Last week, a team of doctors in Pune conducted India's first womb transplant. This is a procedure which can be done if the woman insists on it, but she has to know the pros and cons of such a surgery.
It is important to note that unlike most organ transplants, a uterus transplant is not a life-saving procedure. If you have a kidney, liver or any other organ transplant, probably the lifespan or the quality of life of the person is affected. It can be life-threatening if the organ is not transplanted. In the case of a uterus transplant, it is not as if life is at risk but it allows the woman to have a gestational motherhood.
[I]mmunosuppressants affect the woman as well as the baby, which can have less growth, premature delivery and other side-effects. We still don't know the long-term effects of such drugs on babies.
Unfortunately, some women do not have a uterus or lose the organ during delivery or surgery. They cannot enjoy the pleasure of carrying a baby. In such a case, the uterus can be donated by a woman who has finished with childbirth and does not need her uterus. Hysterectomy (the surgical removal of uterus) is done for several reasons, such as menopause and prolapsed uterus, so it is a common procedure. So if the organ is not useful to her, she can donate it.
However, once the uterus is transplanted it does not just remain there without assistance. As long as the recipient has the uterus within her, she has to take immunosuppressants—any person undergoing a transplant has to take immunosuppressants to retain that organ. If the immunosuppressants do not work in the recipient, that organ will be rejected. If that organ is rejected, the person has to go through the second surgery to remove the organ.
Like steroids, immunosuppressants have their own complications, the most important being a life-threatening infection. They are so serious that they can take the life of the person. While now low dose immunosuppressants have been developed and there are fewer complications, they have many side-effects such as bone weakness. Moreover, immunosuppressants affect the woman as well as the baby, which can have less growth, premature delivery and other side-effects. We still don't know the long-term effects of such drugs on babies.
Then, if a woman does become pregnant with the aid of the transplanted uterus, she will need to remove the organ after delivery. The other option is to continue with immunosuppressants indefinitely, but this is not a risk worth taking since the uterus is not an essential organ. So once she has delivered, it is good to remove the uterus.
It should not become a routine, because it is not a life-saving procedure. Other options are available such as surrogacy and adoption.
So the procedure has very slippery implications but one has to develop the technique. The procedure is still at an experimental stage. Even after the uterus transplant, what guarantee do we have that she will conceive with the transplanted uterus? We have to wait and watch for two months to see if she is menstruating regularly and if the uterus is being rejected. You also have to wait and watch to see whether she becomes pregnant and whether she carries the pregnancy to term.
I won't say such a surgery is very useful. It should not become a routine, because it is not a life-saving procedure. Other options are available such as surrogacy and adoption. Women should be advised to explore these options first. The simplest option for couples who want to have a genetic child is surrogacy.
However, if a woman wants to wants to carry a pregnancy to term herself, then she can undergo a uterus transplant. However, there is no guarantee that she will conceive. The longer she takes to become a pregnant after the transplant, the more will be the complications related to keeping the uterus in the body because she has to take those drugs. Such a surgery requires counselling for the family and proper examination of both the donor and recipient. The team has to sit and decide the indications properly.
(As told to Sonam Joshi.)