Uterus transplantation or autotransplantation of endometrial tissue – what is more effective?

In Tübingen, two women gave birth after uterus transplantation.

Uterus transplantation requires many steps: Uterus removal and transplantation, IVF and cesarean section. The fact that two healthy children were born is a great success.

It is worth noting that the transplanted uterus does not remain in the woman’s body forever. After the birth of a baby or two, it would be better to remove the transplanted uterus so that the woman can stop taking immunosuppressants.

Two women gave birth to children at the university clinic in Tübingen after donor uterus transplantation. Patients could not have children due to congenital disease: Mayer-Rokitansky-Kuster-Hauser syndrome.

The so-called “absolute uterine infertility” due to a congenital defect, deformity or loss of the uterus (for example, due to cancer) occurs in 3-5% of female population. Until now, it has been considered incurable. The only options to become mothers for such women were adoption and surrogacy, but the latter is prohibited in Germany.

This case is not the first, Sweden was a pioneer. In 2014, the first child born after uterus transplantation came to life there. To date, 60 transplantations have been performed in the world, as a result of which 17 children were born. This project is experimental for German-speaking space.

And yet the method is questionable, although it is clear evidence of the omnipotence of modern medicine. But, as Claudia Bozzaro from the Institute of Ethics and History of Medicine at the University of Freiburg says: “The more important part of medical ethics is the so-called command “abstain from doing harm”, that is, the doctor’s duty is not to harm the patient. When uterus is transplanted, a healthy donor undergoes extremely invasive measures – namely, a multi-hour operation that has no health benefits. This is contrary to the aforementioned medical and ethical principle”.

The method is also very expensive and cost-intensive, moreover, there are not so many donors who are ready for it,” Bozzaro says.

Literally in recent years, patients received an alternative – endometrial autotransplantation. But it can be applied only to women with functioning uterus, who have problems with the endometrium.

The method is much more sparing and humane. Firstly, it does not require a donor. For treatment, the patient’s biological material is used. Secondly, after childbirth it is not necessary to remove the uterus.

The uterus cavity is carpeted by the endometrium. Its upper layer matures and dies every month, it is menstruation. But the basal, that is, the lower layer does not die off – it is a permanent tissue. It is a growth medium for the embryo, where the embryo is implanted, “buried” when it enters the uterine cavity. It is after implantation pregnancy occurs. If there is no endometrium, there is not enough of it, or it is of poor structure, then even an embryo of excellent quality cannot be implanted. There is simply no place for it. It is the “bad” endometrium that is the cause of IVF failures in most cases.

In this case, the problem can be solved by endometrial autotransplantation. How does this happen? With the help of an endoscope, a doctor finds a tiny intact piece of the endometrium in the patient’s uterus. It would be enough. Then it is removed, placed in a petri dish, and a full-fledged endometrium is cultured from these cells. After which it is transplanted into the uterine cavity of the woman.

The procedure is much safer than uterus transplantation from a donor. After all, the probability that the tissue not being rooted is virtually absent. In addition, there is no tissue rejection, and therefore it does not have to be removed – unlike the donor uterus.

Of course, there are cases when the patient has no uterus – and then endometrial autotransplantation is out of the question. But such cases are not more than 5% of the total number of patients. Basically, the problem with conception and gestation lies precisely in the poor quality of the embryo and endometrium. Embryo of high quality will afford IVF method, and a good endometrium can be obtained by carrying out an endometrial autotransplantation procedure. A poor endometrium has until recently been considered a direct indication for surrogacy. Now everything may change.