The first womb transplants in Britain are expected to take place by the end of the year using wombs from deceased donors as well as live donors related to recipients.
Researchers from the charity Womb Transplant U.K. have been raising funds to conduct the procedures, in order to help women without wombs carry their biological children. The team now have enough money to provide three women with womb transplants in 2018.
Clinical lead Richard Smith said they plan to go ahead, as evolutions in surgical techniques have reduced the surgery time to between three and five hours — previously operations took 12-13 hours and posed "significant risk of potentially life-threatening blood clots" for women.
"As a result of this innovation, we will now be performing womb transplants using living donors, in addition to the deceased-donor programme, and we hope to carry out the first operations before the end of 2018," Smith said in a statement.
So, what do we know about the procedure so far, and is it likely to become more widely available?
What is a womb transplant?
A womb transplant, sometimes called a uterine transplant, is when a healthy womb is surgically removed from a donor and then transplanted into a recipient. It's a complex procedure, and the surgeons at Womb Transplant U.K. estimate their upcoming donor operations will take between three and four hours, while the implantation of the donated womb will take approximately four-six hours.
If the recipient's body successfully accepts the new womb, after six months the woman will be able to undergo embryo transplant. This involves surgeons inserting embryos into the womb that are usually the result of the recipient and her partner (or donor) undergoing IVF.
The existence of such an operation will come as a great relief to the thousands of women around the world who may have had a hysterectomy due to illnesses such as cervical cancer or endometriosis, or those who were born without a womb. Roughly around one in every 5,000 girls is born without a womb, a condition known as Mayer Rokitansky Küster Hauser syndrome.
Womb-transplant surgery is designed to give such women the chance to become mothers of their biological children without the need to use a surrogate.
How common are womb transplants in 2018?
In a recent review of the global womb transplant research to date, Britain's Royal College of Obstetricians and Gynaecologists warned the treatment should still be considered "experimental".
The latest statistics, which run until May 2017, show that 42 women in total worldwide have received transplanted wombs, and 11 babies have been born as a result. In 2014, the first baby born to a woman with a womb transplant was delivered by doctors from the University of Gothenburg, Sweden.
Lead author of the paper Dr Iori Kisu said far more research is needed before the treatment becomes mainstream. "The first successful birth after a uterus transplantation attracted widespread international attention, and many countries have since begun to prepare for the clinical use — so far with limited success," he said.
"As our review of the available evidence shows, the establishment of womb transplantation as a new and successful therapy will require strict clinical study data, and thorough training and testing in animal experiments, as well as international collaboration and information sharing."
Will the procedure be available to all women?
The team of doctors behind Womb Transplant U.K. are giving their services free of charge to conduct the three initial planned transplants. They have already compiled a shortlist of potential recipients drawn from the hundreds of applications they received.
As it stands, however, the treatment requires a multidisciplinary team of highly skilled surgeons and is, therefore, very expensive. This alone makes it unlikely that operations of this kind will become mainstream for a few years yet. Concerns have also been raised about "sourcing" of donor wombs, until strict international laws are in place around this new type of transplant.
"If there is a member of the family who is willing to help with the womb, it will be a lot easier, but if you're talking about 'sourcing' a womb, it's going to become difficult," she said. "I don't want it to become commercial — I don't want to get into a situation where women are going to other countries to try to find a womb that is available to buy," said Professor Geeta Nargund, fertility expert and clinical director of U.K. IVF specialists Create Fertility.