A new surgical procedure is offering hope to women facing cancer treatment that could leave them unable to carry a pregnancy. The technique, known as uterine transposition, involves temporarily relocating the uterus to protect it from the damaging effects of radiation therapy. While still relatively new, the procedure has already resulted in the birth of at least five babies, including the first in Europe, born in Switzerland.
The procedure is particularly relevant for patients undergoing radiation therapy for cancers like rectal cancer. , a review published in Cureus highlighted uterine transplantation as a potential solution for fertility preservation in cancer survivors. However, uterine transplantation is a far more complex procedure than transposition. Uterine transposition offers a less invasive option for preserving the ability to carry a pregnancy.
“This kind of radiation can kill tumor cells, but it can also damage other organs in the pelvis,” explains Daniela Huber, a gyno-oncologist at Sion Hospital in Switzerland, who performed the surgery on a patient. “That includes the ovaries and uterus. People who undergo these treatments can opt to freeze their eggs beforehand, but the harm caused to the uterus will mean they’ll never be able to carry a pregnancy.” Damage to the uterine lining can hinder implantation of a fertilized egg and radiation can compromise the uterus’s ability to expand during pregnancy.
Huber’s patient, a 28-year-old woman, was diagnosed with a four-centimeter tumor in her rectum. Her treatment plan involved medication and radiotherapy prior to surgical removal of the tumor. While egg freezing was an option, the patient faced a significant hurdle: surrogacy is illegal in Switzerland. This prompted Huber to explore alternative solutions.
Huber turned to the work of Reitan Ribeiro, a gynecologist oncologist who pioneered the uterine transposition technique at Erasto Gaertner Hospital in Curitiba, Brazil. Ribeiro’s approach involves carefully moving the uterus, fallopian tubes, and ovaries from their normal position in the pelvis and temporarily securing them in the upper abdomen, below the ribs. This repositioning shields these organs from the direct impact of the radiation.
Ribeiro and his colleagues first published their findings in , detailing the case of a 26-year-old patient with a rectal tumor. According to Ribeiro, the patient had been informed by other doctors that her cancer treatment would likely result in infertility and actively sought a way to preserve her ability to carry a child. The initial case report, published in The American Journal of Obstetrics and Gynecology, demonstrated the feasibility of the procedure.
The process isn’t without its complexities. The uterus is repositioned either two to four weeks after the start of radiation therapy or concurrently with the surgical removal of the tumor, particularly in cases of rectal cancer where neoadjuvant treatment (treatment before surgery) is employed. Following the completion of cancer treatment, the uterus is returned to its original position. According to a study published on ScienceDirect, cancer treatment and follow-up care adhere to standard medical guidelines.
While uterine transposition doesn’t guarantee future pregnancy, it significantly increases the chances for women who wish to carry their own biological children after cancer treatment. The procedure addresses a critical gap in fertility preservation options, particularly for those who cannot or choose not to pursue surrogacy. Johns Hopkins Medicine has also offered ovarian transposition for decades, a similar procedure focused on protecting the ovaries and preserving ovarian hormone production.
The success stories, including the recent birth of baby Lucien and at least three others, are fueling growing interest in uterine transposition. The procedure represents a significant advancement in the field of oncofertility – a relatively new discipline focused on preserving reproductive health for cancer patients. As more data emerges and surgical techniques are refined, uterine transposition is poised to become an increasingly important option for women facing the difficult choices that often accompany a cancer diagnosis.
