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First baby born after deceased womb transplant (bbc.com)
110 points by daegloe 11 days ago | hide | past | web | favorite | 80 comments





> The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended. (from the lancet article)

So not only the woman got an uterus, it was used specifically to get pregnant and was removed afterwards, so that the mother now doesn't need to get immunosuppressive drugs.

It's amazing because, in the end, it wasn't the common approach to take material from the father, mother, implant in somebody's else body... it was somebody's else uterus, but this time it was implanted inside the mother.

Amazing how much progress is done combining surgeries and drugs, until a new medical protocol is developed.


Brazil, the most violent country in the world (60k violent deaths per year) is also capable of promoting life. I'm feeling a bit prouder of my country today.

Really not sure why this was downvoted. It seems like a reasonable sentiment.

As an American, Americans have a habit of taking anything around pregnancy that mentions the word "life" to mean a pro-life/anti-choice stance, even if the context is from regions of the world without such a distinction. The response varies by audience, but the response on HN to anything approaching pro-life/anti-choice is usually downvotes.

HN also seems to lean against patriotism (and for good reason in general, although this comment seems completely harmless), so that could also have played a part.

HN also seems to lean against patriotism for non-americans. There is plenty of patriotism to go around on HN, but don't try saying anything positive about countries other than the USA or it might just get interpreted as you saying the USA is bad.

Are we on the same website? For a US-centric site, I've always experienced HN as being pretty anti-US in keeping with the seemingly average Democrat attitude of thinking the US has been a detriment to the rest of the world for a long time.

And that's coming from a Brit. I have no horse in the Democrat-vs-Republican fight.


I believe has was probably being downvoted because OP kinda stretched the point of life x death to make a statement about other issue that has absolutely nothing to do with the medical prowess of the current posting.

I totally understand him tho, being from South America as well, allow me to reiterate: violence is rampant. more than ever. And we wish things would just get better down here, but the situation imho is getting worse.

I congratulate the professionals involved in this and I feel kinda 'proud' even tho it's not my feat. you go humanity!


Thank you.

There's a chance that some downvoters simply saw a third-world country being called "violent" and immediately mentally labeled the comment as being hateful or somehow Trumpian, despite this clearly not being the case.

Could a womb be implanted into a male and be functional? Plan on a C-section to skip the birth-capable vagina transplant, which might not be even possible now. I wonder if the necessary hormone manipulations would be practical.

This is a really interesting question, in part because it raises the idea that trans women might be able to give birth someday soon. That could be very welcome news for a lot of people.

Edit: I'm curious if people are downvoting this because they're anti-trans, or because they think I'm somehow anti-trans.


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You say that like people are allowed to transition without psychotherapy.

Perhaps you should educate yourself on trans people.

Male surrogates, nice!

Yes, it is theoretically possible, though I don't even think animal models have been tested for this. Major problems cited are: blood supply for the uterus may be difficult, there may be too little room around organs in males, necessary hormones may be unsafe for the fetus/carrier.

Essentially, it's likely possible, but even womb transplantation into women is highly experimental and may prove to be unsafe, without the added limitations of male anatomy and hormones.


There was a movie about this, starring Arnold Schwarzenegger as the dad (mom?) to be.

https://www.imdb.com/title/tt0110216/?ref_=tttr_tr_tt


And if you liked that medical documentary, enjoy this scientific exploration of the potential for Mars colonization

https://www.imdb.com/title/tt0100802/


This must have been tried in animals… Maybe another case of negative results that didn't make it to publication.

I wonder about the placenta and umbilical cord though.


I apparently do not have a wild enough imagination for what researchers do in their spare time... this seems like something I wouldn't have expected anyone to do more than speculate about.

Why "in their spare time"? We're seriously researching things like that now, for a few years at least.

I assume research just always takes place in spare time I guess :) I'm not up to date on the field and had never considered it is mainly the idea I was trying to get across.

it's an interesting theoretical question, but I'm not sure why you'd want to. I can't think of a reason to choose process A over process B:

A: implant womb in person, implant fertile egg in womb, carry baby, c-section deliver baby, remove womb.

