First Program of its Kind in the Southeast

By Laura Freeman

Learning young that you’ll never be able to give birth to your own baby can be devastating. Whether you were born without a uterus or with a malformed one, or lost it to illness or injury, uterine factor infertility is a daily sorrow that becomes a heartbreaking loss when you fall in love with someone who wants their own genetic child.

Fortunately there are multiple ways to build a family, and for women without a uterus, what was impossible three years ago has become a reality with the birth of the first three infants gestated to delivery within a uterus successfully transplanted into their mother through the new UAB Uterine Transplant Program. The program is the first of its kind in the Southeast, and only the fourth in the United States.

“It’s also the first non-research program of its kind in the country, which means the data we gather here can take uterine transplants beyond investigative procedures to begin consideration as an established procedure on its way toward qualifying for insurance coverage,” transplant surgeon and immunologist Paige Porret, MD, PhD, Associate Professor of Surgery in the UAB Division of Transplantation and Comprehensive Transplant Institute, said.

A baby boy was the program’s first successful delivery during the summer, with two more infants arriving since and other patients at different stages of the process of becoming mothers with the help of the transplant program

To be considered as a candidate for uterine transplant, a woman should be in good health and between the ages of 19 and 40.

“Going from applying to the program to holding your baby in your arms can take a while and involve unpredictable waiting,” Porret said. “It’s so difficult when older patients come to us hoping we can help, but as of now, we have to give each of our candidates the best possible change of a good outcome. Someone who begins at forty would be at the outer limits. We would actually have to look closely at someone who is thirty-five. Sooner is better is the takeaway for anyone considering the procedure and for physicians who are thinking about referrals. We are hoping that as we learn more and streamline the procedures that we will have more latitude on age range.”

Charles Leath, MD is director of the Division of Gynecologic Oncology. He and his fellow surgeons, because of their highly detailed skill set in gynecology surgery, are often called on to perform the multiple procedures involved, from acquiring donated organs to removing them when they are no longer needed.

“While patients generate embryos through IVF, the wait begins for a suitable donor organ,” Leath said. “Some programs accept a uterus from a volunteer or a relative. However, our program only works with organs from deceased donors at this time. The donor should be a healthy woman in her childbearing years. Ideally it’s good to see if she has delivered a child so we know the organ is functioning well, but a healthy organ would be considered.”

The same factors involved in any transplant would be part of the procedure, and the patient would be placed on anti-rejection medications and followed closely.

“After about six months if all is going well, the surgery should be healed and ready to implantat one of the embryos generated earlier through IVF,” Porret said. “We only transplant one since attempting to carry twins would add to the burden and make it a higher risk pregnancy. We have more embryos on stand-by in case the first doesn’t implant or if the parents want to follow with a second pregnancy.”

Leath said, “Both mom and baby are monitored very closely through the pregnancy and we schedule delivery by caesarean as near as possible to the natural due date, but slightly earlier to allow more control. If everything has gone well during this pregnancy and the parents want another child, we can allow the uterus to heal and implant another embryo. After delivery of a second child, we would perform a caesarean so that antirejection medications can be discontinued.

As of now, the biggest factor facing future transplant programs that are not funded as part of a research grant is the cost. Although couples at UAB have been fortunate to find some financial assistance, that won’t always be the case.

“We hope to help establish transplants as non-investigative procedures so a case can be made for insurance coverage. It shouldn’t take a miracle to have a uterus. Where there is a need, there should be hope,” Porret said.