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America's first uterus transplant failed — but surgeons plan to try more

The Cleveland Clinic performed the first uterus transplant in the US on February 24, but officials have now determined it failed, Buzzfeed News reported.

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The surgery took nine hours, and the 26-year-old patient was stable at first. But the next day, her body began rejecting the implanted uterus, according to Buzzfeed News. It ultimately had to be removed.

uterus needlepoint
Women could soon receive a transplanted uterus just like a heart or liver organ donation. hey__paul/Flickr

"I just wanted to take a moment to express my gratitude towards all of my doctors. They acted very quickly to ensure my health and safety," the patient said in a statement released by The Cleveland Clinic. "Unfortunately I did lose the uterus to complications."

The procedure was part of a clinical trial that is expected to include a total of 10 women. Cleveland Clinic officials said in a statement that they plan to go on with the trial.

An experimental procedure

For women without a uterus, because they were born that way or because they had surgery to remove it, getting pregnant had long been an impossibility. Slowly, that's changing.

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Successful uterus transplants have already happened in Europe. A clinical trial in the UK received ethical approval this September, The Guardian reported.

And in 2014, a 35-year-old Swedish woman became the first person to give birth using a donated uterus, from a 61-year-old friend of hers. In that case, the mother went through IVF before the surgery and froze her eggs to use once she got her donor uterus.

But the clinical trial at the Cleveland Clinic is the first in the US. Its announcement back in November set off a media firestorm, including a widely shared article in The New York Times.

Assisted reproduction has been on the rise in the US, with tens of thousands of women now freezing their eggs for later use, and hundreds of thousands undergoing IVF treatment in order to get pregnant, according to the CDC.

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uterus transplant
Surgeons at the Cleveland Clinic perform the first uterus transplant in the US. Cleveland Clinic

Unlike IVF, however, uterus transplants will only be an option for a small number of women in the US — those who don't have a uterus because they were born that way (a condition that affects about 1 in 4,500 girls) or because they had a hysterectomy. Around half a million women get hysterectomies in the US every year, according to the American Congress of Obstetricians and Gynecologists.

For now — though possibly not forever — the experimental procedure is limited to women who were born with female reproductive organs, one of the Cleveland Clinic doctors told The New York Times, largely because expanding the eligible population would create additional levels of complexity for a surgery that is still quite new and complicated.

Transplants are nothing like routine IVF, which is already considered expensive and invasive. They are a costly and complicated procedure, even after getting over the initial hurdle: finding a donor.

Transplanting any organ can be difficult since the body identifies transplants as foreign objects that it must attack. So patients often have to be put on drugs to suppress their immune systems to prevent this from happening. The same happens with uterus transplants; the woman's body recognizes the transplant as an intruder.

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That seems to be what happened in the case of the first US uterus transplant, though the details on what went wrong are scant.

In the successful transplants in Sweden, researchers were able to prevent the body from rejecting the transplanted uteruses, though the women have to keep taking anti-rejection drugs even during pregnancy. Nine women in that trial received uterus transplants, but two had to have them removed because of a blood clot or infection. Four have successfully given birth, and one more was still pregnant as of November, The Times reported.

If the procedure works, women have to wait about a year until their uterus fully heals before they can undergo in-vitro fertilization (IVF) in order to get pregnant.

Perhaps the most remarkable aspect of the procedure in the US is that doctors plan to remove the uteruses transplanted during the trial after the woman gives birth to "one to two babies," the Cleveland Clinic writes. That means they won't have to be on immunosuppressive drugs for their whole lives — something that's not an option for the recipient of an essential organ like a kidney or a liver.

Uterus transplants have a long way to go before they become reliable, safe, and effective — as this first US case clearly shows.

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It is also unclear how much the procedure would cost if and when it might become clinically available. But they may someday make it possible for women to get pregnant who currently have no options for doing so.

"Although there appears to be potential," Dr. Tommaso Falcone of the Cleveland Clinic said in a press release announcing their attempt to perform the procedure, "it is still considered highly experimental."

Women's Health Pregnancy Infertility
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