P-229: Uterine Transplantation, Is It A Promising Technique in Future?

Background: Uterine factor infertility (UFI) refers to the refractory causes of female infertility stemming from the anatomical or physiological inability of a uterus to sustain gestation. Today, uterine factor infertility affects 3-5% of the population. Traditionally, although surrogacy and adoption have been the only viable options for females affected by this condition, the uterine transplant is currently under investigation as a potential medical alternative for women who desire to go through the experience of pregnancy. Although animal models have shown promising results, human transplantation cases have only been described in case reports and a successful transplant leading to gestation is yet to occur in humans .So, uterus transplantation for absolute uterus factor infertility is moving closer to human trials. Patients with the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, patients having had hysterectomy for benign or malignant uterine/cervical diseases and patients with intrauterine adhesions are the major groups of patients, who could benefit from this procedure. Materials and Methods: In this review article it was decided to search in internet about this important surgery and evaluate if is it possible to achieve this technique in human in future? The search was performed with key word of uterine transplantation and there were several papers in regard to uterine transplantation. There was lots of research on uterine transplantation has been performed in appropriate animal models and three cases in human. Therefore, these studies were extracted and discussed. Results: The results of searches showed that in 1896, Knauer published the first study of ovarian autotransplantation documenting normal function in a rabbit and that lead to the investigation of uterine transplantation in 1918. Erslan, Hamernik and Hardy, in 1964 and 1966, were the first to perform a dog autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus in 2011 Ramirez, et al. demonstrated that a pregnancy can be carried in a sheep transplanted uterus under the influence of immunosuppressive therapy. In humans: in 1931, Lili Elbe died from organ rejection three months after receiving one of the world,s earliest uterine transplants. In Saudi Arabia in 2000, a uterine transplant was performed by Dr. Wafa Fagee from a 46 year old hysterectomy patient into a 26 year old recipient whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days, Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns. A 21-years-old Turkish woman, who was born without a uterus, has become the first woman in the world to receive a womb from a deceased donor. The operation performed on 2011 by Dr. Ömer Özkan and his team at Akdeniz University Hospital in Antalya, Turkish Rivera has been a success. She has had 6 menstrual periods post-surgery and it is said that the uterus is fully functioning. Conclusion: It needs to have more trial of this procedure in human until to do this technique successfully and after that many patients with lack of uterus could benefit from this procedure.