Three British women will get pioneering womb transplants: Revolutionary treatment could help thousands conceive, four years after it was first developed in Sweden
- The research could see thousands of women given new hope of conceiving
- Doctors carried out the world’s first successful transplant in Sweden in 2013
- The UK has led the way in research and is now set to start offering surgeries
- It costs £30,000 to carry out the treatment which is not yet available on the NHS
Three women are to become the first in Britain to have womb transplants.
They will undergo pioneering surgery within the next few months using wombs donated by a mother or sister. Doctors believe the procedure may allow thousands of women to realise their dream of motherhood.
‘It’s a truly exciting time,’ said Richard Smith, the consultant gynaecologist leading the project. ‘We have the opportunity to make a real difference.
‘It’s a major step forward for women with absolute uterine infertility. Until now their only options have been adoption or surrogacy, which is not always easy.’ It means the first British baby could be born as a result of the procedure by early 2020. The surgery will take place at the Churchill Hospital in Oxford.
The world’s first successful womb transplant took place in Sweden in 2013. The UK has led the way in research but red tape and lack of funding have let other countries forge head.
The UK has led the field in terms of research into womb transplants but has lagged behind in the implementation of procedure
The treatment, which costs around £30,000 per patient, is being funded by the charity Womb Transplant UK because it is still too experimental for the NHS.
For Mr Smith, an award-winning surgeon from Imperial College London, it is the culmination of 20 years of research by him and his unpaid team. The women are expected to be chosen within weeks from a waiting list of around 50.
All want children but were either born without a functioning womb or have had it removed due to illnesses such as cancer.
Aged between 24 and 38, they must be in long-term relationships, healthy and still have ovaries. They will also undergo psychological examination.
Prior to surgery, the successful couples will undergo IVF treatment so that the embryos can be implanted six months after the transplant. The baby will need to be delivered by caesarean section because the transplanted uterus is likely to become detached during childbirth.
Once a patient’s family is complete, the womb will be removed to stop the need for anti-rejection medication.
Eleven babies have been born worldwide as a result of 42 womb transplants, mostly in Sweden, the US and the Middle East.
In 2014, Malin Stenburg, then 36, became the world’s first woman to have a baby following a womb transplant from a donation from a 61-year-old family friend.
Vincent was born two months prematurely following treatment by Gothenburg University, which has higher success rates than traditional IVF.
Although permission was granted in the UK in 2015 for transplants using dead donors, experts generally prefer live family donors to minimise the chances of rejection. While previous transplants have taken surgeons up to 13 hours, a technique Mr Smith helped develop while treating a patient with cervical cancer will reduce this to between three and four.
Two babies have already been born using the procedure – abdominal radical trachelectomy. Womb Transplant UK has now been given the green light by the NHS to test the technique on UK patients.
The treatment costs £30,000 a pop and is currently only available through private sources
Although many patients on its waiting list have relatives who are willing donors, the charity has only enough money for three procedures.
It hopes today’s announcement could generate the £400,000 needed for a further two live transplants – and ten more from dead donors – in the next two years. If the research is successful, doctors suggest the procedure could become available on the NHS by 2022. Mr Smith warned the whole process would be ‘far from easy’ for those selected for the life-changing procedure.
But the father of four added: ‘Anyone who sees the suffering these women go through – not only being unable to physically carry a child but relationships destroyed, and their heartbreaking sense of somehow being an “incomplete” – would know these are a group of women who we really do need to strive for. It is up to me and other doctors to do the best we can by them and help them to become parents.’
Some doctors have warned that womb transplants require more strictly controlled clinical trials before they can be used more widely. Experts from Japan reviewed the findings so far and said while the technique offered ‘great hope’ for women, little was known about factors which can affect its success.
They say a more targeted approach is needed to see whether factors such as the age of donors and recipients and other health conditions are important.
Writing in the international Journal of Obstetrics and Gynaecology, they said complications have included urinary tract problems, thrombosis, infection and haematoma in those receiving the transplant.
