Tarek S Arab

Uterine transplantation is the final gynaecological frontier

The successful transplantation of a uterus represents the last major surgical goal in the field of reproductive gynaecology. This feat has recently been achieved by a team at the University of Gothenburg in Sweden.

The 36-year-old patient was born with a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome. The condition occurs in one out of every 4,000 babies, and presents as the absence of a uterus and sometimes a vagina. The absence of a kidney may also be a feature of this condition.

MRKH Syndrome usually manifests in late puberty. Because these women appear outwardly normal, the absence of a vagina or uterus will only be suspected after examination, and subsequently confirmed by an MRI. The psychological burden on a young woman discovering that she has this condition is immense, which is why I personally am delighted that this milestone has been accomplished.

The feat is really quite extraordinary when one considers the technical details involved. Transplanting a uterus is not as straightforward as transplanting a kidney or a liver, which requires only that the organ has an adequate blood supply and is ‘plugged’ into the relevant nearby organs. Those organs do not need to radically increase in size or change much in order to function as intended.

A uterus is a far more dynamic organ. In its non-pregnant state, the uterus is the size of a pear, weighs roughly 50 grams and has an inconsequential blood supply. In the pregnant state, however, it reaches a size of 900 grams and has a blood supply equivalent to 20% of the blood pumped by the heart per minute. The pregnant uterus also requires the growth of new blood vessels throughout early pregnancy, which will themselves grow with the pregnancy.

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