Meeting Report: Second World Congress of the International Society of Uterus Transplantation, Cleveland

Abstract

HISTORY OF UTERUS TRANSPLANTATION Until the recent rise in successful uterus transplantation, options for women affected by congenital or acquired absolute uterine factor infertility (AUFI) have been limited. Although varying significantly by geographic region, some women with AUFI have been able to achieve motherhood through adoption, foster parenthood, or in vitro fertilization with the use of a gestational carrier. Sadly, these options are either financially challenging or come at the cost of personal, religious, or philosophical conflict. These obstacles to parenthood can be prohibitive. Women born with Mayer–Rokitansky–Kuster–Hauser (MRKH, or congenital absence of a uterus) describe this to be a life-framing diagnosis that has critical impact on their relationships, work, and sense of self.1 Alternatives are desirable for the treatment of AUFI. Since the first baby born from a live donor uterus transplant from living donor uterus transplant (LDUTx) in Sweden (2015),2 developments in the field have proceeded at a rapid pace. In just a few years, the first live birth from a deceased donor uterus (DDUtx) was announced3 and the first successful robotic and laparoscopic uterus transplants have been reported.4-6 Moreover, numerous centers have either embarked upon or are in the process of establishing clinical trials in uterus transplantation.7,8 HISTORY OF THE INTERNATIONAL SOCIETY OF UTERUS TRANSPLANTATION The International Society of Uterus Transplantation (ISUTx) (www.isutx.org) held their World Congress in Cleveland, Ohio on September 6–7, 2019. The Cleveland meeting was the fourth meeting of the ISUTx since it was founded in 2016 in Gothenburg, Sweden. This meeting was the second biannual international World Congress for the Society; the first World Congress was held in Gothenburg, Sweden in 2017. Given the expedited pace of changes in the field, the Society has agreed to meet on alternate years for state-of-the-art meetings to ensure updated communications from active centers. At the Cleveland meeting, there were over 120 attendees representing transplant teams from almost every continent (Figure 1). Membership of the ISUTx is broad and multidisciplinary, including specialists, scientists, and researchers in transplant surgery, gynecologic surgery, reproductive medicine, maternal fetal medicine, biomedical ethics, and other associated disciplines. The mission of the ISUTx includes facilitating networking and research collaboration, improving education and advocacy, sharing knowledge and new discoveries, promoting research in the field, and establishing both an international outcome registry and consensus guidelines for uterus transplantation.FIGURE 1.: Attendees of the 2019 World Congress of the International Society of Uterus Transplantation.ETHICS PRECONGRESS WORKSHOP The precongress ethics workshop focused on research ethics and human subject protections within the context of innovative uterus transplant and reproductive research. Ethicists at the event underscored the importance of revisiting foundational ethical principles and addressing new ethical questions as transplant teams move to new stages in the evolution of this procedure.9 This has particular importance as minimally invasive approaches and alternate vascular outflow techniques may change risk:benefit for LDUTx.10 As research efforts transition to clinical implementation of the procedure, thoughtful ethical discussions become even more relevant. Ethicists at the meeting spoke about maternal-fetal and pediatric considerations, and the relevance of a yet unknown risk:benefit ratio with current small sample sizes. A true understanding of potential obstetrical and neonatal concerns will only emerge as the number of live births increases substantially and as these neonates are followed into adulthood. With those data becoming available, potential risks to donors, partners, recipients, and neonates can be more fully understood. A registry to ensure accurate and