunity to experience pregnancy, and here we are today at the beginning of that journey. I am so thankful to this amazing team of doctors and all of the nurses and staff who have worked around the clock to ensure my safety. And I feel like I’ve found a new family in all of them. I am a mother already to three beautiful little boys that Blake and I have adopted through the foster-care system. Because of that, I would ask that you would all please our respect our privacy and we will give updates as we can. Thank you so much.”

What We Know About the First Uterus Transplant