A team of Dallas doctors has achieved a significant milestone in an experimental surgery that is hoped to one day dramatically change the lives of women born with no uterus and other fertility issues.

In late November, a baby boy delivered at Baylor University Medical Center became the first in the nation to be born to a mom whose reproductive organs had been implanted from another woman’s body.

Only a handful of teams globally have ever attempted the controversial uterine transplant surgery. In 2016, Baylor became the first in the U.S. to try it, using organs donated by women who are not deceased.

Eight women have received a donated uterus in the Baylor program to date. So far, one has achieved the ultimate outcome: a baby. That infant, delivered via C-section last month, is now known as “Baby Number Nine,” as only eight other babies in the world have been born as a result of the novel procedure.

It’s a major milestone that follows a years-long journey by a determined North Texas team, said transplant surgeon and lead investigator Dr. Giuliano Testa.

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A second woman is pregnant, which means more good news could be delivered "soon," the transplant team revealed in an interview with The Dallas Morning News.

Controversial treatment

It’s a noteworthy advance that researchers believe could lead to treatment for thousands of women with infertility issues, like those who have uterine abnormalities or young women who had to undergo hysterectomies after a cancer diagnosis.

All the women enrolled in the Baylor study suffer from absolute uterine infertility, a condition that affects about 1 in every 500 women. That means they had no uterus and childbirth would never have been an option. Many said they often felt incomplete, embarrassed and isolated — until now, said Dr. Colin Koon, a transplant team surgeon whose expertise is in gynecologic cancers.

“It gives hope to women who didn’t feel like they had hope,” he said.

While the delivery is great news for Dallas and science, it’s important to note that the researchers, health economists, ethicists and others caution that there are many aspects that still need to be considered before this type of transplant can move beyond the very preliminary investigation phase.

It’s not likely going to be available for mainstream consideration anytime soon.

There remain questions, for example, about whether the desire to carry a baby is worth the risks and cost of a procedure that involves surgeries (in a donor and in a recipient) and access to multiple specialists. That’s part of what makes it so controversial from an ethical and economic perspective.

“It’s not lifesaving,” said Dr. Vivian Ho, director of the Center for Health and Biosciences at Rice University’s Baker Institute for Public Policy in Houston. “But it is life-creating, and potentially many women are going to want it.” But given the surgery’s complexity, there would be few competitors, which would be needed to help drive down the cost and make the new procedure affordable and accessible.

It could potentially costs hundreds of thousands and benefit a small number of people, in an era where the benefits covered by health insurance companies are already being heavily scrutinized, Ho said.

Baylor’s advantage

The Dallas uterine transplantation study is funded by an undisclosed amount of money from the Baylor Foundation. The participants, all of whom are married, had to relocate to Dallas for the duration of the trial and pay out of pocket for in vitro fertilization, or IVF, which costs more than $10,000 on average.

The process involved a multidisciplinary team of specialists, including surgeons, pathologists, psychologists, radiologists and obstetricians, some of whom volunteered their time to participate.

The team at Baylor, including (from left) doctors Paul B. Payne, Robert T. Gunby Jr., Giuliano Testa and Liza Johannesson, deliver the first baby born in the U.S. from a woman who had received a uterine transplant. (Baylor University Medical Center)

One of the women who donated her uterus is a registered nurse from Dallas.

It takes a big institution with a large team of experts and resources to make this happen.

And uterus recipients feel it’s worth the investment, said Dr. Liza Johannesson, who was part of a successful uterine transplantation program in Sweden. That European program has seen eight births from six women who’ve undergone the investigational surgery.

“What better reward can you have but a baby?” said Johannesson, who came to Dallas in 2016 to help launch the clinical trial here. In April, she officially joined Baylor’s staff.

Continuing advances

The transplant team at Baylor also acknowledges there are many learning curves. Each new surgery has revealed additional insight about how the body’s immune system and the uterus responds when placed in a new person, and what the potential is for prospective donors.

“I would say that almost all of the areas need refining at this point,” Johannesson said. The science is still in its infancy, added Koon.

And each new infant born as a result of the scientific advancement will need to be monitored over time. Dallas’ newest baby and his mother are both healthy, and the birth was normal, said Dr. Robert Gunby, the medical director of labor and delivery at Baylor.

“The intense part of it was just getting them to this point,” he said.

Each uterus recipient can have up to two babies before the organ is removed. The mother of Baby Number Nine did not disclose whether she will continue taking the immunosuppressants and try for a second child.

In the meantime, the transplant community is excited about the promise of a new option for women with absolute infertility. Progress is already being made on the establishment of a set of guidelines, said Dr. Christos Coutifaris, a reproductive specialist at the University of Pennsylvania and president of the American Society for Reproductive Medicine.

Earlier this year, ASRM organized a group of international experts from organizations such as the American Society of Transplantation and United Network for Organ Sharing. They plan to present an initial set of guidelines in the next few months. “It’s a priority for the transplant world,” Coutifaris said.

“Because the prediction is that this is going to eventually be used relatively frequently. And we need to have good guidance to protect our patients, set up registries and be able to track the outcomes.”