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Bioengineered Uteri and the Promising Future of UFI Treatment

Scientists in a 2019 study experimented with the transplant of artificial uteri to aid patients suffering from UFI. What does this mean for the future of reproductive medicine?

February 19, 2021
Nora Tomer

In the past, women who experienced UFI and desired children had few places to turn. If treatments were unsuccessful they could seek to adopt or pursue surrogacy. But soon there may be more options available to UFI patients thanks to the wonders of bioengineering, transplants, and ectogenesis. 

But first, a few questions: 

What is Bioengineering?

Bioengineering, also known as tissue engineering or regenerative medicine, is a science that seeks to heal wounds, illnesses, and conditions using artificially created or promoted tissue growth

The traditional method of tissue repair and organ replacement is grafting and transplanting. In the case of grafting, patients will have excess tissue taken from another area of their body and sewn, or grafted, onto the body. This process is often painful and can result in scarring. Organ donors are sought when a patient’s injuries or conditions are too great and they require a replacement for the original organ. However, donated organs run the risk of being rejected by the body, resulting in infections, pain, prolonged medical problems, and possibly death. 

In bioengineering, these problems can be avoided altogether. Instead of taking a graft or waiting for a donor, doctors extract stem cells from the patient and plant them into a scaffold, a structured blueprint for the cells to follow. The scaffold is made using porous, growth promoting materials that are safe for the body. Monitored in a lab setting, the stem cells are then stimulated to grow along the scaffold and reproduce the tissue or organ in question. The scaffold is then either allowed to continue developing in vitro (aka the lab setting) or placed inside the patient to regenerate in vivo (aka in the body). 

Scientists have managed to create working kidneys, livers, hearts, and more. While there has been a fair bit of success, bioengineering is still a new scientific field. For this reason, it remains an experimental practice.  

A man stands in a science lab taking a sample from a petri dish. Behind him is a woman conducting an experiment.
New medical fields like regenerative medicine are creating more options for those with chronic illnesses.

What is Uterine Factor Infertility?

Uterine Factor Infertility (UFI) is an umbrella term containing any infertility condition that involves the uterus. UFI can be treatable or it can be an irreversible congenital condition. Patients with various forms of UFI may experience infertility, miscarriage, premature delivery, and other related health issues. 

These symptoms can be painful, stressful, and traumatizing and for some it may seem there is no solution. But, the Wake Forest Institute for Regenerative Medicine (WFIRM) has released a study that may bring a new hope to those experiencing UFI.

Now that we know the basics, let’s dive into the research! 

The Wake Forest Study

In 2019, the Wake Forest Institute for Regenerative Medicine (WFIRM) released a study that sought to discover whether bioengineered uteri could be an effective treatment for UFI

WFIRM, located in Winston-Salem, North Carolina, is the entity behind many of the founding principles of bioengineering. WFIRM deems “regenerative medicine as the “next evolution of medical treatments,” so this study was right up their alley. 

The experiment used four groups of rabbits, all of which had their uteri removed. Two of the groups received polymer scaffolds to facilitate the regrowth of the uterus, with only one received a scaffold implanted with stem cells from the test subject. 

Once the new uteri were finishing growing within labs, they were transplanted into the rabbits. Six months later, after recovering from the surgery, the rabbits mated with fertile males. Of the rabbits who received the seeded scaffolds, all experienced successful conception, gestation, and live birth. Koudy Williams, DVM, co-author of the study, remarked, “Our results indicate that the tissue-engineered uteri responded to the expansion and mechanical strains that occur during pregnancy.”

The researchers hope bioengineered uteri may one day be a solution for women with UFI and other fertility disorders. An artificial uterus seeded with the patient’s stem cells would also be resistant to transplant rejection, resulting in fewer health complications following the surgery. But, although the study is promising, it still has a long way before going to clinical trials or reaching the public. 

Along with bioengineered uteri, researchers are also exploring the possibility of uterine transplants, a process that has reached the human stage of experimentation.

A woman stands outdoors in the sunshine while she rests her hands on her pregnant stomach.
Options like uterine transplants could lead to more successful births by women with UFI.

Uterine Transplants

In June of 2019, a baby girl was born in Cleveland. While that fact alone may not seem newsworthy, her claim to fame comes from the fact that she was the first baby born in America through the use of a transplanted uterus

Her mother was a woman in her mid-30s who participated in a research trial for women with UFI or those who had premature hysterectomies. The trial only used uteri from deceased donors as a living donor would need invasive abdominal surgery to retrieve the organ. Once each mother healed from her surgery, she conceived through in-vitro fertilization. Of five transplants, three were successful. These mothers then carried their babies to term and delivered them via C-Section. 

Similar experiments have emerged worldwide, notably in Sweden. The Swedish study also focused on decellularization (the removal of identifying donor cells) and discovered that even if a donated uterus came from a postmenopausal woman, it still became functional once it was transplanted to the patient

In practical use, researchers believe these bioengineered uteri would not be a permanent solution. After 1-2 conceptions and/or births, the uterus would be removed rather than remain a part of the patient’s lifelong anatomy. Still, even if the uterus is not for keeps, the leaps and bounds of this medical advancement are baffling. Problems that once seemed immutable are now handled using methods previous generations would have deemed science fiction. 

A mother in a hospital holds her newborn baby to her chest.
Whether a baby enters the world by traditional or unconventional means, it is always a reason to celebrate.

Science Fiction No More

A final form of biological experimentation is ectogenesis. It may bring to mind scenes of babies suspended in strange, futuristic looking pods, like something from Aldous Huxley’s Brave New World. But, ectogenesis is not as far fetched as we think. 

In simple terms, ectogenesis is the development of embryos in artificial conditions outside the uterus. In some ways, we have already begun experimenting with ectogenesis through the use of other fertility treatments. In vitro fertilization can be a form of ectogenesis, along with the practice of embryonic freezing. However, ectogenesis could prove an alternative to uterus transplantation. 

Uteri created and maintained outside the human body could foster premature babies who need more development time but cannot remain inside of their mother. It would be a solution involving no surgery or direct health risks to the mother. And, mothers would still have influence on their fetuses’ gestation by providing hormonal/maternal components to benefit the baby in utero. 

Ectogenesis is a concept that still requires immense experimentation before it is even considered being applied to humans. But, given the recent successes of other fertility science experiments (IVF, uterus transplant with live birth, as well as the strides of tissue engineering), this concept may venture outside of science fiction into the world of reality sooner than we thought. 

Whether it be a bioengineered uterus, a transplant, or ectogenesis, fertility treatments continue to advance and evolve beyond what anyone could have predicted. One day soon, anyone who wishes to be a mother will have the opportunity to do so in whatever way suits them best and the world will be a better place for it.

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