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A New South Wales woman is set to become one of the first people in Australia to receive a uterus transplant as part of a landmark research project at the Royal Hospital for Women in Sydney.
Key points:
- Two Sydney hospitals will trial uterus transplant surgeries for the first time in Australia in 2023
- Uterus transplants have been performed more than 70 times globally and resulted in more than 40 live births
- Transplants are temporary and removed once they have been used to carry one or two pregnancies
Coffs Harbour woman Kirsty Bryant, 29, will undergo surgery early next year to receive a donated uterus from her mother, Michelle, 53.
Ms Bryant lost her uterus to an emergency hysterectomy in 2021 after suffering a major haemorrhage giving birth to her first child.
If the transplant surgery is successful and Ms Bryant later becomes pregnant, she will potentially give birth to a baby from the same womb she was born from.
"I'm going to be growing my own child in the same womb I grew in, which is pretty hard to get your head around," Ms Bryant said.
"But I know that this is my only option to carry another baby."
The procedure, which is aimed at helping women who cannot carry a pregnancy because they either do not have a uterus or their uterus no longer functions correctly, has never been performed in Australia.
The Royal Hospital for Women is the second hospital in Australia to be granted ethics approval to carry out uterus transplants, after Sydney's Royal Prince Alfred (RPA) Hospital received approval in 2019.
RPA put its clinical trial on hold due to the COVID-19 pandemic, but has since resumed the trial and expects to also begin uterus transplant surgeries early next year.
To date, uterus transplants have been performed more than 70 times around the world, including in Sweden and the United States, and resulted in more than 40 live births.
Gynaecologist and fertility specialist Rebecca Deans, who is leading the research project at the Royal Hospital for Women, said the procedure offered hope to women "who've been unable to carry a child and have always longed to".
"Whilst it's not a therapeutic option for women just yet, these clinical trials are a step in the right direction towards providing women with a new fertility treatment."
Surgery helps women with absent or damaged uterus
Ms Bryant's surgery is one of 12 uterus transplants Dr Deans and her team are due to perform next year — six from live donors and six from deceased donors.
"The live donors are always an altruistic donor; typically around the world they have been someone like a sister, mother, cousin or close friend," Dr Deans said.
"Deceased donors are people who have passed away in an untimely way; sometimes through a car accident or a bleed to the brain, some very unfortunate event.
"We anticipate those donors will be someone who has elected to become a multi-organ donor and we will have a conversation with their loved ones."
Women who are candidates for a uterus transplant include those born with an absent or underdeveloped uterus or vagina — a condition known as Mayer-Rokitansky-Kuster-Hauser syndrome, which is estimated to occur in 1 in 5,000 females at birth.
Other candidates include women who have had their uterus surgically removed because of uterine or cervical cancer or as a result of childbirth complications, Dr Deans said.
"There are other options for them like surrogacy or adoption, but for many women, that isn't enough to fulfil their deep desire to actually be able to carry a child themselves."
The transplants are removed later
Professor Mats Brännström, who performed the world's first successful uterus transplant in Sweden in 2012, will travel to Sydney in 2023 to oversee the transplants at the Royal Hospital for Women.
Dr Deans said when it came to uterus transplants, donor surgeries were generally more complex and lasted four to 10 hours, while recipient surgeries took two to four hours.
"[Donor surgery] is much more complicated than a standard hysterectomy, as we have to take the uterus out and the blood vessels which surround it," she said.
In many cases, including Ms Bryant's, transplant donors are older than recipients.
Dr Deans said if a donor was older, they would ideally be yet to reach menopause or "within five years of menopause", but that the wombs of older women were still able to grow healthy babies with hormonal treatment.
"The uterus is very good at functioning if it's got the right hormones," she said.
Both donors and recipients are carefully screened and require hospital ethics approval.
"With all organ donations, there is an ethical dilemma in putting two people through an operation for the benefit of one," Dr Deans said.
Transplant recipients are also required to take immunosuppressant drugs to ensure their body doesn't reject the organ.
These drugs come with their own side effects. For this reason, uterus transplants are usually temporary: each recipient's donated uterus is removed once they have used it to carry one or two pregnancies.
"This is different to other forms of organ transplants as it's a temporary transplant which usually lasts around five years — enough time to allow a woman to have children," Dr Deans said.
'An amazing gift'
The Royal Hospital for Women's research project is expected to run for five years and will involve a number of other Sydney hospitals including Westmead, Blacktown, Campbelltown and Prince of Wales hospitals.
Dr Deans said the "ultimate goal" was to one day be able to offer uterus transplants as a fertility treatment to more women.
"You need to go through the research phase to prove it's a worthwhile procedure," she said.
"In Sweden they have moved beyond the research space and the team led by Professor Brännström is setting up a treatment hub for Scandinavia."
Ms Bryant has six embryos in storage in Sydney as she waits to undergo surgery alongside her mother next year.
"It's an amazing gift my Mum is giving me — she is incredibly generous and she is the reason I wanted to become a mother in the first place," she said.
"It doesn't make me any more of a parent, but having done it once, it's just so special to be able to feel your baby moving and kicking inside you. I just want to have the chance to do it again."