Once, no one dared to transplant the uterus. Nobody wants to do it. Because the uterus is not an essential organ for human survival. Just like breast cancer and uterine cancer, excision will not affect human function. Mammary gland, uterus, ovary and other organs exist for reproduction. It doesn't exist and it won't affect survival.

But it's different now. People pay more and more attention to the quality of life. It is a very painful thing to have no children of your own. Therefore, many countries began to put this matter on the agenda.

The uterus transplant happened much earlier than you think. 1882, the first recorded transsexual person was born in Denmark. Of course, he was born as a boy. His real name is Einar Wei Einar Wegener. In the 1920s, he was a famous painter in Paris. One day, his wife (yes, he is married) asked him to dress up as a woman's clothes as a portrait model. The result was out of control. Are you a man or a woman?

In the end, he struggled to cut off his tintin and balls and transplanted an ovary. After the sex change, he changed his name to Lily Abel and Lily Yi Bei. Of course, the ovaries were removed later because of rejection. Later he transplanted another uterus, but the rejection was too strong. There were no anti-rejection drugs at that time. Finally, she died in this uterus in 193 1 year. (Further reading: Lili Elbe-Wikipedia) Eddie Redmayne (Hawking in The Theory of Everything), a popular British teenager, is about to play Lily in the film The Danish Girl dedicated to Lily.

Forty years of scientific research

In fact, in the sixties and seventies, doctors began to do animal experiments of uterine transplantation. The technique used at that time was called omentum fixation.

The so-called omentum fixation is to wrap the omentum around the outer surface of the uterus to create an angiogenesis environment. New blood vessels will grow by themselves. Through this technology, 70% of the experimental animals' uterus can survive.

1964, sheep uterus transplantation was completed in Zhuo Da, Virginia and Gotsiridze. These are two Georgians. They removed the uterus and appendages of the sheep, and then fixed them with omentum and put them back in the stomach of the sheep. Finally, the sheep got pregnant successfully.

However, it was later found that due to the need to wait for the blood vessels to grow by themselves, the omentum fixation was slow, and the uterus might have a large area of necrosis. So another technology has become the mainstream. This is vascular anastomosis.

The so-called vascular anastomosis is to suture one blood vessel with the vascular head or one side opening of another blood vessel. As a result, all the uterus can survive. Therefore, this method is used in subsequent experiments and operations.

However, vascular anastomosis is not 100% successful. In the subsequent experiments on mice, sheep and baboons, 30% of the experiments were still unsuccessful. The examination found that the failure was caused by thrombus leading to necrosis.

From 65438 to 0966, Dr. Ailas Lan removed the uterus, fallopian tubes and ovaries of eight dogs and put them back. Only the inferior vena cava is used to establish the blood supply to the uterus, regardless of the ovaries. The last three dogs got pregnant successfully.

The above two animal experiments are to cut off the animal's own uterus and put it back. Scientists are also annoying. At this time, scholars think that as long as the isolated uterus is preserved and then tries to resist rejection, then uterine transplantation is completely feasible. But is it that simple? Ha ha da.

Previously, people thought that the uterus was the so-called immune privileged organ. In other words, anti-rejection drugs are not needed and will not be rejected. But the fact hit them hard. The transplanted uterus without anti-rejection drugs is necrotic. Therefore, anti-rejection drugs are necessary.

Third, it's the turn of mankind.

The first formal uterine transplant in history took place in 2000. That year, Dr. Wafa Fagee of Fahad Medical College in Saudi Arabia completed the operation. He transplanted the uterus of a 46-year-old woman into a 26-year-old woman. The patient had her uterus removed because of postpartum hemorrhage. This means that she is pregnant. The donor was a patient with bilateral multilocular ovarian cyst, and the uterus and its appendages were removed at the same time. The operation is to anastomose the great saphenous vein with the uterine blood vessels. The operation was a success! Sure enough, local tyrants are magical! Patients took cyclosporine A, azathioprine and prednisone to inhibit postoperative rejection. There are also two cycles of withdrawal bleeding, similar to menstruation. It looks as if it really succeeded!

