Uterine transplantation

Abstract

Successful human uterine transplantation followed by subsequent pregnancy and live birth in a woman for whom this would otherwise have been impossible is a laudable goal. Research programs have been developed in several countries aimed at achieving this goal. The pioneering Swedish program has reported live births in six women, two of whom had a second pregnancy and birth. Five other live births have been reported from other countries. Most transplants were from a live donor, although recently a live birth has been reported following transplant from a deceased donor. The surgical procedure on a live donor is highly invasive, complex, hazardous, and long and may decrease her quality of life. The use of a deceased donor would partly simplify this issue and is being explored in several centers. Also explored are technical modifications to simplify the procedure and shorten the operating times. The American Society for Reproductive Medicine (ASRM) reminds us of the full array of options available to patients: ‘including gestational carriers (surrogacy), adoption and child-free living’. The ASRM also recommends 55 years as the upper age limit for transfer of donor oocytes and embryos in healthy women. Would it not be more practical and less onerous for the prospective live donor to carry the pregnancy instead? Uterine transplantation remains an experimental procedure that requires the study and resolution of ethical, technical, financial, and social issues, all very important.

摘要

成功的人子宫移植的目的是移植后出现怀孕和活胎妊娠, 否则不可能是值得称赞的目标。为实现这一目标, 许多国家已经制定了研究方案。瑞典首先报道了6例女性的活胎情况, 其中2名女性有第二次妊娠和分娩。其他国家也报道了5例活产。大多数子宫移植来自活体供体, 尽管最近有报道显示, 从一名已故捐献者进行移植后, 又有一名婴儿出生。活体供体外科手术具有高度侵入性、复杂性、危害性并且可能长期降低其生活质量。用已故捐献者的子宫在一定程度上简化了这个问题, 并且在几家中心进行研究。此外, 还进行了技术上的改进, 在一定程度上简化了程序和缩短手术操作时间。美国生殖医学会（ASRM）提示我们, 患者也有其他各种各样的选择：“包括：代孕、收养和无子女生活。”ASRM建议女性捐献卵子和胚胎移植的年龄上限为55岁。对活体捐献者来说, 代孕不是更实际、更轻松吗？子宫移植仍然处于实验过程, 需要研究和解决伦理、技术、经济和社会问题, 这些都是非常重要的问题。

Keywords:

• Human
• infertility
• uterine transplantation
• pregnancy
• ethics

Conflict of interest

No potential conflict of interest was reported by the author.

Source of funding

Nil.