An early September night in 2014, together with the rest of the team behind the Swedish uterus transplant trial, I prepared for a landmark delivery. The birth of a baby that would transform both the fields of reproductive and transplantation medicine. This was the groundbreaking finale—a culmination of a ten-year journey and preparatory work in different animal models.
The mother-to-be had, a year and a half earlier, received a donated uterus from a family friend. A friend who, at the time of the uterus donation, had been postmenopausal for ten years. The mother-to-be was born without a uterus because of a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. As a teenager, she was told by her doctors that she would never be able to carry her own pregnancy and give birth to a child.
That September night we were to prove this previous statement wrong. Her pregnancy had been without any complications until she developed signs of preeclampsia in the 31st week of pregnancy. As this was the first successful pregnancy, the team didn’t dare to wait, and we decided to deliver the baby boy prematurely. It was completely silent in the operating room until the most beautiful cry filled the room. There was awe, relief and joy. We knew at that time that we created hope for millions of women in the world affected by uterine factor infertility, a new hope to be able to give birth.
Since that first birth in 2014, at least 12 more babies around the world have been born to mothers following uterine transplantation. I have been fortunate to be the only doctor in the world to be involved with not only the first uterus transplant centre that delivered a baby, but also the second one. At the Baylor University Medical Center in Dallas, we were successful in replicating the successes of my former Swedish team when we, in 2017, delivered the first baby after uterus transplant in the US and outside of the Swedish trial.
To work as a uterus transplant surgeon means facing novel medical and surgical questions. It means balancing a field that is an intersect between transplantation, gynaecology, reproductive medicine, pathology, radiology and new ethical challenges. Since the onset of the first uterus transplant trial, the discussions in the medical community have morphed from questioning the need for uterus transplantation and its possibility to improving the procedure and outcome, and finally to discussions of financing, organ allocation and clinical implications. Always keeping the Hippocratic oath close to heart and remembering that 'Primum non nocere' (first, to do no harm) in this procedure is applicable to both donor and recipient.
A uterus transplantation is not a lifesaving or even life-prolonging procedure. Nonetheless, by restoring a bodily function lost or missing, it is instead a thoroughly life promoting procedure—creating life where none could grow before.
I believe that this truly beautiful procedure will now bring joy in India for many mothers-to-be, and I congratulate Dr Shailesh Puntambekar and his team for their achievement.
Johannesson is medical director, uterus transplant, Baylor University Medical Center, Dallas, Texas, United States.