UAB Medicine News
UAB establishes uterus transplant program
Led by Paige Porrett, M.D., Ph.D., associate professor of surgery in the UAB Division of Transplantation and Comprehensive Transplant Institute, the uterus transplantation program will provide women with uterine factor infertility an innovative option for child-bearing using deceased donor organs.
Uterine factor infertility may affect as many as 5 percent of reproductive-age women worldwide and was a previously irreversible form of female infertility. A woman with UFI cannot carry a pregnancy to term either because she was born without a uterus, has had the uterus surgically removed during a hysterectomy, or has a uterus in place that does not function properly. Congenital absence of the uterus is a condition called Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), which affects approximately one out of every 4,500 females, and makes it impossible for a woman to get pregnant.
Most uterus transplants performed to date in the world have been in women with MRKH syndrome. However, women who have undergone a hysterectomy and had the uterus removed surgically are also potential candidates for uterus transplantation.
“Uterus transplantation is a new and effective treatment for absolute uterine factor infertility, but this important innovation is not yet widely available to women around the world,” Porrett said.
UAB is the first program in the United States to offer uterus transplantation outside of a clinical research trial and is one of very few centers in the world accepting new patients.
“We are tremendously excited to announce that UAB is expanding access to uterus transplantation and offering hope to couples unable to get pregnant,” Porrett said. “Our doors are open to both providers and patients anywhere who want to learn more about this exciting new therapy.”
How uterus transplantation works
The process from transplant to successful birth varies from person to person but can take two to five years for many participants. It includes five phases:
- Embryo generation. Before the uterus transplant surgery, a woman generates embryos through in vitro fertilization (IVF). During the process of IVF, she is given fertility drugs to produce eggs, which are then removed from her ovaries and fertilized outside of her body. These embryos are then frozen for later use.
- Transplantation. A uterus is removed from a donor and surgically placed into the recipient. The recipient begins taking immunosuppressive medications to prevent rejection of the transplant. These medications are taken while the transplant is in place, including during pregnancy.
- Pregnancy. Several months after the transplant surgery, one of the recipient’s embryos will be thawed and placed directly into the uterus. If implantation is successful, the recipient will become pregnant. The health of both baby and mother is monitored very closely at frequent prenatal care visits with a high-risk obstetrician, known as a maternal fetal medicine specialist.
- Delivery. The child is born as close to term as is possible via a planned Cesarean section. If the pregnancy has gone well and the recipient and her partner desire a second child, the uterus is left in place and immunosuppression medications are continued. Approximately six months after delivery, another embryo transfer can be attempted.
- Uterus removal. After childbearing is complete, the transplanted uterus is removed and immunosuppressive medications are stopped.
Unique expertise arrives in Birmingham
Uterus transplantation is no simple task, and that is why Porrett was recruited to lead the program at UAB. Porrett is an abdominal organ transplant surgeon and immunologist who started the third uterus transplant program in the United States at the University of Pennsylvania along with colleagues from the Penn Department of Obstetrics and Gynecology. Porrett was the surgical director of the Penn program and performed all of the uterus transplants to date in that program. Thanks to the outstanding care provided by a team of over 100 people, the transplant and pregnancy outcomes have thus far been excellent, including 100 percent graft survival.
“UAB is committed to providing the most comprehensive and innovative care to vulnerable populations, and we could not be more excited to offer uterine transplantation as a therapy option for women with uterine faculty infertility,” said Jayme Locke, M.D., director of the UAB Comprehensive Transplant Institute. “Dr. Porrett and our comprehensive transplant team of professionals are poised to yet again make a profound impact on the lives of our patients and communities.”
“Organ transplantation has been used for many years to save lives, and now it can be used as a tool to generate life,” Porrett said. “That said, neither the tool nor the process is simple. Not every medical center can support it. You need a highly skilled multidisciplinary team with strength at every position. With one of the largest transplant centers in the country and incredible expertise in women’s health, UAB has a very deep bench. Perhaps more important than the expertise on the bench, however, is the grit in each of the players on the team. UAB has a track record of service to complex and historically underserved patients that is second to none.
When you add UAB’s spirit of innovation to that profound patient commitment, spectacular things happen. Brains, brawn and heart combine to bring you a kind of magic.”Porrett is a national and international leader in the field and is an NIH-funded specialist in the field of transplant and reproductive immunology. She is currently the secretary of the International Society of Uterus Transplantation and sits on the Vascularized Composite Allograft Transplantation committees for the Organ Procurement and Transplantation Network, as well as several professional transplantation societies.
Specialists in the Comprehensive Transplant Institute and the Department of Obstetrics and Gynecology will work together to provide the best possible comprehensive care.
“The Department of Obstetrics and Gynecology looks forward to collaborating with Dr. Porrett and the entire UAB Comprehensive Transplant Institute on this new initiative in uterine transplantation at UAB,” said Todd Jenkins, M.D., professor in the Department of Obstetrics and Gynecology. “We believe this represents a new frontier in the care of women who would otherwise be unable to experience pregnancy. This program aligns with our overall goal of improving the lives of the women whom we serve.”
Am I a candidate?
Porrett says that candidates for uterine transplants should be generally healthy and without a uterus — either born without one or have had one surgically removed. As part of an intensive evaluation, candidates are educated about the risks of uterus transplantation and counseled about alternatives to uterus transplantation for family building. Porrett encourages any individual interested in uterus transplantation to contact the program for more information. This includes both providers and potential candidates.
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