First womb-transplant baby born

http://www.bbc.com/news/health-29485996

by forrest_t • 12 years ago

85 56 12 years ago

bbc.com

fcoury• 12 years ago

May be a dumb question but in this case which genes will the baby inherit: the mom's or the womb donor's?

maxerickson• 12 years ago

The mom. Here's the portion explaining that:

The identity of the couple in Sweden has not been released, but it is known the mother still had functioning ovaries.

The couple went through IVF to produce 11 embryos, which were frozen. Doctors at the University of Gothenburg then performed the womb transplant.

Which makes it sound like eggs from her ovaries were used for the IVF.

lmkg• 12 years ago

Genes of the baby are 100% determined by the fertilized egg. The genes will be from whoever donated the egg. This is usually the mother in practice, but since you need to do In-Vitro Fertilization anyways, there's no fundamental reason it couldn't be someone who is genetically unrelated to either the mom or womb-donor.

Note that genetics are not 100% in control, and the conditions of the pregnancy affect the outcome of the pregnancy. We don't know the full effects of this, and we certainly don't know which aspects of it are from the womb specifically vs other biological aspects of the mother (e.g. blood chemistry). Health of the mother certainly has correlations with birth weight and developmental progress, but the extent & mechanisms are still pretty opaque.

car3• 12 years ago

Slight correction; the genome is 50% maternal (egg), 50% paternal (sperm).

wyager7• 12 years ago

People can be so insanely desperate to have children exactly in some arbitrary and specific way.

I mean, this woman went through a very dangerous and expensive transplant surgery that then required the use of immunosuppressant drugs to prevent organ rejection, when she could have used a surrogate or, gasp, adopted.

I hope they had to pay for this surgery with their own cash. There is absolutely no medical necessity behind it.

Edit: This comment seems to be eliciting some disapproval. I'm curious why; please let me know what you're thinking.

kurokikaze• 12 years ago

It's a scientific achievement.

dublinben• 12 years ago

A completely unnecessary one. This is just progress for the sake of progress.

gfodor2• 12 years ago

You're saying that the specific manner of giving birth to a child you carry in a womb in your own body over 9 months that is of your own genetic makeup is "arbitrary," despite the fact that this is the exclusive mechanism of human procreation up until recent history.

gpvos• 12 years ago

The counterargument is of course that transplants and immunosuppressant drugs are also artificial, and even more recent. Also, adoption has always been possible. I guess the main point is that it feels closest to the natural method.

wyager7• 12 years ago

Yes. If you're asserting that "giving birth to a child you carry in a womb in your own body over 9 months" is somehow inherently preferable or special compared to any other form of child rearing, your argument that "this is the exclusive mechanism of human procreation up until recent history" is an argumentum ad antiquitatem and/or argumentum ad naturam fallacy.

gliese1337• 12 years ago

  This comment seems to be eliciting some disapproval. I'm curious why; please let me know what you're thinking.

I expect due to the implied tone. I agree with the general sentiment: there are much easier ways to get a kid, adoption arguably has more positive social impact, so why did they go with this route? But the way you phrase it, it seems rather like an attack that does not leave much room open for discussion.

chrisseaton• 12 years ago

Having children of their own is life goal number 1 for many people. Asking them to be rational about it is disregarding just how primal this drive is.

derefr• 12 years ago

I would phrase that as "having children of their own is goal number one for [all adaptively-fit lifeforms that undergo sexual selection pressure]." The genes of all plants and animals alive today came from the subset of their species that wished to procreate.

Or, to put it another way, among gene sequences that attain fixation through sexual selection pressure, any sequence that impels procreation as a terminal goal is going to be fixated more quickly than any other.

quarterto• 12 years ago

Surrogacy is legally problematic in Sweden. http://en.wikipedia.org/wiki/Surrogacy_laws_by_country#Swede...

zach• 12 years ago

And essentially all adoption in Sweden is international - only about 100 adoption cases a year involve Swedish births. Foreign adoptions are troublesome enough to make a womb transplant look like a reasonable alternative. Now you know why this would happen in Sweden.

So since you're curious, wyager, it seems a little hand-wavy to say "she could have used a surrogate or, gasp, adopted." Combining sarcasm and hand-waving makes for poor commentary.

car3• 12 years ago

Medical necessity is determined by the needs of the patient, which can be physical or psychological. That's really a standard view in medicine, and thus justifies insurance payments for any required procedures. Examples would be gender reassignment, or plastic surgery.

wyager7• 12 years ago

Examples would be gender reassignment, or plastic surgery.

Almost nowhere (as far as I'm aware) offers taxpayer-funded plastic surgery, except perhaps in cases of extreme congenital deformation.

I don't think the case presented here is comparable. Many people are sterile, and it doesn't tend to have a cripplingly negative impact on their lives.

roghummal• 12 years ago

Medical necessity is determined by the needs of the patient, which can be physical or psychological.

Tell that to my insurance company. Bah :(

Mz2• 12 years ago

I am reminded of discussions I had with people about the article "War in the Womb" about what babies do to the mom. Both here on HN (https://news.ycombinator.com/item?id=8155574) and elsewhere, I talked a bit with people about how the cells left behind by the baby might impact my genetic disorder.

There is an awful lot we do not know about what motivates people to want a particular thing. Coping with my genetic disorder has been a long strange journey and has made me aware of a lot of weird potential explanations for why people sometimes go to crazy lengths for something.

We can never know what the path not taken would have led to for this woman. We can never know how her life would have turned out had she simply adopted instead or used a surrogate. We can do studies and we can talk about statistical correlation and so on, but there will never the chance to A/B test this for this specific individual. Maybe she did what was best for her, even if some total stranger on the Internet doesn't approve.

darklajid2• 12 years ago

It's not arbitrary and specific, it's natural.

