Reply of the authors: Uterus transplantation in nonhuman primates

8 04 2013

To the Editor:

It was encouraging to see that our article on uterine transplantation in nonhuman primates was discussed on the editorial page. We believe that it is important for attainment of clinical application to validate uterine transplantation in primate models. We agree with many of the comments made by Dr. Tzakis (1). These comments accurately identify challenges specific to the background of uterine transplantation experiments in primates.

First, uterine transplantation is conducted for improved quality of life, which differs from transplantation of organs for life support. Organ transplantation started decades ago; however, studies of the uterus were rare because uterus dysfunction is not life-threatening. However, the bioethical view has changed over time and with technology development, the number of uterine cancer survivors has increased, with a corresponding need for improved postoperative quality of life. Consequently, uterine transplantation with the goal of delivery in patients with uterine factor infertility is of increasing importance. It is clear that such patients cannot deliver a child without intervention, and many also lose female identity or may experience marital problems, resulting in psychological and social distress. Uterine transplantation has the potential to improve quality of life by providing the potential for pregnancy and delivery with assisted reproductive technology (ART). Read the rest of this entry »

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“Reply of the authors: Uterus transplantation in nonhuman primates”

8 04 2013

To the Editor:

It was encouraging to see that our article on uterine transplantation in nonhuman primates was discussed on the editorial page. We believe that it is important for attainment of clinical application to validate uterine transplantation in primate models. We agree with many of the comments made by Dr. Tzakis (1). These comments accurately identify challenges specific to the background of uterine transplantation experiments in primates.

First, uterine transplantation is conducted for improved quality of life, which differs from transplantation of organs for life support. Organ transplantation started decades ago; however, studies of the uterus were rare because uterus dysfunction is not life-threatening. However, the bioethical view has changed over time and with technology development, the number of uterine cancer survivors has increased, with a corresponding need for improved postoperative quality of life. Consequently, uterine transplantation with the goal of delivery in patients with uterine factor infertility is of increasing importance. It is clear that such patients cannot deliver a child without intervention, and many also lose female identity or may experience marital problems, resulting in psychological and social distress. Uterine transplantation has the potential to improve quality of life by providing the potential for pregnancy and delivery with assisted reproductive technology (ART). Read the rest of this entry »





Non-surgical dilation for vaginal agenesis is promising, but better research is needed

26 03 2012

To the Editor:

We write with concerns about the paper “Mayer-Rokitansky-Küster-Hauser syndrome: a review of 245 consecutive cases managed by a multidisciplinary approach with vaginal dilators” (1). Whilst we agree with the authors that non-surgical dilation supported by a multi-disciplinary team is a promising approach, we also wish to highlight the deficiencies in this report.

The methods section consists of a description of the dilation programme with no research methodology in what is positioned as an intervention study. There is no mention of ethical approval or consent. Referral and attendance at a clinical service per se cannot be construed as informed consent to be researched. There is no description of how patients were recruited for the study or how women were assessed for treatment completion – whether at clinic, by telephone, or postal questionnaires. The abstract states functional vaginal length as one of the main outcome measures, whilst the results refer to anatomical vaginal length. These are different assessments, depending on whether an individual is sexually active. The authors refer to “clinical examination” but do not describe what this entailed, and although they defined success as a vaginal length of more than 6 cm, there was no description of how this was derived. Read the rest of this entry »





Creatsas modification of Williams vaginoplasty: more than 20 years of experience

18 08 2009

To the Editor:

In a recent article in Fertility and Sterility, Fedele et al. discuss the efficacy of the Williams vaginoplasty as a method of treatment for the colpopoiesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients with a pelvic kidney, and compare the safety and efficacy of this method with those of the Vecchietti’s laparoscopic modification. (1) Read the rest of this entry »