Uterus transplantation research at the cutting edge?

13 09 2013

To the Editor:

We appreciate Dr. Donnez’s interest in our recent manuscript and his insightful remarks on uterus transplantation (1).

Uterine factor infertility affects 3% to 5% of the population (2). Uterus transplantation aims to increase the quality of life in uterine factor infertility patients facing psychological and social problems related to the loss of female identity. Gestational surrogacy offers the only current option for being a genetic parent, with limited availability and potential ethical and psychological problems (3).

Research experience in animals is essential prior to the introduction and attainment of the clinical application of a new surgical innovation. This is especially important when the indication is not life-threatening. Dr. Brannstrom’s group remains the leading team in uterus transplantation research (4). His group has described the basic techniques for uterus transplantation and reported the first pregnancy following uterus transplantation in an experimental animal model.

Due to limitations in postoperative care, assisted reproductive technology (ART), poor control of serum immunosuppressive levels, and financial issues, animal models have not been able to give sufficient information regarding its feasibility and role in acquirement of fertility potential. Read the rest of this entry »


Uterus transplantation

27 08 2013

To the Editor:

We read with great interest the paper “Current status of uterus transplantation in primates and issues for clinical application” by Kisu et al. (1). In that paper, the authors address the present status of experimental and clinical uterus transplantation research and potential medical, social, and ethical issues related to it.

Uterine factor infertility (UFI), congenital or acquired, affects 3% to 5% of the general population (1, 2). At present, UFI patients have no option for having a genetically linked child other than with gestational surrogacy, which is illegal in many countries (1). Experimental studies carried out in the last decades have shown pregnancy and delivery in some allograft animal models (1). End to site anastomoses of two arteries and two veins in appropriate length and thickness to the recipients’ relevant external iliac vessels are defined as the best technique for vascular anastomoses based on experimental and clinical data (1-3). Warm ischemia time (WIT) both involves the ischemia during organ retrieval, from the time of cross clamping until cold perfusion is sustained, and the ischemia time starting with removal of the organ from ice until reperfusion (4) (35 minutes in our case). Cold ischemia time (CIT) starts when the organ is put in ice and cooled with a cold perfusion solution after organ procurement surgery, and ends after the tissue reaches physiological temperature during the transplantation procedure. Decreasing the length of CIT as well as WIT are important factors in improving graft survival in transplantation (4, 5). Read the rest of this entry »