Uterus transplant a milestone, but is it for all?https://indianexpress.com/article/explained/uterus-transplant-a-milestone-but-is-it-for-all-5408178/

Uterus transplant a milestone, but is it for all?

In India, about 17% of all women face issues relating to infertility, and the reason is related to the uterus in 20% of such cases.

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For women whose uterus is not healthy, or who do not have one, a transplant is the newest form of infertility treatment. (File Photo)

A woman who had undergone a uterine transplant delivered a child in Pune Thursday, the first such birth in India, and the 12th in the world, all since 2014. How did medical science in India reach this milestone?

Why transplant

For women whose uterus is not healthy, or who do not have one, a transplant is the newest form of infertility treatment. In India, about 17% of all women face issues relating to infertility, and the reason is related to the uterus in 20% of such cases. In some cases, the uterus is altogether missing from birth. Meenakshi Valand, the woman who delivered the child Wednesday, had a scarred uterus due to multiple abortions and cases of stillbirths. It was unable to hold another foetus. Valand is from Bharuch; the transplant took place at Galaxy Care Hospital. Her mother donated the uterus. Usually, women related to the recipient are potential donors. The donor may be either living or deceased, and is chosen from among women up to age 60.

READ | Woman gives birth after undergoing uterus transplant

How far it helps

The transplanted uterus is generally intended to be removed after the woman has gone through one or two childbirths. Normal reproduction is not possible with a transplanted uterus. Therefore, a transplant makes sense only because of the success of the technology of in vitro fertilisation (outside the body). The childbirth happens through surgical intervention; the woman experiences no labour pain. The first successful transplant was performed in Saudi Arabia in 2002 but did not result in pregnancy. In Turkey, pregnancy following a 2011 transplant lasted only eight weeks. The first birth after a transplant, in 2014, happened in Sweden.

Procedure & risks

In the earliest cases, doctors took almost 13 hours to retrieve the uterus, because they performed open surgery. With laparoscopic intervention, the time has now come down to about six hours, said Dr Shailesh Puntambekar, director of Galaxy Care Hospital, who performed the transplant on Valand last year. If the uterus is taken from a dead woman, the risk of organ rejection increases. This is because often, it would be the last organ harvested — life-supporting organs like heart and liver are retrieved first — and a decreased blood supply increases the chances of rejection of the uterus. The first attempted transplants in Sweden and the United States failed because of these reasons.

Still rare & expensive

Uterine transplants are still extremely rare procedures, complicated and expensive. In the case of Valand — and Shivamma Chalgeri from Solapur who had undergone a transplant the day before Valand underwent hers — the entire process (up to the birth of Valand’s child) was made free because these were the first two such cases in India. Doctors say there are about 600 applications across the country. A uterus transplant, like that for other organs, requires clearances at several levels. So far 12 women have been shortlisted, of whom six, including Meenakshi and Shivamma, have already had their transplants.

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