B: implant fertile egg in surrogate, carry baby, c-section or give birth to baby.

Or: it's just surrogacy with extra steps.


All this waste of medical resources to deliver essentially a feeling to the mother, while there are plenty of adoptable and miserable children all over the world. At least in this case, they used the mother's own DNA.

"waste of medical resources" - over and above the outcome of the procedure, each preceding failure likely yielded new information about female anatomy, interactions between host and donor immune responses and the impact of those immune responses, and a plethora of other useful information about human reproduction. Yes, adopting would be easier, but procedures like this can yield valuable insight into women's health and the reproductive process, which is still fraught with risk in much of the world.

The suggestion was that the same procedure be applied for male biology. And of course, the waste should be examined on the long run, where every transwoman should have the right to a similar procedure if the money and donor are available and they so desire.

Some people are interested in having their DNA passed down. I can totally see how this may not be regarded as a waste of medical resource by a lot of individuals.

Adoption has its own place in the world but everything which allows women to give birth (especially in the West, where this is starting to be a problem) should be ok from this perspective. If you want to talk about wasted medical resources, just take a look at the plastic surgery market.


> while there are plenty of adoptable and miserable children all over the world

You seem to be unaware of how difficult it is to adopt children in most countries: it's years of paperwork and bureaucracy and you never know if and when it's going to work.


Adoption is hard, harder then you think. Both for legal and practical reasons.

Do not underestimate effort adoptive families, kids and parents, do.


Brief overview of the article if anyone is interested. Very interesting case.

Background

Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after 8 days' observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26–32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

Interpretation

We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.


I'm not sure why this is preferable to a surrogate mother. It seems like it's much less risky to implant a fetus into a surrogate mother than to implant it into a transplanted womb that is removed after the pregnancy.

It’s one of those feelings, personally. Sure, surrogate mothers and adoptions are preferable, but it’s just not the same as giving birth _myself_. It’s all in my head, I guess.

If nothing else, you're taking the medical risks on yourself. In the US there is a 26-per-100,000 mortality rate, so there is a small but nonzero chance that when you ask someone to be a surrogate they will be killed by the process.

Would you rather ask someone else to take a 0.026% chance of dying or take a (say) 5% chance of dying yourself?


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I generally agree with the sentiment, but there's no shortage of adoptive parents for infants. The desperate need is for older children, which is a very different kind of experience.

Imagine that there is a neurotype that loves the idea of adopting (I have actually known people like this). So they adopt children in lieu of having quite so many of their own. Or they have none of their own at all. Nature, our harsh mistress, will weed people like this out of the gene pool very quickly.

Now imagine that such a neurotype is an environmentally-mediated part of the phenotype, not a strictly hereditary trait.

Maybe it's called "Amazing Grace," or maybe it's called a principled commitment, or maybe it's called love. And experiencing it from others (maybe by being adopted by them) inspires it in you.

Then, our harsh mistress would in fact tend to favor its expression and grow its prevalence among the population.


Doubtful. Cultural practices are subject to the same selection dynamics that genes are. A cultural group that doesn't create its own children will eventually die out unless they have some other group producing new members for them at a very high and stable rate. See shakers for instance. Dead. Gone.

Contrast that with homosexuals, who haven't until recently been having children en masse. But where there is a certain percentage of the population born with a tendency to be gay. So they can always count on having new members.

Unlike being gay, people aren't born with "Amazing Grace" so ... it's a bad strategy that will be weeded out over time. Just like with the Shakers.

This isn't to say that some highly fecund cultural group, like Mormons, can't get away with adopting children here and there. But if they start going too far with it their numbers will start to dwindle.


There are not all that many babies.

Older legally free kids do gain awful lot by being adopted. It is generally also very hard to adopt older kids. Not everyone has what it takes. And when people fail, the failure is euphemism "they got abusive unable to deal with very real issues doing awful lot of harm".


Would it be practical to keep the womb alive via a heart/lung machine and blood transfusions? Just remove human beings from the process altogether?