Immuno-suppressants, which are used to reduce risk of rejection of a transplanted womb, may also play a role in the development of pre-eclampsia, and high-risk pregnancy monitoring is necessary, said the authors. Measures for the management of treatment-resistant rejection of the womb during pregnancy were required and this remained a major task, they add.
The Japanese scientists said there had been only ‘limited success’ since the first womb transplant in 2013.
It’s taken 20 years. Now I can’t wait to tell the women: you could have a baby
Richard Smith is a consultant surgeon at Imperial College London
Within a few weeks, my colleagues and I at Womb Transplant UK will be telling a handful of women they will be the first in this country to have a womb transplant. At last they will be able to carry their own baby. We literally can’t wait.
Around 50 women aged between 24 and 38 are on our waiting list, some of whom have been on it for over five years. All of them are in a long-term relationship, all of them yearn to have a baby. They find themselves in this heartbreaking situation for a variety of reasons: some were born without a womb, some had their womb removed because of cancer; others have a womb that does not ‘work’ – possibly lacking the lining needed for an embryo to embed into it.
From that list we will select three women for surgery because that is all we have the money for right now – each operation costs £30,000. We will start using live donors – either the woman’s mother or sister – but from the autumn it will be possible for us to do transplants from dead donors too. By joining the national donor register we will be alerted if a womb becomes available.
At last we are at a point that I wondered if we would ever reach. I have been involved in this project for 20 years, during which time we have experienced many setbacks.
But what has kept me going are the times when I have found myself sitting opposite women who, for whatever reason, need a womb transplant. It is so humbling to hear what they’ve been through. As a father of four, I could not and would not want to imagine life without children.
Anyone who sees the suffering these women go through – being unable to carry a child, relationships destroyed, a heartbreaking sense of somehow being ‘incomplete’ – would know they really deserve this chance.
It will be far from easy for those selected – they face multiple and sometimes arduous operations. There is the transplant itself, followed by the implantation of the embryos they’ve conceived with IVF, then a caesarean birth (a vaginal delivery would put too much strain on the uterus that has been stitched into place). And when their family is complete they will need to have the womb removed, to avoid a lifetime on immune suppressing drugs.
But I hope that when they are able to feel their baby’s kick and experience the thrill of pregnancy it will all be worthwhile.
It is hoped the new procedure could be refined to the stage where it is available on the NHS by 2020
One of the main reasons it has taken us so long to get to this point has been financial – the NHS has not funded the 20 years of research nor will it fund the operations themselves. It does not normally back work on ‘blue sky’ surgical techniques.
Instead the money has come via the charity Womb Transplant UK from fundraising – volunteers running marathons, baking cakes and hosting dinners.
None of the team – including five senior gynaecological surgeons, two transplant surgeons and three junior surgeons – and at least ten others including infertility and obstetrics specialists, pathologists and psychologists – has been paid. We’ve also had to go through layers and layers of regulation and consult with interested parties such as the British Transplant Society and NHS England.
We had intended using only brain-dead donors but this has been limiting, because we have to ensure that we did not disrupt the national organ programme.
Everyone knows there is a shortage of organs for life-saving operations, and a womb will not save lives (though that is not to say that this is not vital, life-changing surgery).
Other countries have largely avoided this issue by sticking to using mainly live donors. We too are now moving toward using live donors – and the reason we are able to move ahead confidently is we now have a way of retrieving the womb that dramatically reduces the time involved and the risk to the donor.
Surgeons working with live donors in Sweden, which led to their first live birth in 2014, were using the ileac artery and vein, the blood vessels that take blood to and from the main organs in the pelvis, to carry blood to and from the transplanted womb.
But removing the ileac vein from the live donor is difficult because it runs very close to the ureter, which takes urine from the kidney and the risk of damage is high. The surgery itself is also long and complex. To extract the womb and blood vessels takes up to 13 hours, and the risk of blood clots forming starts to increase after around seven hours of surgery to over 1 per cent. In our view the risk was too high for a woman donating her womb and not benefiting in anyway.
