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What Happens When Uterus Transplants Fail

Two weeks after what seemed like a successful uterine transplant, 26-year-old Lindsey McFarland's body rejected the organ because of a routine yeast infection. Although advancements in reproductive health technology are staggering, the case highlights...

by Cole Kazdin
Apr 14 2016, 3:30pm

Image by Katarina Radovic via Stocksy

Just hours after a press conference where surgeons at the Cleveland Clinic introduced the first woman in the US to undergo a uterus transplant, 26-year-old Lindsey McFarland started bleeding and was whisked into emergency surgery.

Born without a uterus, McFarland was told at age 16 that she would never have children. "From that moment on," she told reporters, her husband, Blake, at her side, "I have prayed that God would allow me the opportunity to experience pregnancy, and here we are today at the beginning of that journey."

But that very evening, surgeons were removing the uterus they had transplanted only two weeks before.

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"Preliminary results suggest that the complication was due to an infection caused by an organism that is commonly found in a woman's reproductive system," the Cleveland Clinic wrote in a statement. "The infection appears to have compromised the blood supply to the uterus, causing the need for its removal."

In other words, it was a common yeast infection, which the clinic confirmed to Broadly.

For a healthy woman, a yeast infection is normally an easy fix—a quick hit of Monistat and a vow to never wear thong underwear again. However, because McFarland was taking anti-rejection drugs to prevent her body from rejecting her new uterus, as patients do with any organ transplant, these drugs prevented her immune system from fighting the infection.

You may be thinking, Why would any woman want to go through all of this to have a baby?

Complications aren't entirely unexpected in transplant surgery. But the yeast infection was a surprise, and it's a setback for surgeons and researchers, who will not proceed with another transplant until they determine what went wrong with this one.

McFarland is one of ten women out of over 250 that the Cleveland Clinic screened to be eligible for a transplant. Qualifying factors included being between the ages of 21 and 29 and having uterine-factor infertility.

Even though she was born without a uterus, McFarland has healthy ovaries that grow and release eggs, the difference is, her eggs have nowhere to go.

Once McFarland was accepted to the clinical trial, she started taking fertility drugs and underwent the in vitro fertilization (IVF) required to bank embryos. Once the transplant was complete—and if all went well—she would have to wait a full year before even thinking about pregnancy. Then the embryos would be implanted.

"This is more complicated than other transplants because the uterus lies deep inside the pelvis, and it's difficult to access," says Andreas Tzakis, the program director and a transplant surgeon with Cleveland Clinic.

In McFarland's case, surgeons used a uterus from a deceased donor. The surgery took nine hours. Some of the most intricate and important elements of the surgery, according to the surgeons involved, were the vascular connections—among them connecting the uterine artery and vein—which feed the uterus.

Image by Alita Ong via Stocksy

The transplant is designed to be temporary, because of all of the anti-rejection drugs that need to be taken. With a successful transplant, a woman could have one to two babies delivered by C-section before the uterus would be removed.

The surgery has already been successfully performed in Sweden.

"Nine transplanted, five babies delivered, all healthy," Mats Brännström, the surgeon and chair of the department of obstetrics and gynecology at the University of Gothenburg in Sweden, tells Broadly.

The Swedish transplants all used the uteruses of living donors. Of the five women who have given birth, three used their mothers' uteruses, one used her sister's, and one had a friend donate a uterus. So far, Brännström says, there has been no success yet with a transplant using a deceased donor's uterus.

While we are likely years away from uterus transplants becoming common, the latest in pioneering fertility research is bringing new hope and opportunities for women who previously thought they could never naturally have a child. The research also brings up new ethical concerns as science crosses over into science-fiction territory. With researchers in the field of regenerative medicine experimenting with the development of organs and parts of organs, the idea of a bioengineered uterus—or even growing a baby outside a woman's body—is becoming increasingly imaginable. And there would be no donor required.

"The sky is the limit," says bioethicist Art Caplan. "There is relatively little regulation of who can use reproductive technology, for what reason, and with what level of competence. We have turned the area into a flourishing market where those with money can find someone to give them what they want."

In 1978, the first "test tube baby" was born in England—and the NY Daily News heralded her with the headline "Birth Gives Hope to 15,000"—but now, IVF is virtually routine. According to the Society for Reproductive Technology, in 2014 alone more than 65,000 babies were delivered in the US after having been conceived with the help of IVF.

In 2001, Hung-Ching Liu, then a professor at Cornell's Center for Reproductive Medicine (she has since retired), created an artificial womb using engineered cells. She implanted embryos donated by patients, leftover from IVF treatments, in the artificial uterus, and they grew. She had to end the experiment after ten days due to federal regulations—well before the embryos were viable.

Liu then set her sights on mice instead, creating an artificial mouse womb. In 2003, a mouse embryo grew almost to term but died shortly after. She told Popular Science that it moved and breathed.

"You may be thinking, Why would any woman want to go through all of this to have a baby?" Cleveland Clinic ob/gyn surgeon Rebecca Flyckt asks. "The answer to this question lies in speaking to these patients, talking to them and their spouses, hearing them and their motivations."

For McFarland, who already has three boys that she and her husband adopted through foster care, it's the fulfillment of a dream she never thought possible.

While she cannot go through another transplant procedure, she told NBC News that her 44-year-old mother has offered to be a surrogate for her and her husband.

Surgeons at Baylor University in Texas have announced their own plans for a uterus transplant trial and are seeking candidates now—both for women to receive a uterus and for living donors. Surgeons at the Cleveland Clinic hope to resume their trial in the coming months. There are nine more women on the list.

Pioneering research like this feels revolutionary and hopeful for people who want to have children and feel out of options, and it could potentially eliminate the need for surrogates. But nevertheless, Caplan notes, things become dicey as science outpaces ethical guidelines.

"The main issue is, if there is surrogacy and adoption, then who needs uterine transplants?" asks Caplan. "There are, in the case of a transplant, a living person, a recipient, and one or more embryos involved. We have no idea what to do if the uterus malfunctions with 20-week or older fetuses in it—there is no policy guidance from anywhere or anybody," he says.