August 23, 2023

expert reaction to first womb transplant performed in the UK

A case study published in BJOG looks at a living donor uterus transplant in the UK.

Mr Stuart Lavery, Consultant in Reproductive Medicine/Honorary Associate Professor, University College London Hospitals NHS Foundation Trust (UCLH), said:

“This news represents a significant surgical milestone in British reproductive medicine, and offers patients with absolute infertility (those born without a uterus) the chance of carrying their own baby. Up till now their only option of becoming biological parents would have been through the use of surrogacy- a technique that can be challenging and not acceptable to many. Richard Smith and his team should be congratulated for their dedication, expertise and perseverance over many years. The courage and sacrifice of this first recipient patient and her donor sister should also remind us of the strong and powerful desire that many women have to be pregnant and carry their own child. It is also reassuring to know that the technique was performed under the strong ethical and regulatory guidance of the UK Human Tissue Authority.”

Prof Ying Cheong, Professor of Reproductive Medicine and Honorary Consultant in Reproductive Medicine and Surgery, University of Southampton, said:

“This case report presents the first case of a successful uterine transplantation, from a living donor (patient’s sister) and the patient has resumed her periods for 3 cycles with no complications thus far. It does not report any pregnancy or pregnancy outcome.

“Uterine transplantation is a great surgical transplant advancement, although the patient journey for transplantation and also the surgical journey is still filled with challenges.

“Uterine transplantation has been reported elsewhere in over 90 cases internationally, so the surgery is technically feasible. And there has been livebirths.

“In women who cannot access uterine transplantation, surrogacy would be the alternative – but this treatment is not currently funded by the NHS and surrogacy treatment is extremely expensive.”

Dr Meenakshi Choudhary, Consultant in Reproductive Medicine and Gynaecology, Newcastle upon Tyne Hospitals NHS Foundation Trust, said:

“Exciting news of the first successful womb transplant in the UK! This medical milestone offers hope not only to young girls born without a womb but also to a broader range of individuals facing reproductive challenges following removal of uterus for various indications such as cancer. The implications are immense, giving them the possibility to experience the joys of pregnancy and motherhood. A remarkable stride forward in medical science and gender inclusivity.

“This groundbreaking womb transplant achievement, though in its infancy, may also offer a beacon of hope for transgender individuals as well, illustrating the evolving landscape of reproductive possibilities. This medical advancement opens up new avenues for those seeking a more complete and authentic experience in aligning their physical and emotional selves. A step toward greater inclusivity in healthcare.”

Prof Adam Balen, Professor of Reproductive Medicine and Surgery, Leeds Teaching Hospitals NHS Trust, said:

“This is an excellent and highly significant achievement, being the first uterine transplant to be performed in the UK and I congratulate the Oxford/London team. There have been many successful transplants performed around the world now and this brings hope for women born without a uterus for whom conceiving a baby through IVF surrogacy may not be an option. The surgery is highly complex for both donor and recipient and requires the need for the use of anti-rejection drugs taken by the recipient for the duration of the transplant. Pregnancies are usually then achieved through the transfer of embryos created by IVF, delivery would need to be by caesarean section and the transplanted uterus is usually removed after the family is complete to avoid the prolonged use of anti-rejection medication. In some countries surrogacy is either illegal or not acceptable on religious grounds, hence the development of uterus transplantation. Whereas in the UK surrogacy is legal and works very well for many people who may require it for a variety of reasons, including the absence of a uterus.”

Prof Andrew Shennan, Professor of Obstetrics, King’s College London (KCL), said:

“This is the first report of a womb transplant in the UK. The procedure has been performed in many women around the world and a few dozen babies successfully delivered. About 1 in 500 women are unable to have pregnancies due to an abnormal or absent uterus. The procedure is an alternative to surrogacy (another woman will carry the pregnancy) or adoption.  These pregnancies need very specialist care, require drugs for immunosuppression and Caesarean section, but it allows a woman to give birth to her own genetic baby.”

‘Living donor uterus transplant in the UK: A case report’ by Benjamin P. Jones et al. was published in BJOG at 00:01 UK time Wednesday 23 August 2023.

DOI: 10.1111/1471-0528.17639

Declared interests

Mr Stuart Lavery: No coi.

Prof Ying Cheong: Prof Cheong is the Medical Director of Complete Fertility.

Dr Meenakshi Choudhary: Secretary on the Executive Committee of British Society of Paediatric & Adolescent Gynaecology, BritSPAG

Prof Andrew Shennan: “No conflicts.”

Prof Adam Balen: “No CoI.”