However, 99 days later, the transplanted uterus was infarcted due to vascular stenosis. I have to take it off. Why is it narrow? It is said that due to the lack of support in the uterus, the uterus is twisted in the body, resulting in twisted blood vessels. Very thin. It can be seen that local tyrants may not be able to create miracles. The doctor thinks there is something wrong with anticoagulation. Um ... just a question. They think that if the radial artery is used in the future, the blood vessel wall will be thicker and unable to move, and it will probably be fine.

According to research, uterine infertility (UFI) accounts for 3-5% of female infertility. There are two reasons, one is congenital uterine underdevelopment or dysplasia, and the other is acquired uterine tumor leading to hysterectomy or tuberculosis leading to intrauterine adhesion. There is also postpartum hemorrhage that leads to the need to remove the uterus.

It is said that out of every 4,500 women in the world, about 1 woman is born without a uterus. In the United States, the incidence of this disease in newborns has reached 1/5000. This disease is called congenital uterine and vaginal defect syndrome, which is abbreviated as MRKH in English. Although these patients have no uterus, their ovaries are developing normally, but sometimes they still lack a kidney. If you lack a vagina, you can use colon and amniotic membrane to rebuild the vagina. If you lack a uterus, you can't do it. In addition, there are many male and female patients who also want to have their own children. Just like Lily in the first example. In the past, these people could only adopt children or find surrogate mothers. But surrogacy is illegal. What should we do?

In 2002, El-Akouri et al. published the first report that allogeneic mice were pregnant and gave birth to normal mice. This is the first report of pregnant animals with allogeneic uterus transplantation.

In vitro uterine preservation is still a problem. Because the isolated organs will face ischemia-reperfusion injury when they are put back. After ischemia, blood circulation leads to the influx of a large number of calcium ions and the production of a large number of free radicals, and many cells die. This is called ischemia-reperfusion injury.

In 2003, El-Akouri preserved the uterus of six mice in UW solution for 24 hours, and five of them were still pregnant.

In 2005, the Wranning study in Sweden found that the isolated rat uterus can also be preserved at low temperature for 24 hours under the protection of perfusate. Later, they found that human uterus in vitro could be preserved for 6 hours under UW solution and low potassium dextran organ protection solution (PER solution).

In 2008, Sieunarine found that the isolated human uterus preserved in Celisor solution was still intact after 24 hours.

In 20 10, a mouse from the team of Matz Bryan Si Tong in Sweden was successfully transplanted into the uterus and was pregnant and gave birth. They said, "We proved for the first time that the transplanted uterus can give birth to offspring." This is really a big deal. This is the first mouse with different genes that can be born by transplanting foreign uterus, and it is also the first animal to do so. I don't know if you left any photos.

In the same year, Edwin Ramirez, a gynecologist and surgeon at St. John's Regional Medical Center in California, announced that they had successfully performed a caesarean section on a sheep with a strange uterus. Lanning of Sweden also conducted a similar study on five sheep. Also on 20 10, Guangdong Province approved the Third Affiliated Hospital of Guangzhou Medical University to carry out "Homologous Uterine Transplantation in Primates", which is the first primate research in Asia.

Then, on 20 1 1, Ms. Derya Sert underwent a uterine transplant in Akbar Denise University Hospital. The surgeon is Professor Ou Mo Ozakan. The uterus donor was a woman who died in a car accident. Three weeks after the operation, Zete had her first period. Although the uterus looks healthy, the patient miscarried twice during pregnancy. It was not until two years later that Zete successfully got pregnant through artificial insemination. But there is no news about production.

When she married Mustafa, 35, Mrs. Setter said, "If I had a magic wand, I wish I could get pregnant now. I just want to hold my baby in my arms. I just want to be a mother. " Now, she has at least half a wand. It's half the battle.

Professor Ozakan said: "It takes a long time for every woman to receive a uterus transplant. We hope to reach the goal of one and a half years before things develop. So far, the transplant operation looks good, and this goal is expected to be achieved within three months. " Look, he did succeed. Although it is only a uterine transplant, it is still the first successful human allogeneic uterine transplant in history.

