It’s taken 20 years. Now I can’t wait to tell the women: You could have a baby
Within a few weeks, my colleagues and i at Womb transplant UK will be telling a handful of women they will be the first in this country to have a womb transplant. At last they will be able to carry their own baby. We literally can’t wait.
Around 50 women aged between 24 and 38 are on our waiting list, some of whom have been on it for over five years. All of them are in a long-term relationship, all of them yearn to have a baby. they find themselves in this heartbreaking situation for a variety of reasons: some were born without a womb, some had their womb removed because of cancer; others have a womb that does not ‘work’ – possibly lacking the lining needed for an embryo to embed into it.
From that list we will select three women for surgery because that is all we have the money for right now – each operation costs £30,000. We will start using live donors – either the woman’s mother or sister – but from the autumn it will be possible for us to do transplants from dead donors too. By joining the national donor register we will be alerted if a womb becomes available.
At last we are at a point that i wondered if we would ever reach. i have been involved in this project for 20 years, during which time we have experienced many setbacks.
But what has kept me going are the times when i have found myself sitting opposite women who, for whatever reason, need a womb transplant. it is so humbling to hear what they’ve been through. As a father of four, i could not and would not want to imagine life without children.
Anyone who sees the suffering these women go through – being unable to carry a child, relationships destroyed, a heartbreaking sense of somehow being ‘incomplete’ – would know they really deserve this chance.
it will be far from easy for those selected – they face multiple and sometimes arduous operations. there is the transplant itself, followed by the implantation of the embryos they’ve conceived with iVF, then a caesarean birth (a vaginal delivery would put too much strain on the uterus that has been stitched into place). And when their family is complete they will need to have the womb removed, to avoid a lifetime on immune suppressing drugs.
But i hope that when they are able to feel their baby’s kick and experience the thrill of pregnancy it will all be worthwhile.
One of the main reasons it has taken us so long to get to this point has been financial – the nhS has not funded the 20 years of research nor will it fund the operations themselves. it does not normally back work on ‘blue sky’ surgical techniques.
instead the money has come via the charity Womb transplant UK from fundraising – volunteers running marathons, baking cakes and hosting dinners.
none of the team – including five senior gynaecological surgeons, two transplant surgeons and three junior surgeons – and at least ten others including infertility and obstetrics specialists, pathologists and psychologists – has been paid. We’ve also had to go through layers and layers of regulation and consult with interested parties such as the British transplant Society and nhS England.
We had intended using only brain-dead donors but this has been limiting, because we have to ensure that we did not disrupt the national organ programme.
Everyone knows there is a shortage of organs for life-saving operations, and a womb will not save lives (though that is not to say that this is not vital, lifechanging surgery).
Other countries have largely avoided this issue by sticking to using mainly live donors. We too are now moving toward using live donors – and the reason we are able to move ahead confidently is we now have a way of retrieving the womb that dramatically reduces the time involved and the risk to the donor.
Surgeons working with live donors in Sweden, which led to their first live birth in 2014, were using the ileac artery and vein, the blood vessels that take blood to and from the main organs in the pelvis, to carry blood to and from the transplanted womb.
But removing the ileac vein from the live donor is difficult because it runs very close to the ureter, which takes urine from the kidney and the risk of damage is high. the surgery itself is also long and complex. to extract the womb and blood vessels takes up to 13 hours, and the risk of blood clots forming starts to increase after around seven hours of surgery to over 1 per cent. in our view the risk was too high for a woman donating her womb and not benefiting in anyway.
My eureka moment came last September when i heard Liza Johannesson, a gynaecological surgeon from the Baylor University Medical Centre in Dallas, give a talk about a new simpler technique to plumb in the new womb from a live donor that resulted in two live births.
i realised what she was talking about was essentially radical abdominal trachelectomy – a technique that i had invented with two other colleagues some years ago, as a way to operate on a patient with cervical cancer!
it involves plumbing in the new womb using the ileac artery to take blood into the uterus and then the ovarian vein to take blood away. the ovarian blood vessel is much easier to reach so the retrieval time drops from at least eight hours to just three or four. i was so excited by the possibilities that this opened up that after she had finished talking i ran after Dr Johannesson and said: ‘Can i just check i have this right?’
i couldn’t believe i hadn’t thought of using this method myself – not least because i had first thought womb transplants might be possible many years ago when doing cervical cancer surgery. For this you sometimes have to remove the patient’s womb, still attached to two blood vessels, and stitch it back into place once the cancer is cleared.
With this new approach now a possibility, i started to put the wheels in motion. Using a related live donor is a major advantage because there is less risk of the woman’s body rejecting the donated womb.
We already had women who had contacted us with a mother or sister willing to donate their womb, so all we had to do was ensure they were a good match.
it is exciting to be at this stage but we still need to be cautious and careful about selecting the right women.
they should be in a stable relationship; they must have their own ovaries and eggs, be aged 24 to 38 (or 40 if their eggs were frozen before 38) and have no significant health problems such as diabetes or a high Body Mass index.
those on our list have been interviewed by myself and others to check on this. they then go for formal psychological assessment because it’s vital to ensure these women (and their partners) are in a suitable mental state.
ThE live donor needs to be seen by a psychologist as well. And obviously there are blood tests to ensure the living donor is a good match. With all this information we will make our final selection.
Once the woman has the transplant the embryo can be implanted six months later.
As well as family donors, we have also had offers from over 100 women who would like to donate their womb, but this is for the future.
We can carry out five live transplants and have the authorisation to carry out ten more from brain-dead donors. We have also approached the nhS about offering the surgery in the future.
it’s a truly exciting time: this surgery is groundbreaking and we have the opportunity to make a real difference. it has been a long time in coming and i can’t wait for these women to start their families.