Really this is the question I'm interested in. Hopefully some animal models can be attempted in the near future.

Given that we're getting better at growing body parts from stem cells, you could easily imagine in the nearish future being able to gestate an embryo in a womb grown from an individuals own stem cells and enough attached organs to provide the full environment.


This is a bit horrifying to me. Babies are quite familiar with their mothers' voices by the time they are born, among other influences; would we also attempt to artificially simulate that sort of pre-birth bonding?

Here, I'll crank it up a notch: instead of animal models, how about just gestating humans in animals? There is your artificial womb. It just requires a bit of anti-rejection drugs, or a bit of GMO effort for tissue similarity.

Whales have the right body temperature. There is enough room to do dozens of babies at once.

Cows are close enough. A cow can probably handle a half dozen babies.


Fortunately or unfortunately, neither cows nor whales are close enough.

https://en.wikipedia.org/wiki/Interspecific_pregnancy#Causes...


They are close enough after "a bit of anti-rejection drugs, or a bit of GMO effort".

We can suppress the immune response, one way or another. If the animal is unable to clear the placenta after the birth, we lose the animal, but we still get a baby.


I presume that the children of mute mothers tend to turn out fine... but maybe not? Cursory search found nothing.

Baby's also bond to the sound of their mother's hearts, and yes, every baby carried by a woman with no heart beat is disadvantaged.

The Bene Tleilax called; they want their Axlotl Tanks back. #Dune

the Axlotl Tanks were living Tleilaxu females (women? Can't remember if they were humanoid) though.

The lack of hormones would probably create some very very weird effects. Food allergies, immunological effects, social habits...

I bet there’s a market for a sci fi book in which a generation of test tube babies simultaneously develop a fetishization for some low quality diet supplement that happens to be present in the natal feeding fluid they were exposed to for their formative years.


I... Don't get the point. How many orphans are there who will never be adopted? Why go to such length if you really want a kid? I find this a bit perverse personally. While the medical and scientific achievement is amazing, I don't know if it's a net positive overall.

> How many orphans are there who will never be adopted?

In most developed countries, very, very few.


How far are we from artificial wombs? afaik they can support the growth of lamb fetuses.

This kind of procedure could be a breakthrough for transgender women who want to bear their own children.

I think if I was that kid I might feel a bit creepy.

Why?

Maybe too much Lovecraft, horror channel, or Slayer, but there's an element of "born of dead womb". Certainly nice for the transplant recipient and partner, but I think I'd feel a bit weird having groen in a transplanted womb, even with downvotes telling me I'm not allowed to have an opinion.

Shouldn't you feel the same way if your mother had a heart, kidney, or liver transplant? You'd be directly hooked up to it as a fetus and it's as "dead" as the womb in this case.

No, because feelings don't work by strictly following nutrient flows.

People said the same things about IVF.

Cool, and on an individual human level I'm happy for the parents. But at the larger societal level I find such procedures very disturbing. I don't mean to sound like a eugenicist, everyone has the right to have kids imho, but the resources spent to create this one kid were immense. There are far easier ways for these parents to have genetic children, a surrogacy being top of the list.

The possibility of men carrying children is scientifically interesting, but again the human race is not struggling for kids. We are a growing population. I'd rather the resources spent on these procedures go towards vaccinations or the basic medical treatments that so many people lack on this planet.


We have enough scientists to work on multiple things concurrently. There is always something "more worthy" of research/funding/time/facility allocation/manpower than whatever it is you're working on at the moment.

Research is one thing, it advances human knowledge. My issue is with the procedure that comes from the research. I would not support this becoming a therapy, something to be used not to advance knowledge but to cure disease. I'm all for the experiment. I get worried when people talk about this as another answer to infertility, or those who suggest it as a means for men to carry babies.

Similarly, I have no issue with some of the so-called "vampire" experiments, blood transfusions between young and old (ie moving blood both ways). Much can be learned through this (liver functions, immune cells etc). But I would very much against such a thing becoming a standard therapy beyond the lab.


