Uterine transplantation is not a good use of limited resources: AGAINST: It is a highly effective infertility treatment.

Abstract

Infertility is, according to the World Health Organization, ‘a disease of the reproductive system’ and ‘generates disability and access to health care falls under the Convention on the Rights of Persons with Disability’. After the medical breakthroughs of in vitro fertilisation and intracytoplasmic sperm injection, absolute uterine factor infertility (AUFI) remained the only untreatable, major infertility subgroup. In the UK there are >12 000 women with AUFI (Sieunarine et al. Int Surg 2005;90:249–56). Gestational surrogacy has until now been a way for women with AUFI to acquire genetic motherhood. The procedure is prohibited in most countries because of legal, religious or ethical concerns. The first livebirth after uterus transplantation (UTx) in 2014 [Brännström et al. 2015;385(9968):607–16] has been followed by four births (our unpublished observations). Naturally, these healthy livebirths have led to a substantial increase in the quality-of-life of these couples. In the UTx trial (Brännström et al. Fertil Steril 2014;101:1228–36; Johannesson et al. Fertil Steril 2015;103:199–204) there is a high (87%) clinical pregnancy rate, indicating that it is a highly effective infertility treatment. Importantly, UTx will stay at the clinical experimental stage for several years, as will ovarian autotransplantation. Hence, all new attempts of human UTx should be performed within clinical trials to acquire all possible data. All the active UTx groups worldwide met in January 2016 to form an international society. Three important goals of this society will be: to form a compulsory registry with data from all new cases, to establish mandatory requirements that would apply for teams performing human UTx, and to perform yearly audits at centres that are conducting UTx. These regulations and the registry will be beneficial for the efficiency and safety of the procedure. Hence, the UTx-related assisted reproductive technologies and surgical procedures will be optimised. It is not until we have data from several studies and the registry that the health authorities in each country can decide whether this procedure should be a clinical infertility treatment. The cost of the procedure will differ between countries, just as the price for a live-donor renal transplantation differs by a factor of at least four. In some countries the public health insurance will most probably pay for UTx whereas others will consider that the procedure should be paid for by the patient, just like cosmetic surgery. The introduction of new medical treatments may raise important ethical conflicts that often have conflicting effects, for example the principle of human dignity that states that ‘all people are equal in dignity regardless of their personal characteristics’ and the principle of need and solidarity, which states that ‘resources should be committed to the person more in need’. In conclusion, patients with AUFI should in the future be offered UTx as an alternative treatment to surrogacy. Surrogacy after in vitro fertilisation has been practised for more than 20 years. However, the possible effects on offspring and families after gestational surrogacy are not clear (Söderström-Anttila et al. Hum Reprod Update 2015). The cost of a UTx procedure is markedly less than of other types of transplantations, because the expensive immunosuppression is for only a few years. Moreover, UTx will not only increase the quality of life of the infertile couple but also create new life. None declared. Completed disclosure of interests form available to view online as supporting information.■ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.