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Abstract(s)
A infertilidade é definida pela Organização Mundial de Saúde como a incapacidade de
conseguir uma gravidez clínica após 12 meses de relações sexuais desprotegidas. Ao
longo dos anos, com o intuito de ultrapassar diversas causas de infertilidade e, em
última instância, alcançar uma gravidez, as técnicas de Reprodução Medicamente
Assistida (RMA) têm sido desenvolvidas e aprimoradas. Porém, a infertilidade por fator
uterino (IFU), caracterizada pela ausência congénita ou adquirida do útero ou presença
de um útero não funcional, que impossibilita, de forma permanente, a gestação e
descendência de origem biológica, permanece a principal causa de infertilidade
feminina sem tratamento.
Nas últimas décadas, a investigação com recurso a modelos animais e ensaios clínicos,
a par dos avanços científicos no campo da cirurgia reprodutiva, permitiram a
introdução do transplante de útero (TxU) enquanto tratamento da IFU. O TxU restitui
a anatomia reprodutiva e, dessa forma, possibilita a gravidez e a oportunidade de
experienciar a gestação e alcançar a maternidade.
Atualmente, o TxU é unicamente realizado em mulheres com IFU, sendo possível a
utilização de dadoras vivas ou post-mortem. A seleção rigorosa da recetora e da dadora
é um passo essencial para maximizar o sucesso do TxU e minimizar os riscos
associados. De momento, a laparotomia é a abordagem clássica utilizada na
histerectomia da dadora e na reimplantação do enxerto na recetora. As complicações
relacionadas com o procedimento são descritas com base na classificação de ClavienDindo e estão, sobretudo, associadas aos procedimentos cirúrgicos. Em relação à
descendência, de acordo com os dados publicados até ao momento, os valores da escala
de Apgar, peso à nascença e desenvolvimento, têm sido normais.
Assim, o TxU assume relevância clínica por ser um possível tratamento da IFU e,
portanto, uma alternativa à adoção e gestação de substituição que, por diversas razões,
poderão ser opções inviáveis para as mulheres. Embora subsistam desafios éticos e
médicos, o progresso alcançado até ao momento destaca o potencial do TxU que tem
modificado a ideia de que a IFU é absoluta e permanente.
As defined by the World Health Organization, infertility is the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. To overcome some of the causes of infertility and achieve successful pregnancies, Medically Assisted Reproduction (MAR) techniques have been developed and perfected throughout the years. However, uterine factor infertility (UFI), characterized by congenital or acquired lack of a uterus or the presence of a non-functional uterus, permanently making pregnancy and offspring of biological origin impossible, remains the main cause of untreated female infertility. In the last few decades, research using animal models, clinical trials and several scientific advances in reproductive surgery have led to the introduction of uterine transplantation (UTx) as a possible treatment for UFI. UTx restores reproductive anatomy, thus enabling the opportunity to experience pregnancy, gestation, and biological motherhood. Nowadays, UTx is only carried out on women with UFI and both living and postmortem donors can be used. A rigorous recipient and donor selection is an essential step in maximising success and reducing associated risks. At the moment, laparotomy is the classic approach used for donor hysterectomy and graft reimplantation in the recipient. Complications related to the procedure, described using the Clavien-Dindo classification, are mainly associated with surgical procedures. According to data published so far, Apgar scores, birth weight and development of the offsprings have been normal. UTx is, thus, clinically relevant to treat UFI and therefore, an alternative to adoption and surrogacy, which, for different reasons, may not be viable options for women. Although ethical and medical challenges remain, the progress so far highlights the potential of UTx and is changing the idea that UFI is an absolute and permanent condition.
As defined by the World Health Organization, infertility is the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. To overcome some of the causes of infertility and achieve successful pregnancies, Medically Assisted Reproduction (MAR) techniques have been developed and perfected throughout the years. However, uterine factor infertility (UFI), characterized by congenital or acquired lack of a uterus or the presence of a non-functional uterus, permanently making pregnancy and offspring of biological origin impossible, remains the main cause of untreated female infertility. In the last few decades, research using animal models, clinical trials and several scientific advances in reproductive surgery have led to the introduction of uterine transplantation (UTx) as a possible treatment for UFI. UTx restores reproductive anatomy, thus enabling the opportunity to experience pregnancy, gestation, and biological motherhood. Nowadays, UTx is only carried out on women with UFI and both living and postmortem donors can be used. A rigorous recipient and donor selection is an essential step in maximising success and reducing associated risks. At the moment, laparotomy is the classic approach used for donor hysterectomy and graft reimplantation in the recipient. Complications related to the procedure, described using the Clavien-Dindo classification, are mainly associated with surgical procedures. According to data published so far, Apgar scores, birth weight and development of the offsprings have been normal. UTx is, thus, clinically relevant to treat UFI and therefore, an alternative to adoption and surrogacy, which, for different reasons, may not be viable options for women. Although ethical and medical challenges remain, the progress so far highlights the potential of UTx and is changing the idea that UFI is an absolute and permanent condition.
Description
Keywords
Cirurgia Reprodutiva Fator Uterino Infertilidade Transplante Útero