A team of doctors in Pune Galaxy Care Laparoscopy Institute recently conducted a successful India’s first uterine transplants on a 21-year-old woman from Solapur and a 24-year-old woman from Baroda. In both cases, uterus had been fitted from their mothers. While the 21-year-old woman was suffering from congenital absence of uterus by birth, the 24-year-old patient from Baroda was suffering from Asherman’s syndrome (scarring of the uterus) and her uterus had been non-functional for the last two and a half years.
The 24-year-old woman, who was the second case of uterus transplant, was married for six years. She had lost her two babies after full term pregnancies and had two abortions also. The Asherman’s can have serious consequences in fertility. In some cases, the scarring can be so extensive that women, on one hand, are unable to conceive and they also can’t have fertility treatments like IVF or IUI because the lining of their uterus is too damaged. In such cases, the option left was only surrogacy and adoption.
“Asherman’s Syndrome is a syndrome which takes place due to vigorous curettage for abortion. The walls of uterus become adherent to each other leading to absence of menses”, said Dr Sheetal Agarwal, Senior Gynecologist and Obstetricians.
“The procedure was complicated as it involved removal of four arteries and veins including two uterine arteries and two ovarian arteries and the corresponding veins. The size of these vessels is very small as compared to kidney or heart or liver which are the routinely transplanted organs. Since it was the mother donating, one has to be extra careful,” said Dr Shailesh Puntambekar, Director of Galaxy Care Hospital, Pune. “We have done both transplants with the help of minimal access laparoscopic surgery, which is the first-of-its-kind in the world.”
The uterus was first removed from the mother and then brought on the bed of ice and all the blood was washed from inside with a special solution. Then the uterus was cooled using crushed ice. The whole process is called the table surgery. The time taken was 45 minutes in the first patient and 32 minutes in the second one. The time allowed is one hour for this particular procedure. The uterus was then fitted in the recipient and all the blood vessels were joined by the cardiothoracic surgeon and also by a vascular surgeon the time taken was 1.50 hours in each surgery.
“The time taken for retrieval of the uterus was about 4.5 hours in the first patient and 3.15hours in the second patient , 80 per cent of the surgery was done laparoscopically that is through the keyhole .The only in the last part a small incision was taken to take out the uterus so that the blood vessels supplying should not get damaged,” Said Dr Puntambekar.
At present, both mothers and patients are doing well. The patients were scheduled to stay in the ICU for 7 days and later in the hospital for 22 days.They are being monitored daily with the blood reports and Doopler Study to see the blood flow to the transplanted uterus. After the transplants, patients from other countries are also raising queries. “I am getting lot of queries from countries like Afghanistan and Iraq for uterus transplants. But uterus transplant still is a long journey. If it gets successful in India then it will be a revolution in itself.” said Dr Sheetal.
The current statistics shows one in 5,000 females is born without a uterus. While most patients interested in transplant procedures are those who have had to go undergo hysterectomy due to cancer or other medical conditions. A woman, who undergoes uterus transplant, will not be able to conceive naturally. She has to undergo for the IVF (in vitro fertilization) procedure. The risk factor involved in such procedures is organ rejection when body rejected donated organ. Once the transplant takes place, the recipient has to be put on immunosuppressant drugs to ensure that the body doesn’t reject the uterus. After these transplants the major concern remains is the side effects of immunosuppressant which has now reduced.
The first successful uterus transplant was done in Sweden. There has been 11 unsuccessful attempts have been made by the doctors worldwide and only 6 attempts were reported successful.