Earlier this year, a boy in Sweden celebrated his 10th birthday. Reproductive scientists and doctors marked the occasion too. This little boy's birth had been special. He was the first person to be born from a transplanted uterus.
The boy was born in 2014 after his mother, a 35-year-old woman who had been born without a uterus, received a donated uterus from a 61-year-old close family friend. At the time, she was one of only 11 women who had undergone the experimental procedure.
A decade on, over 135 uterus transplants have been performed globally, resulting in the births of over 50 healthy babies. The surgery has had profound consequences for these families -- the recipients would not have been able to experience pregnancy any other way.
But legal and ethical questions continue to surround the procedure, which is still considered experimental. Who should be offered a uterus transplant? Could the procedure ever be offered to transgender women? And if so, who should pay for these surgeries?
These issues were raised at a recent virtual event run by Progress Educational Trust, a UK-based charity that aims to provide information to the public on genomics and infertility. One of the speakers was Mats Brännström, who led the team at the University of Gothenburg that performed the first successful transplant.
For Brännström, the story of uterus transplantation begins in 1998. While traveling in Australia, he said, he met a 27-year-old woman called Angela, who longed to be pregnant but lacked a functional uterus. She suggested to Brännström that her mother could donate hers. "I was amazed I hadn't thought of it before," he said.
According to Brännström, around 1 in 500 women experience infertility due to what's known as absolute uterine factor infertility, or AUFI, meaning they do not have a functional uterus. Uterus transplants could offer them a way to get pregnant.
His meeting with Angela kick-started a research project that started in mice and eventually moved on to pigs, sheep, and baboons. Brännström's team started performing uterus transplants in women as part of a small clinical trial in 2012. In that trial, all the donors were living, and in many cases they were the mothers or aunts of the recipients.
The surgeries ended up being more complicated than he had anticipated, said Brännström. The operation to remove a donor's uterus was expected to take between three and four hours. It ended up taking between eight and 11 hours.