You're attacking people for their inherent wish to be 'normal' and just have a kid like every other couple on this planet.

If we throw out the 'insane' label, I'd rather apply that to your position here. There's nothing wrong with adoption, but it's not the same thing (and usually not the first choice). I cannot even begin to imagine what you're complaining about here and why you consider that attitude worth sharing.

wyager7• 12 years ago

I cannot even begin to imagine what you're complaining about here

It seems pretty simple to me: it's stupid to waste hundreds of thousands of dollars (at least) to satisfy "their inherent wish to be 'normal'".

and just have a kid like every other couple on this planet.

There are many couples who don't have any kids. This doesn't mean it's not OK to want to have children if you can't; it just demonstrates that it's probably pretty silly to waste a ton of (public?) money and risk your life just for the sake of having children, particularly when you can acquire them in other ways.

RexRollman• 12 years ago

What I don't understand is the medical effort to do this in a world overrun with humans. It seems to be that we could be making better use of our time.

Mz2• 12 years ago

So tell me, are you American? Do you have a car? Do you eat everyday? Are you gainfully employed? Do you have any savings?

Surely you should be concerned about starving people in Africa or something instead of, say, wasting time on Hacker News?

We all put our time and effort into things that make sense for us. You are free to invest your time, money and effort in those things that matter to you. This mattered to them.

pygy_• 12 years ago

Next up: m2w trans pregnancies, then just male pregnancies.

Stem cells-derived gametes (of both types, regardless of the sex of the donor) are also around the corner.

Exciting times :-)

cherry_su• 12 years ago

Thomas Beatie (a m2w trans) got pregnant in 2007.

>> Beatie chose to become pregnant because his wife Nancy was infertile, doing so with cryogenic donated sperm.

https://en.wikipedia.org/wiki/Thomas_Beatie

stormbrew• 12 years ago

That's the other way around. Thomas Beatie was assigned female at birth. The GP is talking about someone assigned male at birth, I'm pretty sure. That's what 'm2w' or 'mtf' generally means.

bayesianhorse• 12 years ago

The amazing part here is that the immune system is very much involved in the early parts of the pregnancy. Successful "implantation" of an embryo in a transplanted womb with an immune-suppressed host is no mean feat...

Amarok2• 12 years ago

I don't understand why the successful implantation of the embryo is amazing.

Many women take immunossupressants while pregnant, and many undergo IVF to give birth, some of which to allogeneic embryos (egg donations). This last one doesn't seem to affect significantly implantation, with the main concern being a higher risk of pregnancy hypertension[1]. I expect conceiving with an allogeneic uterus would be similar, since in both the genetic differences between embryo and uterus are comparable.

Succeeding in combining the two is just a matter of probability, which I don't think is that low. Especially if you consider that the uterus had to come from a compatible donor, so the number of HLA mismatches will be lower.

1. http://www.ncbi.nlm.nih.gov/pubmed/20543201

mrfusion• 12 years ago

Would she have the womb removed when she's done having children? Seems like that would be worth doing to get off immunosuppressants?

And follow up, could the womb then be transplanted in someone else??

gus_massa• 12 years ago

Last sentence in the article:

The drugs used to prevent the womb being rejected would be damaging in the long term - so the couple will either try again or have the womb removed.

whiteshadow• 12 years ago

The only thing that made me weary here was having a baby on immunosuppressants, and the danger that could present for the fetus. Anyone knows if this can affect the baby on the long term (associated with premature birth)?

3rd3• 12 years ago

http://www.news-medical.net/news/20131111/Women-taking-immun...

Amarok2• 12 years ago

During pregnancy the mother was on a triple immunosuppressant regimen: azathioprine, tacrolimus, and prednisolone (corticosteroid). The first is a Pregnancy Class D drug (some reports of human birth defects), and the two are class C (birth defects only in animal studies)

A study on azathioprine use in early pregnancy found an increased risk of congenital malformations which wasn't statistically significant (from 4.7% to 6.2%) , and an association with preterm birth and low-weight[1]. But a later meta-analysis concluded only the increased risk of preterm birth was significant for this class of drugs[2]

It's mentioned in the article that the mother developed pre-eclampsia (simply put, hypertension during pregnancy, which can lead to eclampsia, with seizures and coma). This should also be a concern for the other women in the study[3]: Firstly, immunosuppressants might increase pre-eclampsia, since the risk is about double in women with a kidney transplant (22%). Also, the age of the donated uterus should be considered: the risk increases seven-fold for pregnancies after 50, though it hasn't been shown the problem is in the uterus itself. Finally, the risk is higher for IVF conception.

Given this accumulation of risk, I'm curious how the other pregnancies carry on.To understand what's at risk, being born preterm is associated with increased morbidity and mortality, as well as lower achievement in general. Some papers point towards epigenetic changes (DNA methylation) as the etiology.

1. http://www.ncbi.nlm.nih.gov/pubmed/19343728

2. http://www.ncbi.nlm.nih.gov/pubmed/22434610

3. http://press.thelancet.com/wombtransplant.pdf (original paper)

usbreply• 12 years ago

Why is it called a "womb" transplant rather than a uterus transplant ?

Womb is such a weird word to use.

blahedo• 12 years ago

In the US the word "womb" has a vaguely archaic or religious feel, but it seems to be much more current in UK English (and the link here is to the BBC). I've seen "womb" used regularly on UK sites. US-based news feeds (that I've seen) have indeed generally used the term "uterus transplant" about this story.

threedaymonk• 12 years ago

I can confirm that 'womb' is a perfectly normal word here in the UK. It's no stranger than 'fortnight' or 'autumn'.

First womb-transplant baby born

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