201September 18, another team competing for the first place, the team of Matz Bryan Si Tong from Gothenburg University and Sal Gerrens University Hospital in Sweden, performed two cases of uterus transplantation. They started their efforts at 1999. In both cases, the mother transplanted the uterus to her daughter. The two women who received the uterus transplant were between 30 and 40 years old. One of them was born without a uterus, and the other had her uterus removed because of cervical cancer. It is said that both of them are in good shape at present. But she hasn't given birth yet

13 May 10, Japan's Keio University and Tokyo University announced that the cynomolgus monkey gave birth to a baby monkey after its uterus was removed and replanted. Vascular anastomosis was also used this time. On the 35th day after the operation, the cynomolgus monkey came back for menstruation. On day 1 16, it was confirmed that she was pregnant naturally, and the fertilized egg was not artificially implanted! Then a baby monkey was born by caesarean section.

In 20 13, Matz transplanted 9 more women, and 4 women gave birth. In addition, one person needs to have the uterus removed because of uterine infection and the other because of blood clots.

Fourth, the baby born in the first transplanted uterus.

Next, I'm going to tell the story of the first baby born from a transplanted uterus.

His name is Vincent. In Sweden, the word means conquest. He conquered the uterine transplantation that human beings have been trying for nearly 100 years. 2065438+At the beginning of September, 2004, there was a loud cry in the operating room of obstetrics and gynecology of Sahlgrenska Medical College in Gothenburg, Sweden. He's here.

He only weighed 1.77 Jin when he came. In foreign countries, babies weighing less than 1.5 kg are called very low birth weight babies. He's close. His father was by his side when he was born. A man was in tears. "He is no different from other children, but he must have a different story to tell when he grows up. Because he is unique. " Yes, he is unique, unique.

In fact, it is not easy for little Vincent to come here. His mother began to be a test-tube baby from 20 1 1. A * * * sent 1 1. You must want to know why a woman without a uterus is busy doing IVF. In fact, this is because Sal Gerrens Hospital, where he is doing IVF, is still having a uterus transplant.

At the beginning of 20 13, she and eight other volunteers underwent a uterine transplant. Her uterus comes from a friend of 6 1 year old. She went through menopause seven years ago and already had two children. She also has the same blood type as Vincent's mother. She doesn't smoke, is healthy, neither fat nor thin, and is flawless.

During the operation, it took 10 hour and 7 minutes to remove the uterus. It took another 4 hours and 55 minutes to put the uterus on. He was discharged from the hospital six days after the operation. 43 days later, she had her first period in her life.

I think she must be crying with joy. Aunt, a thing that people love and hate, has only love and no hate for her. My period came for four days, and then she left. Less than a week. Fortunately, I will come every month from now on. Thank you for your period.

One year after transplanting the uterus, the doctor thawed three embryos, selected a healthy and strong seed and put it in Vincent's mother's stomach. Fortunately, three weeks later, I found out that I was pregnant. You know, IVF is not so easy to get pregnant.

Two weeks later, the doctor checked the heartbeat of the fetus. Everyone breathed a sigh of relief. However, this is only the beginning. Pregnant in October, maybe even more than ten years.

At 3 1 week and 5 days, pregnant women developed pre-eclampsia. Hypertension, headache, thrombocytopenia. If you continue to be pregnant, it will be bad for both the mother and the child. So the doctor decided to let him come into this world! So, here he is.

He's here. He just had a caesarean section for 26 minutes. Everyone is red-eyed, but everyone is smiling. Oh, this is the real tearful smile.

Vincent was the first of four women who received a uterus transplant and became pregnant. This is the first child born among nine women who received a uterus transplant in Sweden. It is the first child born among tens of thousands of women without uterus in Sweden. It is also the hope of millions of women without uterus around the world.

V. Uterus 20 15

20 15 the Cleveland clinic in Ohio, USA plans to transplant several palaces in the next few months. They removed the uterus from the dead donor. Dr. Andreas G. Chaches, director of organ transplant surgery, said that 65,438+00 trials will be conducted first. At present, eight women are ready for transplantation. Britain also announced that it would conduct experiments in June+10, 5438. It is said that the whole operation will cost 50 thousand pounds.

