The world's first womb transplant has taken place on a 26-year-old woman in Saudi Arabia, it is revealed today, raising the hopes of thousands of childless couples whose only chance of a baby is currently surrogacy.
More than 15,000 women a year in the UK who seek the help of fertility specialists are found to be incapable of becoming pregnant because their womb has been destroyed by fibroids or as a result of cancer treatment or because they were born without one. Only around 200 go down the precarious and emotionally draining route of finding a surrogate mother to carry their child for them. Among Muslims, surrogacy is unacceptable.
Yesterday British gynaecologists, including a leading pioneer in the field, applauded the work of the Saudi team, who published the first report of their breakthrough in the International Journal of Gynaecology and Obstetrics.
"They have achieved a lot," said Richard Smith, consultant gynaecologist at the Chelsea and Westminster hospital in London. "They have shown it is technically feasible to perform the operation in a woman, which is a world first."
Peter Bowen-Simpkins, spokesman for the Royal College of Obstetricians and Gynaecologists, said: "It is a very, very exciting development."
An editorial in the journal, by Louis G Keith of Northwestern University medical school and Giuseppe Del Priore of New York University medical centre - who is a collaborator of Dr Smith - said the Saudi team had crossed one of the last fron tiers of transplantation. Although uterine transplants did not save lives, their importance to many women should not be underestimated, they said. "To some individuals, childbearing is the greatest event of a lifetime. To such persons, transplantation of organs of reproduction would not be considered frivolous or unnecessary, even though these organs do not sustain life."
The surgery took place two years ago, on April 6 2000, which will give rise to speculation that the team may have performed further transplants since. The donor was a 46-year-old woman whose medical condition required her to have a hysterectomy.
Wafa Fageeh, Hassan Raffa, Hussain Jabbad and Anass Marzouki carried out the complex surgery at King Fahad hospital and research centre in Jeddah. The 26-year-old had lost her own womb when a hysterectomy was carried out because of massive bleeding following a caesarean section, and wanted another baby.
After 99 days, the transplanted womb had to be removed because of blood clotting, but experts say that does not detract from the significance of the achievement.
The transplant went well, the scientists report. The young woman was given drugs to prevent the womb being rejected by her body. The drugs used were those given to kidney transplant patients, hundreds of whom have had successful pregnancies afterwards.
Stimulated by hormones, the lining of the womb thickened to 18mm, which was more than enough to sustain a pregnancy and the woman had normal periods. After 14 weeks, however, the surgeons had to remove the womb. They believed the blood clotting was a result of the uterus moving within the pelvis.
Dr Smith, who has carried out pioneering and successful preliminary studies on womb transplantation, said his own work has ground to a halt because he cannot get the £500,000 funding his team needs.
"There are difficulties in that we are talking about transplanting a non-vital organ and there is no doubt that it is hazardous surgery," he said. But he has a file full of letters from women desperate to be given the chance. "In an era of non-paternalistic medicine, it is something there ought to be a public debate about."
A transplant did not have to mean a lifetime on drugs, he added. "Our view always was that the uterus would go in and the woman would have one or two babies and then the uterus would come out - she would only be on immuno-suppressive therapy for a few years."