My eureka moment came last September when I heard Liza Johannesson, a gynaecological surgeon from the Baylor University Medical Centre in Dallas, give a talk about a new simpler technique to plumb in the new womb from a live donor that resulted in two live births.
I realised what she was talking about was essentially radical abdominal trachelectomy – a technique that I had invented with two other colleagues some years ago, as a way to operate on a patient with cervical cancer!
It involves plumbing in the new womb using the ileac artery to take blood into the uterus and then the ovarian vein to take blood away. The ovarian blood vessel is much easier to reach so the retrieval time drops from at least eight hours to just three or four. I was so excited by the possibilities that this opened up that after she had finished talking I ran after Dr Johannesson and said: ‘Can I just check I have this right?’
I couldn’t believe I hadn’t thought of using this method myself – not least because I had first thought womb transplants might be possible many years ago when doing cervical cancer surgery. For this you sometimes have to remove the patient’s womb, still attached to two blood vessels, and stitch it back into place once the cancer is cleared.
Doctors say there has been limited progress since the world’s first womb transplant was carried out in Sweden in 2013
With this new approach now a possibility, I started to put the wheels in motion. Using a related live donor is a major advantage because there is less risk of the woman’s body rejecting the donated womb.
We already had women who had contacted us with a mother or sister willing to donate their womb, so all we had to do was ensure they were a good match.
It is exciting to be at this stage but we still need to be cautious and careful about selecting the right women.
They should be in a stable relationship; they must have their own ovaries and eggs, be aged 24 to 38 (or 40 if their eggs were frozen before 38) and have no significant health problems such as diabetes or a high Body Mass Index.
Those on our list have been interviewed by myself and others to check on this. They then go for formal psychological assessment because it’s vital to ensure these women (and their partners) are in a suitable mental state.
The live donor needs to be seen by a psychologist as well. And obviously there are blood tests to ensure the living donor is a good match. With all this information we will make our final selection.
Once the woman has the transplant the embryo can be implanted six months later.
As well as family donors, we have also had offers from over 100 women who would like to donate their womb, but this is for the future.
We can carry out five live transplants and have the authorisation to carry out ten more from brain-dead donors. We have also approached the NHS about offering the surgery in the future.
It’s a truly exciting time: this surgery is groundbreaking and we have the opportunity to make a real difference. It has been a long time in coming and I can’t wait for these women to start their families.
Transplant granted me my dream of motherhood
Malin Stenberg never thought she would be able to carry children when she discovered she had been born without a womb.
After being diagnosed with MRKH syndrome she resigned herself to a life without children and threw herself into her career as a broker in the aviation industry. But in September 2014, she became the first woman to successfully have a baby with a womb transplant.
Now three, her son Vincent is thriving in his native Sweden. Miss Stenberg, 40, and her partner Claes Nilsson, a former professional golfer, refused to accept they would never have children.
Proud parents: Claes Nilsson and Malin Stenberg with Vincent as a newborn baby
The couple joined a pioneering project taking place at Gothenburg University.
Nine young women were given wombs removed from mothers, sisters and friends who had completed their own families and no longer needed them.
Miss Stenberg’s donor was 61-year-old family friend Ewa Rosen, who is now godmother to Vincent.
‘When I held him for the first time, it was just amazing,’ she has said.
‘I felt immediately that he was my baby. It just felt so natural. We truly are a family now. If you wish for a family and you are unable to have one naturally, for whatever reason, it is so sad.
‘Total happiness comes from having family and it doesn’t matter if it is through a womb transplant, or adoption, or something else. It is magical.’
Around one in 5,000 women are born without a womb, or have had it removed because of cancer or other illnesses. Miss Stenberg had the donor womb removed after birth because doctors feared a second pregnancy would be riskier.
Recalling the moment she was told she had no womb, she said: ‘I wasn’t ready to hear it, I couldn’t take it in. I thought that this means that I’ll never be able to carry a child of my own – but that is what women are made for. It felt so unfair. I loved kids and babies.
‘I wanted to know what I had done to deserve this. I felt so alone.’
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