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Transplantation of the uterus
Transplantation of most of the vital organs of man no longer surprises anyone. These operations are practically put on stream already in the last century. Transplantation of the uterus for a long time did not attract the attention of doctors. After all, without this organ it is possible to live - a woman does not lose work capacity, remains active in all spheres of life.
Congenital aplasia (agenesis) of the uterus is often found only in adolescence, when a girl gets to see a gynecologist because of a lack of menstruation. Sometimes a very young woman is forced to agree to a hysterectomy because of an oncological disease of the reproductive organs or as a result of other pathologies and injuries in order to save her life and live on. However, until recently the absence of the main reproductive organ completely deprived her of the opportunity to become a mother.
Transplantation of the uterus in the near future will give women such a chance. At present, this operation is in the experimental stage in many countries of the world. Already there are impressive results - for today in transplanted wombs are brought out and safely born babies.
Ahead of the whole planet - Swedish medical scientists. Of the nine uterine transplant operations made in Gothenburg, seven were successful. To date, this has already given birth to several babies. The last one was recently born in the USA.
Indications for the procedure
The organ is transplanted to women of childbearing age, in whom it is absent, for the purpose of further pregnancy, gestation and childbirth.
The reason for the absence of the uterus can be, both congenital and acquired.
The woman-recipient should be sufficiently healthy to safely transfer the operation, and subsequently - to become pregnant and give birth to a healthy child.
In the experiments conducted to date, young women with a diagnosis of absolute infertility because of the absence of the uterus, who are married to men who are capable of fertilization, participated.
Preparation
The main stage of preparation for transplantation is the selection of an immunologically suitable donor. Preference is given to the female relatives of the patient, since in this case the donor organ has good hysters resistance to the body of the recipient, and the risk of rejection is significantly reduced. In all cases, Swedish doctors used organs of close relatives, while the age of the donor did not matter. It can be a woman who has had menopause. The main criterion for selection is a healthy uterus. Five Swedish recipients had their mothers as donors, and four had close relatives.
A woman successfully transplanted in Turkey was transplanted with an organ taken from a dead body. The patient eventually managed to become pregnant, however, because of complications, the pregnancy was interrupted.
In preparation for the experiment, both spouses undergo a special course of in vitro fertilization to preserve the embryos until the moment when the uterus, according to experts, will be ready for pregnancy.
Preparation or so-called conditioning of the recipient is to suppress her immunity in order to prevent the rejection of the donor organ and allow it to settle down.
Technique of the uterine transplantation
The operation for the transplantation of the uterus presents certain difficulties, firstly, the organ is in a sufficiently inaccessible place; secondly, it is braided with many small blood vessels, and thirdly, the purpose of transplantation is the pregnancy of the recipient and the birth of a healthy child, that is, the body does not simply have to to get accustomed and function, but also to work in extreme conditions.
The technique of conducting the uterus transplantation was tested and ground during repeated transplantations to laboratory animals with subsequent genera of healthy offspring.
Before the operation, each of the recipients had their own eggs, they were fertilized with the sperm of the spouses and saved for the subsequent IVF.
Independently women could not become pregnant, as the fallopian tubes to the uterus are not yet joined. All women gave birth also through Caesarean section. However, science does not stand still, and scientists are already thinking about the possibility of not only giving birth naturally, but also conception. For this, it is necessary to transplant the whole complex of reproductive organs, and studies in this direction are already under way.
Scientists already say that the transplantation of the uterus is not far off for a man. Transgender women also want to experience the joy of motherhood, followed by an initiative from gay men and single men. However, such opportunities are only being discussed from the point of view of ethics and legislative base. Nevertheless, in the next decade, according to the scientists' forecast, the transplantation of the uterus to a man will become a reality.
Contraindications to the procedure
Absolutely allotransplantation from incompatible donors is not permissible, in the presence of a malignant disease of the organs outside the one that will undergo transplantation; resistant to the medical treatment of infectious processes, tuberculosis, HIV infection, mental pathologies that interfere with the understanding of the process and clearly follow the doctor's recommendations.
Currently, the operations were conducted by young married women wishing to have children. While operations are conducted in the framework of the experiment, social, sexual and age categories of patients are not clearly marked.
After radical treatment of oncopathology of the reproductive organs, which results in the absence of the uterus in the patient, it must be one to two years.
Relative contraindications are individual features of the patient's health condition, which obviously complicate the technical side of transplantation.
Consequences after the procedure
The need to take life-long medications that reduce immunity to prevent transplant rejection is the most significant consequence of an organ transplant operation.
Therefore, the uterus is transplanted not permanently, but temporarily. It is designed for a maximum of two pregnancies. Then it is removed to rid the already become mother of the patient from having to constantly depress her immunity and expose the body to the risk of all kinds of infections. There was information that the first woman, who gave birth to a child through a transplant of the uterus, decided not to test fate and get rid of the alien organ.
Extracorporal fertilization and childbirth through Caesarean section are also the only way to know the joy of motherhood. However, what kind of woman who wants to become a mother can stop such "trifles".
Complications after the procedure
Transplantation of queens, especially from dead donors, was complicated by the development of thromboses and infections that led to the termination of pregnancy at the end of the sixth to eighth week and the removal of the transplanted organ.
The most successful were operations in which live donors participated. With the need for regular intake of immunosuppressants, the risk of a serious pregnancy complication, pre - eclampsia, is presumably associated , although no direct link has been identified so far.
Care after the procedure
Transplantation of the uterus is a clean cavity operation and, accordingly, patients require standard care, relying after such a procedure - bed rest, pain syndrome and intoxication after anesthesia, prevention of infectious complications, bleeding and blood clots and other symptomatic treatment.
The main task is to prevent rejection of the transplanted organ, by setting the optimal dose of immunosuppressors.
The woman is constantly under the supervision of medical personnel in connection with the upcoming pregnancy and childbirth.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"