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Archive for the ‘uterine polyps’ tag

Uterus Transplants in the News

By Kathleen Droesch MD

September 24th, 2012 at 8:31 pm

credit: david castillo dominici/freedigitalphotos.net

Swedish doctors this week reported on two women who each received a donated uterus from her mother in the hope of one day being able to become pregnant, carry, and deliver their own children.*

Until recently, uterine transplants were only performed successfully in animal models.  After many years of research, a live-to-live donor uterus transplant has now been offered to two women.  One woman was born without a uterus while the other had a hysterectomy for cervical cancer. Previously, these women would have been unable to have a biological child unless they utilized a gestational carrier to carry the pregnancy to term.

Prior to the transplants, both patients underwent in vitro fertilization (IVF) procedures for the purpose of stimulating their ovaries to produce multiple follicles (eggs). The eggs were retrieved, combined with a semen specimen for fertilization to occur, and (because the women did not yet have a uterus to transfer the embryos back into) the resulting embryos were cryopreserved (frozen for future use).  The embryos will be transferred after waiting one year to allow for healing and confirmation of the viability of the transplanted uterus.

Certainly there are disadvantages and potential concerns regarding this procedure.  The recipients will need to take immunosuppressive medication to prevent rejection of their transplanted organs. Although, there are studies of women after kidney transplant that have had successful pregnancies while on immunosuppressive medications. It will also be more than a year before they will be able to attempt pregnancy and there are no guarantees that they will ever be successful. Even if the women achieve pregnancies, the ability of a transplanted uterus to function normally in pregnancy has not been studied.

Currently at Long Island IVF, we have patients using donated oocytes (eggs) or embryos. We also have a number of patients who’ve had their embryos transferred into the uterus of a gestational carrier.  Not only is this a complicated decision for a couple to make, but a carrier that the couple trusts may not be available.

It is exciting to see the ongoing research into fertility issues.  Although uterine transplants are currently considered experimental, one day they may take their place alongside kidney transplants for women who desire the ability to experience pregnancy after the loss of their uterus.

*For the full report, click here: http://www.cnn.com/2012/09/19/health/uterine-transplant/index.html

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What do you think of this breakthrough in technology?

 

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Infertility Podcast Series: Journey to the Crib: Chapter 7: Are Fibroids and Polyps Preventing You From Getting Pregnant?

By David Kreiner MD

May 3rd, 2012 at 11:05 am

Infertility Podcast Series: Journey to the Crib: Chapter 7 Are Fibroids and Polyps Preventing You From Getting Pregnant?

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Seven: Are Fibroids and Polyps Preventing You From Getting Pregnant? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=52

Are Fibroids And Polyps Preventing You From Getting Pregnant?
Fibroids, also known as myomata, are benign smooth muscle tumors of the uterus.   Most are located in the muscle wall and become clinically significant if they invade the uterine cavity or take up so much space in the uterine wall that they may distort the uterine cavity, obstruct the blood vessels serving the endometrial lining or even block the fallopian tubes.   Fibroids may also extend outside the uterine surface, subserosal or pedunculated when connected to the uterus by a stalk.  These tend to be clinically significant only when they affect the fallopian tubes from picking up the eggs.  Fibroids growing into the uterine cavity are called submucosal myomata and these have the greatest impact on implantation and fertility.
 The diagnosis of fibroids may be suspected at a bimanual examination of the uterus or a hysterosalpingogram but ultrasound and MRI are the best diagnostic modalities to evaluate the extent of the fibroids.  A hydrosonogram where water is injected into the uterine cavity allows delineation of the myoma or, for that matter, polyps (endometrial growths).  Further examination of the uterine cavity is performed at a hysteroscopy when the myoma or polyp may be excised.
 There remains controversy regarding the indication to surgically remove intramural fibroids or those that reside within the uterine wall and not significantly affecting the uterine cavity.   Some specialists believe that intramural fibroids greater than 3 cm are more likely to affect fertility and recommend surgery for these.  Others have a larger threshold or smaller if there are numerous myomata or they cause tubal obstruction.
 Polyps like submucosal fibroids are thought to effect implantation and it is therefore recommended they be removed when trying to conceive.  Patients with a history of anovulation and unopposed estrogen are more likely to have hyperplastic endometrium which can include polyps.  Rarely, in these cases they can be neoplastic and need to be removed and examined by a pathologist.
 Examination of the uterine cavity is essential prior to performing an IVF procedure to ensure the optimal result for patients.
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Was this helpful in answering your questions about the effects of fibroids an polyps on TTC?

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