How many of you know about Uterus Transplantation?

Recently, the United Kingdom's first uterus transplant was conducted, providing new hope for women facing reproductive challenges. 

• India is one of a few countries to have had a successful uterine transplant; others include Turkey, Sweden, and the U.S. 
• Doctors now aim to reduce the surgery cost, currently at Rs 15 to 17 lakh in India, and develop a bioengineered artificial uterus to simplify transplants and eliminate live donors for ethical organ transplantation. 

What is a Uterus Transplant? 

• About:
  • Unlike heart or liver transplants, uterus transplants aren’t life-saving transplants. Instead, they are more like limb or skin transplants – which improve the quality of individuals’ lives. 
  • Uterus transplants can help women who lack a uterus fulfill their reproductive needs. 
  • The first live birth after a uterus transplant occurred in Sweden in 2014, marking a breakthrough in treating uterine factor infertility. 
• Steps Involved in a Uterus Transplant:
  • The recipient undergoes thorough physical and mental health evaluations before the transplant.  
  • The donor's uterus, whether from a live or deceased donor, is rigorously examined for viability. 
    • Live donors undergo various tests, including gynecological examinations and cancer screenings. 
  • The procedure doesn’t connect the uterus to the fallopian tubes, which ensures the ovum from the ovaries moves to the uterus – so the individual can’t become pregnant through natural means. 
    • Instead, doctors remove the recipient’s ova, create embryos using in vitro fertilization, and freeze them embryos (cryopreservation). 
      • Once the newly transplanted uterus is ‘ready’, the doctors implant the embryos in the uterus. 
  • Robot-assisted laparoscopy is used to precisely remove the donor's uterus, making the process less invasive. 
  • After the transplantation procedure, the vital uterine vasculature (the network of vessels connecting the heart to other organs and tissues in the body) and other important linkages are methodically re-established. 
• Post-Transplant Pregnancy:
  • Success is determined in three stages:
    • Monitoring graft viability in the first three months. 
    • Assessing uterus function between six months to one year. 
    • Attempting pregnancy with in vitro fertilization, but with higher risks like rejection or complications. 
    • The final stage of success is a successful childbirth. 
  • Frequent check-ups are essential due to potential risks like rejection, abortion, low birth weight, and premature birth. 
• Considerations and Side Effects:
  • Immunosuppressant drugs are necessary to prevent rejection, but may cause side effects. 
  • Side effects include kidney and bone marrow toxicity and an increased risk of diabetes and cancer. 
  • For these concerns, the uterus must be removed after successful childbirth and regular follow-ups for at least a decade are recommended after childbirth. 

• Artificial Uteri 

  • Researchers, at the University of Gothenburg, are working on bioengineered uteri. These are created using stem cells taken from a woman's blood or bone marrow as a foundation for a 3D scaffold. 
    • Preliminary experiments with rats show promise. 
  • Artificial uteri could eliminate the need for live donors, addressing ethical concerns and reducing the potential risks to healthy donors. 
  • Artificial uteri could benefit women facing infertility issues, as well as members of the LGBTQ+ community. 
    • However, trans-women recipients may still need additional procedures, like castration (removing the testicles of a male animal or human) and hormone therapy. 
    • Also, ensuring consistent blood flow to support a developing fetus is a challenge in creating artificial uteri, as the male body lacks the necessary structures for uterine and fetal development. 
  • Future Possibilities:
    • Artificial uteri offer exciting possibilities for reproductive medicine, but require further research and development before becoming a practical solution for human reproduction. 

• Assisted Reproductive Technology 

  • • ART is used to treat infertility. It includes fertility treatments that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's body and mixing them with sperm to make embryos. The embryos are then put back in the woman's body. 
    • In Vitro fertilization (IVF) is the most common and effective type of ART. 
    • ART procedures sometimes use donor eggs, donor sperm, or previously frozen embryos. It may also involve a surrogate carrier. 
  • Legal Provisions:
    • The ART (Assisted Reproductive Technology Act) Regulation 2021 provides a system for the implementation of the law on surrogacy by setting up of the National Assisted Reproductive Technology and Surrogacy Board. 
    • The Act aims at the regulation and supervision of ART clinics and assisted reproductive technology banks, prevention of misuse, and safe and ethical practice of ART services. 
  • Shortcomings:
    • Exclusion of Unmarried:
      • The Act excludes unmarried men, divorced men, widowed men, unmarried yet cohabiting both gender couples, trans persons and same gender couples (whether married or cohabiting) from availing ART services. 
      • This exclusion is relevant as the Surrogacy Act also excludes above said persons from taking recourse to surrogacy as a method of reproduction. 
    • Reduces the Reproductive Choices:
      • The Act is also limited to those commissioning couples who are infertile - those who have been unable to conceive after one year of unprotected coitus. Thus, it is limited in its application and significantly reduces the reproductive choices of those excluded. 
    • Unregulated Prices:
      • The prices of the services are not regulated; this can certainly be remedied with simple directives.