Womb transplant – another medical milestone

Medical journal Lancet reported last month that that a woman with a transplanted uterus had given birth to a healthy baby boy in Sweden. The 36-year-old unnamed woman born without a uterus — a rare condition called Mullerian agenesis — had received a womb transplant from a friend in 2013. The baby, a male, was born eight weeks premature by caesarean section but was a healthy 1.8 kg.

It's undoubtedly a major scientific breakthrough, crowning efforts that go back to the early decades of the last century. In 1931, a Danish woman, Lille Elbe, was the first to undergo such a surgery, but she died soon after. The first real success came in 2011. The recipient, a 21-year-old Turkish woman, even got pregnant in 2013, but the foetus had to be aborted after eight weeks. In Sweden, doctors at the Sahlgrenska University Hospital at Gothenburg University, have been leading research in this area and have conducted trials on nine recipients, one of them a mother to daughter transplant.

The breakthrough may have created ripples but it doesn't really hold out much hope for infertile couples, say ART (artificial reproductive techniques) experts in India. "Mullerian agenesis is a relatively less significant cause of female infertility. It only affects about one in 4,500 women," says Dr Suneeta Mittal, director and head of obstetrics and gynaecology at Fortis Medical Research Institute.

"Uterine transplantation will only work if a woman has healthy ovaries, which means that she has the capacity to produce eggs which can be fertilised. The lack of a uterus means that the fertilised zygote has nowhere to develop," explains Mittal, who was earlier head of department of the ART Centre at AIIMS, the country's premier government medical college, hospital and research centre.

Dr Rita Dutta, an IVF specialist in Delhi, believes that uterine transplantation is still at a very experimental stage and has a long way to go before it can be offered as a general treatment for infertility. "There has been only one reported success. Several other transplants are still at the observation stage. In some cases, women have even had several menstrual cycles. But the real test of the success of such a surgery will be when the women become pregnant and successfully complete a full term," she adds.

Commercial use will come later, after getting approvals from various government agencies. "It will take at least 10 years," Dutta estimates, "before Indian clinics and hospitals can offer uterine transplant as a therapy to infertile women. And it also promises to be very expensive, at least initially."

Rising infertility is fast becoming a major problem in India, especially in urban areas with changing lifestyles, especially late marriages, prolonged exposure to gadgets like mobiles and laptops, stress and regular alcohol or cigarette intake. Estimates vary. WHO puts the percentage of infertile couples at between 3.9 and 16.8 per cent, while one alarming survey by the Indian Society for Assisted Reproduction last year found that as many as 46 per cent of the 2,500-plus people interviewed were infertile. Analysing census figures, the study showed that infertility levels had risen by 50 per cent between 1981 and 2001.

Female infertility, says Dutta, accounts for more than half the cases of childlessness, but the most common cause for that is delaying the decision to have a child until the late 30s or early 40s, by which time both the quantity and quality of her eggs have gone down drastically. "I think women should plan their reproductive cycles more carefully," she advises.

gargi.gupta@dnaindia.net; @togargi