July 24, 2024
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Puah Discusses the First Uterine Transplant Performed in the U.S.

Modern medicine and science continue to amaze by making the impossible possible. One of the latest of these advances is the possibility of transplanting a uterus. Puah has been busy educating the community on the halachic components of uterine transplant. In February, Rabbi Gideon Weitzman, Puah director, was a guest scholar-in-residence at the Young Israel of Deerfield Beach. One of the presentations Rabbi Weitzman gave was on the topic of uterine transplant. Also, at Puah’s annual East Coast conference, held December 2015 at Yeshiva University, Rabbi Dr. Edward Reichman and I both spoke on the topic in a joint presentation. Just in the last few weeks, uterine transplant has gained even further interest, as you may have seen in the media.

Following on the heels of a successful experimental study in Sweden in which nine uterine transplants were performed, resulting, to date, in five pregnancies and four live births, on Feb. 24 the Cleveland Clinic performed the first such attempt on American shores. Unfortunately, the transplant—the first of 10 planned trials—ended in failure, as a complication arose in the patient, which necessitated the immediate removal of the uterus.

Nevertheless, researchers are optimistic that this new scientific development can offer hope to women suffering from uterine factor infertility (UFI). Women with UFI are unable to carry a pregnancy either because they lack a uterus (whether due to congenital causes or a hysterectomy) or because their uterus is nonfunctional. This transplant, which is still at a highly experimental stage, offers the potential of one to two pregnancies for these women, in a temporarily transplanted “borrowed” uterus.

The temporary nature is what makes the uterine transplant, which is considered life-enhancing rather than lifesaving, unique. After the woman gives birth to one or two children, the uterus is removed, and she stops taking the anti-rejection medications, which can carry serious side-effects from long-term exposure.

In the Cleveland Clinic protocol, the woman first undergoes the initial stage of in-vitro fertilization, in which her ovaries are stimulated to produce multiple eggs, which are then fertilized and the embryos stored via cryopreservation. After finding a donor, the uterus is transplanted and given 12 months to heal inside the body, after which the frozen embryos are transferred to the recipient. Throughout the pregnancy, the patient takes anti-rejection drugs, and undergoes a monthly cervical biopsy. After delivering one or two babies via cesarean section, the woman undergoes a hysterectomy to remove the uterus.

While the medical technology is cutting-edge, the possibility of a uterine transplant was actually discussed in halachic literature over 100 years ago. Among the wide range of issues discussed is the question of whether a woman is allowed to subject herself to the risks of surgery, particularly if the operation has a high chance of failure. Even in the event that it is successful, is she allowed to expose herself to the medical hazards of anti-rejection drugs—especially when there exists a viable halachic alternative to the entire procedure in the form of surrogacy (which has been sanctioned by several contemporary authorities)?

It remains to be seen whether or not this treatment will become more commonplace in the treatment of infertility in the United States. Whatever the case, Puah will be ready to bridge the gap between the scientific and halachic worlds.

To contact PUAH [email protected] or call 718-336-0603

By Rabbi Shaul Rappeport

Rabbi Shaul Rappeport is the Director of Rabbinic Services and Outreach for Puah and Rabbi of Lido Beach Synagogue in Long Island, NY.

 

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