31 more women have lined up for the potentially unviable procedure

Two medical centres in Pune and Bengaluru are gearing up to perform the country’s first uterus transplants. The medical breakthrough has triggered a strong debate over how far a woman should go to become a mother as 31 more women have lined up for the procedure.

A uterus transplant is an extremely complex procedure that will enable women with absent or diseased uteruses to carry a pregnancy to termafter a donor uterus is transplanted into them. While there is no debate that womb transplant will be a medical leap for Indian doctors, the question remains about the viability of the procedure.

One in every 4,000 women in India is born without a uterus. There are about 4 lakh women with congenital absence of uterus all over the world. “Experiencing pregnancy and motherhood for those who are born without a uterus is a dream come true. While we have received permission to perform the procedure as a research project in two patients, we have 31 couples enrolled for a uterus transplant. They are of the opinion that when a technology is available, why not use it,” says Kamini Rao, Medical Director of Milann-The Fertility Centre, the Bengaluru-based facility that has received permission to perform uterus transplants from the Indian Council of Medical Research (ICMR).

Agra-based gynaecologist and former president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) Dr. Narendra Malhotra feels that the uterus transplants, if successful, will be a victory for science. “It will go down in medical history by proving Indian doctors are capable of pulling it off. But if you ask me whether the surgeries are practical, the answer is no,” said Dr. Malhotra.

At first, a donor undergoes a surgery for the removal of her uterus. Unlike other hysterectomies, blood vessels and vascular pedicels around the uterus have to be carefully preserved and then re-attached to the recipient. After the transplant, the recipient is put on immunosuppressants so that her body does not reject the donor’s organ. She waits at least for a year before attempting a pregnancy as an In Vitro Fertility (IVF) procedure.

‘Is that viable?’

The woman’s eggs are extracted much before the transplant and the embryos formed with her husband’s sperms are frozen. If the IVF cycles are successful, the woman conceives. However, the delivery is carried out through a C-section and the transplanted uterus is removed after the delivery so that she does not have be on immunosuppressants continuously. “The success rate of an IVF cycle is merely 40%. The woman also faces a high risk of miscarriage and the babies have to be delivered pre-term. Now, does that look viable?” questions Dr. Malhotra.

The very first uterine transplant in the world was carried out in 2002 in Saudi Arabia, and the second one in Turkey in 2011. Both were cadaveric transplants wherein the uterus was taken from a brain dead patient. However, both the transplants failed due to rejection of the organ. In 2014, Dr. Mats Brannstrom carried out the first successful live donor uterus transplant in Sweden and till date, he alone holds the record for carrying out successful uterus transplants. “With such high risks and limited results to show, I do not see any practical implementation of this procedure,” says Mumbai-based infertility expert Dr. Hrishikesh Pai, adding that other organ transplants are life-saving procedures but a uterus transplant is simply a “surgical feat”.

Head of the Department of Obstetrics and Gynaecology in Vikram Hospital, N. Venkatesh, says only time would determine the success of such procedures in an emerging economy like ours.

“The prospect of uterus transplantationsounds more exciting than promising [against the backdrop of options like adoption and surrogacy], the practicality and cost-effectiveness of such procedures needs to be studied,” says Dr. Venkatesh, who is also former president of the Bangalore Society of Obstetrics and Gynaecology.

The two surgeries in Pune are scheduled for May 18 and 19.