This would be a surprisingly backward and anti-science viewpoint for the general public, let alone HN.

The human race is not struggling for children, but many individual women certainly are. This is a technology that could help these women achieve something that they desire, and we shouldn't ignore that just because there are other problems to be solved too.

Surrogacy is fraught with its own problems. Whomever you choose to be the surrogate has to carry the baby to term for 9 months. And they connect with the child while carrying it. If you ask a friend to do it, it puts a strain on the relationship regardless of whether they agree.


I find it troubling in these sense that it's another repetition in the pattern of technology being developed to satisfy innate human desires as opposed to actually bettering the human being. It can be said that such advances can lead to a bettering of the human being, but I have my doubts as to whether even 1% of the effort we are currently putting forth(collectively speaking) will lead to us becoming "better" creatures with a greater understanding of the universe and our place within it. If we're so disinterested in actual betterment, as opposed to taking ourselves apart and reassembling our pieces in novel ways, then we are really no better than bacteria developing new ways to mutate and multiply.

> technology being developed to satisfy innate human desires as opposed to actually bettering the human being

Society works better when everyone is allowed, to the maximum extent reasonably possible, to draw this line on their own. The entirety of art, for example, could be categorized as either.


Allowed and enabled. If even the brightest of us have to focus so much of their time on finding income, housing, and families, that really doesn't leave much time for them to as accurately draw those lines as they could.

You're right that transplanting a womb from a corpse to a living woman doesn't scale well, for a lot of reasons, but this seems like a big step toward other, more practical womb-replacement treatments in the future.

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We detached this subthread from https://news.ycombinator.com/item?id=18608942.

The topic was not how to make males produce eggs.

I think the question was interesting, and calling "misogyny" (hatred of women) a question on whether a female organ would be able to work within a male body is kinda ridiculous.


It's not exactly ridiculous - it's an emotional response. To be fair, viewing women as pieces of meat / breeders / subhuman is a pretty widespread part of society and is a kind of misogyny.

Giving birth is an ability that most women have (and is potentially the flip-side of disadvantages like the gender pay gap adjusted for job choices and maternity leave), that men categorically do not have (while men wield the strength advantage), and giving that ability to men on a large, cheap scale is a scary thought for women and could have huge implications.


I think you are the ignorant one, people can get pregnant without functional ovaries, it happens all the time. It just requires an egg donor and in virto fertilization to be performed.

I take your point but it's an interesting issue, isn't it? What would the world look like if it was the norm for men to reproduce without women, and/or for women to reproduce without men?

It is indeed interesting (and reminds me of the axlotl tanks of Dune) but in this instance, the uterus ultimately comes from a woman anyway, so this particular medical feat (and the original question of this thread) doesn't really have much to do with it.

It's also much more practical (and already technically possible, I think?) for females to reproduce without males than the other way round, so that's the most likely development for the future.


I was also thinking of the Vorkosigan series, in which external technologically-assisted gestation and birth is a key liberatory technology.

Why are you expressing such outrage in response to what seems like an earnest and valid question?

The cyberwomb account was created 5 minutes before that comment was posted. And the name "cyberwomb" seems to be problematic under the philosophy expressed. So I'm guessing it's a troll.

I have to say, it seemed more like the account holder was just someone who was honestly angry about it, and made a new account to post for the first time, rather than being a troll.

Human life is more about emotions than logical argument, and this is an emotionally charged issue for people who naturally have wombs.

I mean for a trivial example, I even used to get annoyed by people who have braces, because I always had good teeth and people would always ask me "Oh when did you have braces? When did you have your teeth whitened?". It was only after I had laser eye surgery to correct my terrible vision that I was OK with it all ;)


Hiding that post feels like damage. We're worse off for not having it available as context for this worthwhile discussion. There must be better ways to handle flagged content than by disappearing it. Maybe "jail" the offending account temporarily instead.

At extraordinary expense, including the entire machine to provide the doctors, facilities, etc. This and tech like it only allow the elite to further separate themselves from anybody else.



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