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Jones BP, Vali S, Kasaven LS, Mantrali I, Saso S, Bracewell-Milnes T, Nicopoullos J, Thum MY, Diaz-Garcia C, Quiroga I, Yazbek J, Smith JR. INvestigational Study Into Transplantation of the Uterus (INSITU): a cross-sectional survey among women with uterine factor infertility in the UK assessing background, motivations and suitability. BMJ Open 2023; 13:e073517. [PMID: 38070921 PMCID: PMC10728960 DOI: 10.1136/bmjopen-2023-073517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
IMPORTANCE The study summarises the selection prescreen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed. OBJECTIVES To assess the demographics, motivations, reasons and suitability among women with absolute uterine factor infertility (AUFI) to undergo uterine transplantation (UTx). DESIGN A cross-sectional survey. SETTING An electronic questionnaire was sent via email to women with AUFI who had previously been referred to the UTx research team or approached the Womb Transplant UK Charity. The questions assessed suitability to undergo UTx based on demographic information, perceptions to adoption and surrogacy and reasons why UTx was preferable. Responses were assessed against the study selection criteria. PARTICIPANTS Women with AUFI. RESULTS 210 women completed the questionnaire. The most common aetiology of AUFI in our cohort was Mayer-Rokitansky-Küster-Hauser (68%; n=143) whereas 29% (n=62) had previously undergone hysterectomy. 63% (n=132) of the cohort had previously considered adoption, 5% (n=11) had attempted it and 2 (1%) had successfully adopted. The most common reason cited to undergo UTx over adoption was to experience gestation (n=63; 53%), while 37% (n=44) wanted a biologically related child. 76% (n=160) of participants had previously considered surrogacy, 22 (10%) had attempted it and 2 (1%) had successfully become mothers using a surrogate. The most common reason to undergo UTx over surrogacy was to experience gestation (n=77; 54%). 15% (n=21) were concerned about the legal implications, 14% (n=20) identified the financial cost as a barrier and 8% (n=12) could not consider it due to religious reasons. On adhering to the selection criteria, 65 (31%) women were suitable to proceed with the trial. CONCLUSION The study demonstrates that implementing commonly used selection criteria for a UTx led to an attrition rate of more than two-thirds of women who requested to initially undergo the process. As more studies present outcomes following UTx, critical assessment of the selection criteria currently used is warranted to ensure potential recipients are not being unnecessarily excluded. TRIAL REGISTRATION NUMBER NCT02388802.
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Affiliation(s)
- Benjamin P Jones
- Lister Fertility Clinic, The Lister Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Saaliha Vali
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lorraine S Kasaven
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Ifigenia Mantrali
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Imperial College Healthcare NHS Trust, London, UK
| | - Timothy Bracewell-Milnes
- Lister Fertility Clinic, The Lister Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | | | | | - Joseph Yazbek
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James Richard Smith
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Vendrell M, Magaldi M, Tena B, León I. Perioperative Management for the First Uterine Transplant in Southern Europe: A Case Report. Transplant Proc 2022; 54:2811-2813. [DOI: 10.1016/j.transproceed.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022]
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Dorafshar AH, Hamidian Jahromi A, Horen SR, Schechter LS, Johannesson L, Testa G, Hertl M, Dewdney S, Aschkenasy J, Wood-Molo M, Brincat C, Cherullo E, Behel JM, Hebert C, Shulman R, Bassi S, Alecci AT, Konety B. Strategic Planning and Essential Steps for Establishing a Uterine Transplant and Rehabilitation Program: From Idea to Reality. Ann Surg 2022; 276:74-80. [PMID: 34793341 DOI: 10.1097/sla.0000000000005301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UTx is performed to address absolute uterine infertility in the presence of uterine agenesis, a nonfunctional uterus, or after a prior hysterectomy. After the initial success of UTx resulting in a livebirth (2014) in Sweden, there are over 70 reported UTx surgeries resulting in more than 40 livebirths worldwide. Currently, UTx has been performed in over 10 countries. As UTx is transitioning from an "experimental procedure" to a clinical option, an increasing number of centers may contemplate a UTx program. This article discusses essential steps for establishment of a successful UTx program. These principles may be implemented in cis- and transgender UTx candidates.
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Affiliation(s)
- Amir H Dorafshar
- Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | | | - Sydney R Horen
- Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Loren S Schechter
- Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL
- The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, Chicago, IL
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Martin Hertl
- Division of Transplant Surgery, Rush University Medical Center, Chicago, IL
| | - Summer Dewdney
- Division of Gynecologic Oncology, Rush University Medical Center, Chicago, IL
| | | | - Mary Wood-Molo
- Division of Reproductive Endocrinology and Infertility, Rush University Medical Center, Chicago, IL
| | - Cynthia Brincat
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, IL
| | - Edward Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL
| | - Jay M Behel
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
- Rush Center for Gender, Sexuality & Reproductive Health, Chicago, IL
| | - Charles Hebert
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Robert Shulman
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Shruti Bassi
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL
| | | | - Badrinath Konety
- Department of Surgery, Rush University Medical Center, Chicago, IL
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