Six hundred women have queued up at a hospital in Pune to experience motherhood. In May 2017, Galaxy Care hospital became the first in India to carry out a womb transplant. Since then, women from all over the country have registered with the facility. On October 18 this year, after a 27-year-old woman from Gujarat (who was transplanted with her mother’s uterus) delivered a 1.45 kg girl, enquiries have jumped.
High risk
Doctors say that the process of harvesting the uterus and transplanting it to another woman is extensive and tricky. Damage to the ureter, infection and haemorrhage are the major risks.
Therefore, such a response at the hospital raises the question: When surrogacy and adoption are safe and acceptable choices, what makes these women keen to undergo such a high-risk surgery? “Surrogacy can give a genetic and legal child. Adoption can give a legal child. But through a uterus transplant, the woman gets a genetic, legal as well as a gestational child,” says Dr. Shailesh Puntambekar, the surgeon who heads the hospital’s uterine transplant team. “These are women with scarred, diseased or absent uteruses who cannot carry a pregnancy. Their urge to have a baby grow inside them is strong. We are simply technology providers who now offer an option to these women. The choice is completely theirs.”
Not anyone can walk in and opt for the surgery. Just like all other live-organ donations, the decision to undergo a womb transplant is scrutinised by a 10-member committee at Sassoon Hospital, Pune. “They interview the couple, the wife’s family as well as the husband’s. The (committee) keeps dissuading the couple (with the risks) and promoting alternatives, such as surrogacy and adoption, before determining that they are truly keen. The donor (so far, the mother of the expectant women) and her husband are also quizzed by the committee,” says Dr. Puntambekar. Of the six uterus transplants carried out, one has had a baby. Another 12 are in the process of taking permissions from the authorisation committee.
The steps
The entire exercise consists of three surgeries on the expectant woman. The first is the ‘transplant surgery’ that involves making a nine-inch abdominal incision; the second is a Caesarean section at the time of delivery. A live birth is ruled out as the nerves are not transplanted along with the organ and there is no labour pain. The final surgery is a keyhole surgery (that involves a very small incision) to remove the uterus, a few months after the birth of the child.
“Uterus transplant is a temporary solid-organ transfer. Once pregnancy is attained, the uterus is removed so that the woman does not have to be on immunosuppressant drugs,” says Dr. Milind Telang, a gynaecologist. While Galaxy Care has decided to carry out the first three cases free of charge, the cost for delivering babies through uterus transplants is pegged at ₹16 lakh.
Additionally, there is an expense of between ₹10,000 to ₹20,000 for the immunosuppressant drugs, per month.
Is there a future?
An article published in 2016, the International Journal of Women’s Health pointed to a crucial risk associated with the procedure. “Throughout pregnancy, intake of immunosuppressive agents is vital to prevent organ rejection. All common medications used to avoid episodes of rejection in crossing the placenta barrier and subsequently reaching the foetal circulation, expose the child to potentially teratogenic agents (factors which can disturb the development of the foetus) during important phases,” the article noted.
It added that before introducing uterus transplantation in a wider general setting, several more carefully monitored pregnancies are required to evaluate major obstetrical risks, including miscarriage, preeclampsia (high blood pressure and organ damage), preterm birth, and foetal growth restriction.
Dr. Mats Brännström, Professor and Chairman, Department of Obstetrics and Gynaecology, University of Gothenburg, Sweden, who carried out the world's first successful uterus transplant, feels there is a future for this new science. “Surrogacy is prohibited in most parts of the world. With a uterus transplant, the mother bears the maximum risk of the pregnancy. Then there is bonding between the couple and the child during gestation,” he says, adding that Sweden has eight uterine transplant babies, the U.S. two, and Brazil and Serbia one each. “There are several ongoing pregnancies at the moment in many Asian countries,” he says.
Mumbai-based gynaecologist Dr. Duru Shah says that the whole science of uterus transplants is fairly new. “Medical science is constantly advancing. Researchers are now experimenting to create oocytes (eggs) with the help of stem cells. Such evolved technologies will gradually find a footing.”
jyoti.s@thehindu.co.in
