The stage has been set to carry out uterine transplants in India and Pune’s Galaxy Care Laparoscopy Institute (GCLI) is likely to be the first hospital in the country to conduct this groundbreaking medical procedure.
Richa is one of the three patients on whom uterine transplants will be carried out. This childless woman, who never got menstrual cycle, underwent various medical tests including Sonography and came to know about the absence of uterus in her body. Richa’s mother Santosh, who could not see her loneliness without a baby, has agreed to donate her uterus to her daughter. After the successful transplantation by the team of doctors, Richa will become India’s first uterine transplant recipient, providing her baby with a womb which once home to her for nine months.
“Another one suffers from scarring (adhesions) of the uterus (Asherman’s syndrome) and the other woman’s uterus was removed due to cancer three years ago. The donors are their own mothers and the first transplants are going to be conducted for free,” said DrShailesh Puntambekar, Medical Director, Galaxy Care Laparoscopy Institute, Pune.
The transplant costs around `7-8 lakh, but the hospital will do it for free. Richa will go under the knife for womb transplantation on May 14 at the institute, which is the first to get the permission from the government of Maharashtra for the surgery.
According to Dr Shailesh, the procedure can be done laparoscopically in just two hours. “We are the first to get the permission from the government of Maharashtra based on our efforts, infrastructure and the expertise in this field. Based on our experience, we decided to embark on this surgery. We all practised first on human cadavers in Tubingen, Germany, and also in the US. Later we visited the team who is credited to have done the first transplant and spend few days in learning the actual protocol and the surgery,” laparoscopically said Puntambekar.
The uniqueness of the surgery is that team of doctors will be retrieving the uterus laparoscopically Most of the childless couples try for the IVF, adoption or surrogacy, but the transplant gives the mother legal, biological and also gestational motherhood which gives the maximum satisfaction. The procedure includes immune suppression.
“Though the patient is going to be on immune suppression, these are healthy patients and will tolerate that. The immune suppression does not cause any side effects on the baby is a long term data in patients of kidney transplants who already had pregnancies following transplant and still did not have any teratogenic effect,” said Dr Puntambekar. “We have planned few cases of uterus transplantation in May, which will give new hope to the childless couples in India”, he said. “If this surgery gets successful then it would be India’s first and that too in Pune. The facilities were inspected by the team of government appointed team and the hospital was granted permission to conduct uterine transplant. The license has been granted for a period of five years.”
The research on uterus transplant was first started on animal transplant programme in Sweden. This programme included transplanting the uterus in pigs. After success of these transplants it was decided to consider human uterine transplants.
The first uterine transplant was performed in Saudi Arabia and in Turkey in 2011 but uterus was retrieved from cadaver donor which got unsuccessful after organ rejections. The first successful transplant was done in Sweden by Mats Brannstron in Sahlgrenska University, Gothenburg.
Since then 11 transplants have been done with 7 of them being successful pregnancies in Swedish trial. The first human live birth was reported in 2014 and the recipient was delivered by C-section at 31 weeks five days due to preeclampsia.
Uterus transplantation includes various stages before surgery takes place. The donor and recipient have to undergo for various screening procedures. If both clears the screening procedure then in vitro fertilization process gets started, after this surgical procedure gets started by the team of doctors and after which transplantation takes place.
The woman who is recipient has to undergo for three major surgeries. She has to undergo for the transplantation surgery, she can’t deliver baby normal and has to go for C-section only.
In India infertility has become major issue which is between 3.9-16.8 per cent. Among the various reasons for infertility uterine factor is the cause in 20 per cent of cases. The uterine factor can be due to congenital absence of uterus which is prevalence 1 in 4500, but this number could be high because most of the cases are not reported. A uterine malformation, Genital Tuberculosis is 18 per cent, Ashermann’s syndrome, patients with surgical removal of uterus for cancers and who is long- term survivors.
“The natural process of contraction and relaxation can’t happen without the nerves, which cannot be transplanted with the uterus. So, the baby will have to be delivered through a Caesarean,” said Dr Puntambekar.
The two types of donors are used for the transplant cadaveric and live donor. Uterus transplant has shown hope to the couples who cannot even go for the surrogacy according to the upcoming new guidelines of the government.
“If the surgery gets successful then it would be a major breakthrough and hope for the childless couples in India,” said Dr Sheetal Aggarwal, Senior Gynaecologist and Obstetrician.