Be Well, Marsha 12/08/15

A new frontier

By Marsha Bonhart

It’s a loss to gain. That is a convoluted statement that I will explain. One of the world’s most renowned medical facilities and research centers is in northeast Ohio. It has the reputation of creating groundbreaking achievements that have saved and improved lives by pushing the envelope in medical discovery and experiments. What I have learned now from the Cleveland Clinic is there is another miraculous step being taken—one in the field of infertility. In the next few months, surgeons at the hospital will transplant a uterus. That surgery will hopefully allow a woman to become pregnant and give birth.
A New York Times article explained how it can be done: to avoid putting the life of a healthy woman at risk, surgeons will remove the cervix, uterus and part of the vagina from a recently deceased organ donor. The small blood vessels connected to the uterus will also be removed which will give doctors six to eight hours for the organ to remain vital if it’s kept cold. That’s the time frame the transplant team will have to connect the donor’s uterus to the recipient’s vagina. The newspaper reports that before the transplant, the recipient patient will be given hormones to stimulate her ovaries to produce multiple eggs of which the procedure needs 10, so she may have to go through more than one cycle on hormone treatment. The eggs will be collected and fertilized with the selected sperm and frozen during which time the patient will be put on the waiting list for the transplant, until a donor with a matching blood and tissue type is found. After doctors implant one embryo at a time in the uterus and the recipient becomes pregnant, the baby will be delivered by cesarean section before the due date, to protect the transplanted uterus from the strain of labor.
The recipient’s large blood vessels located outside the pelvis will be prepared to receive the donor’s small, redirected uterine vessels. The donated uterus is connected to the recipient’s vagina with ovaries left in place, but fallopian tubes will not be connected to the transplant. It will take a year before any attempt is made to begin in vitro fertilization.
The article reads, initially, the goal of organ transplantation was to save lives, but now its platform is to improve the quality of lives. The uterine transplantations will be temporary. Doctors will remove the transplanted uterus after one or two children because of the amount of anti rejection medications that are necessary for the recipient. If the patient does not want to have surgery to have the uterus removed, doctors say it may be possible to quit the drugs and allow the immune system to reject the uterus, which should gradually wither. The women all have to be healthy, but they will face risks. An estimated 50 thousand women could be candidates.
Screening processes have already begun with eight women who say they are desperate to give birth, and a six-member team of doctors at the hospital has already made a 90-minute practice run. One of the women in the program is 26 years old with two adopted children. The newspaper reported her saying she wanted the full feel of pregnancy, complete with swollen feet, backaches and morning sickness. “I want to feel the baby move. That is something I’ve wanted for as long as I can remember.”
For women who want to be considered as a prospective recipient, the article reports the woman must be in a stable relationship, because of necessary help and support. They must also have ovaries. The psychological process includes a screening for mental health disorders that could interfere with a candidate’s ability to be part of a study or to cope with a transplant and to make sure they are not being pressured to have the procedure. Candidates also need to maintain finances because they will have to stay in Cleveland and pay for their own food and lodging if they live outside the area.
One member of the uterine transplant surgical team is Dr. Andreas G. Tzakis who directs a solid transplant team at a Florida branch of the Cleveland Clinic. The article quoted him as saying, “there are women who won’t adopt or have surrogates for reasons that are personal, cultural or religious. These women know exactly what this is about and they are informed of the risks and benefits. Our job is to make it as safe and successful as possible.”
The 26-year-old woman who was referred to earlier in this article recently began the hormone treatments to stimulate egg production. “I know the risks,” she says. “It’s a high-risk pregnancy. But I think we’re in the best of hands. I think we can handle anything that comes our way. I know there will be people who don’t understand or agree, but this is not a whim.”
For the thousands of women who want to give birth, this is an option, and it raises curiosities about the possibility of male pregnancies and how this procedure could affect the future of surrogacy pregnancies and adoptions. But what is for certain, the loss of one life literally connects to the creation of a new one.

Be well,

Marsha

Marsha Bonhart is an assistant vice president of public relations and programs at Wilberforce University, the nation’s first private, historically black college. Reach her at MarshaBonhart@DaytonCityPaper.com.

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