Summary: For the first time in the UK, a woman born without a functioning womb has new hope for carrying her own child thanks to a groundbreaking womb transplant. A team led the procedure from Imperial College London and Oxford University Hospitals.
As a monumental achievement after 25 years of research, this transplant was part of the UK living donor program, funded by the charity Womb Transplant UK. Both the donor, the recipient’s sister, and the recipient have recovered well and look forward to the possibility of a successful pregnancy.
This is the first womb transplant to be performed in the UK, marking a major milestone after more than 25 years of research.
One in 5,000 women in the UK is born without a viable womb, and many others lose their wombs to illness or other conditions.
The operation took nearly 18 hours and was carried out by volunteer surgical and anesthetic teams on a non-working day for the NHS.
Source: Imperial College London
After more than 25 years of research, a team co-led by Imperial’s Professor Richard Smith has performed the first womb transplant in the UK.
The operation has given a woman who was born without a functioning womb the possibility of getting pregnant and carrying her own baby.
As detailed in a case report published today by the BJOG, an international journal of obstetrics and gynecology, both the woman and the donor, her sister, have recovered well. They wish to remain anonymous.
One in five thousand women in the UK are born without a viable womb and are unable to conceive and carry their own child. Many other women have had to have their womb removed following cancer or other illnesses and conditions, including endometriosis.
The transplant was undertaken as part of the UK living donor programme, which is sponsored and funded by the charity Womb Transplant UK, following approval from the Human Tissue Authority.
The surgical team was co-led by Professor Richard Smith, who is a consultant gynaecological surgeon at Imperial College Healthcare NHS Trust and Professor of Practice at Imperial College London.
The other co-lead was Isabel Quiroga, an Oxford University Hospitals consultant transplant and endocrine surgeon and clinical lead for organ retrieval at the Oxford Transplant Centre.
Professor Smith, who is based at Imperial’s National Heart and Lung Institute, said: “This is a first for the UK, following over 25 years of research, and is only possible thanks to the recipient’s sister who came forward and was willing to donate.
Both the donor operation and subsequent transplant took place at the Oxford Transplant Centre at OUH’s Churchill Hospital.
The two procedures overlapped and together took almost 18 hours. The operations took place on a Sunday in early 2023 when NHS facilities were not being used by NHS patients. The whole surgical and anaesthetic team volunteered and took part in their own time.
All being well, the recipient will undergo embryo transfer later this year at the Lister Fertility Clinic in London, part of HCA Healthcare UK. Once pregnancy is confirmed the recipient will be closely monitored in a specialist antenatal clinic at Queen Charlotte’s and Chelsea Hospital, where the delivery would also take place.
While this is the first transplant of its kind in the UK, approximately 100 transplants have been performed globally, with around 50 babies born so far. The first successful womb transplant operations were carried out in 2013 at Gothenburg in Sweden.
More than 25 years of womb transplant research in the UK has led to the development of other surgical procedures. In 1997, Professor Smith developed the radical abdominal trachelectomy operation, a fertility sparing procedure that treats early-stage cervical cancer without the need for hysterectomy. This led on to studies on uterine transplantation.
Professor Smith is also the founder and chair of Womb Transplant UK. He added: “Any further transplants will depend on the willingness of suitable donors and funding for the operations, which comes through Womb Transplant UK. However, we very much hope we will be able to help other women born without or with underdeveloped wombs in the near future.”
Isabel Quiroga said: “It was a privilege to carry out the UK’s first womb transplant. The operations, while long and complex, went according to plan and I am delighted to see that the donor and recipient are recovering well.
“I look forward to the time when this procedure becomes more common and more women have the opportunity to have their own baby.”
Living donor uterus transplant in the UK: A case report
Uterine transplantation (UTx) is the only intervention that restores reproductive anatomy and functionality in women with absolute uterine factor infertility (AUFI). UTx involves transplantation of the uterus, cervix, surrounding ligamentous tissues, associated blood vessels and a vaginal cuff to offer women with AUFI an alternative to adoption and surrogacy as a route to motherhood.
UTx provides women with AUFI with the unique prospect to gestate and give birth to genetically related offspring, enabling them to acquire biological, social, and legal parenthood, thereby circumventing many of the challenges associated with adoption and surrogacy.
Following more than 90 cases, and the achievement of 49 livebirths, there is no question regarding the feasibility of the procedure as it now transitions from research concept to clinical practice.
Given that the goal is to achieve the livebirth of healthy offspring, it is important to note that there does not appear to be an increased risk of fetal growth restriction in cases so far, and age-appropriate neonatal and developmental outcomes have been observed for the first 2 years of life.
However, it remains a procedure associated with significant risk. Detailed analysis of the first 45 cases revealed that more than a quarter of grafts needed to be removed prematurely because of complications, and in living donor cases, one in ten donors required further surgery as a consequence of complications.
We describe herein, the first UTx case performed in the UK using a living donor. Both the donor and recipient have given written consent for the case to be reported.