In France, the permission for uterine transplantation is 20 15+065438+ 10/month 1 1, which is carried out by the obstetrics and gynecology team of limoges Hospital in central France. The first case is expected to be carried out on 20 16.

On June 4th, 65438, the team of zhujiang hospital Obstetrics and Gynecology Department of Southern Medical University, that is, the team of Professor Yif Wang from the Third Affiliated Hospital of Guangzhou Medical University, successfully transplanted the uterus of rhesus monkeys to restore menstruation. They will perform uterine transplants for three women in their twenties.

Recently, Xijing Hospital of the Fourth Military Medical University announced that the discipline of Xijing Hospital 1 1 cooperated with 38 experts and professors, and finally successfully completed a uterus transplant operation. This is the first case in China, and it is the mother who transplanted the uterus to her daughter.

The success of this operation has given many patients hope. In this case, the patient who underwent surgery in Xijing Hospital was born with an undeveloped uterus. There is no uterus. In this case, if you want to get pregnant, you must transplant the uterus.

The uterus transplant in Xijing Hospital was successful this time. But the success of the operation does not mean that everything is normal. The uterus may be necrotic due to insufficient blood supply after operation. It may be unable to get pregnant because of maladjustment, and may even have other complications. For example, leukemia caused by taking anti-rejection drugs produces other fistulas. Until the patient can successfully conceive and give birth to a child, and finally remove the uterus, the operation is a complete success.

Verb (abbreviation of verb) postscript

It's just technically, in fact, men can also transplant uterus to get pregnant and give birth. But there is great ethical resistance. After all, this is against the laws of nature. Moreover, because uterine transplantation is not to cure diseases and save lives, it is also controversial in medicine. Anti-rejection drugs are not the most critical. Kidney transplantation has been carried out for more than 50 years, during which countless women who took anti-rejection drugs gave birth to their own children. The only problem is prone to deformity and premature birth.

Many people will think, what is the use of transplanting uterus? Why not adopt or surrogate? But surrogacy is illegal. How can you do something illegal? There may be millions of women around the world who have no uterus. As long as a woman wants a child of her own sooner or later. This is instinct, and it can't be controlled. We should also respect their needs. The purpose of medicine is not to save lives, but to make life more quality. Having children of their own will obviously make these women live a better life. As long as the donors and recipients have no opinions, this is beyond reproach.

Nowadays, most people accept those transsexuals. Don't those men and women want a child of their own? Since they think they are women, I'm afraid they all want it. Uterine transplantation brought them hope. In theory, it is possible to enter the male uterus.

At present, all babies who transplant uterus need caesarean section. Because the cervix can't be enlarged according to the demand during delivery. At present, no baby is born. But the future is still possible.

Let's bless them.

References and websites:

1. The first uterus transplant operation in the United States restored women's fertility.

2. The first human uterus transplant in China, where the mother donated the uterus to her daughter.

3. Uterine transplantation: attractive prospects, risks and controversies. com

4 、/ 20 14-04/02/content _ 1087 13 1 1 . htm

5. Uterine transplantation technology: ethical issue or technical issue? -Observe. -Biological exploration

6. No uterine pregnancy

A case report of human uterus transplantation in 2002.

8. Current situation of uterine transplantation

9. Yi Jiajia, Xia Wei. Research status of uterine transplantation [J]. China Cosmetic Medicine, 20 12,No. 1 1 (15):2083-2087.

10, Leo Chou, Xiong Zhen 'ai. Current situation of uterine transplantation [J]. Chinese Journal of Obstetrics and Gynecology, 20 1 1, 46 (1): 67-69.

Yif Wang LV Xiaogang 1 1. Progress in experimental research of uterine transplantation [J]. Progress in Obstetrics and Gynecology, 20 1 11(11): 904-906.

Yif Wang Zhu Ying 12. Progress in immunology of uterine transplantation [J]. Progress in Obstetrics and Gynecology, 2014,23 (01).