Insurers in the life sciences sector know that fertility treatment is one of the fastest developing areas of medicine. The recent news of the first successful womb transplant is a reminder of the challenges faced by insurers every time science takes a leap forward.
In October this year, a 36 year-old Swedish woman gave birth to a healthy baby boy. Although over 350,000 babies are born every day worldwide, the birth of Vincent (meaning “to conquer”) generated universal interest, particularly in the life sciences sphere. Why? Because Vincent is the first child to be born from a transplanted womb.
Whilst Vincent is a medical miracle, insurers should note the scientific reservations that have been raised regarding the safety, reliability and mainstream use of the procedure.
Despite having healthy ovaries, Vincent’s mother was born without a uterus. Her condition, known as Rokitansky Syndrome, is a congenital abnormality which affects one in every 5,000 women. Other women can be left without a functioning womb because of cancer treatment.
Vincent’s mother did not accept the inevitable: that the absence of a womb would prevent her from carrying her own child. As a result of Professor Mat Brannstrom’s pioneering approach, and a day-long operation, Vincent’s mother was successfully transplanted with the uterus of a 61 year-old family friend.
Relying on three different immunosupressants to prevent rejection of the womb, a year after the transplant, surgeons transferred a single embryo (created in vitro, using the woman’s eggs and her husband’s sperm) into the transplanted womb.
Despite three mild rejection episodes, the baby was developing well until the 31st week of pregnancy when his mother developed the extremely dangerous condition, pre-eclampsia. Surgeons acted quickly and Vincent was delivered by caesarean section, weighing 3.9lbs. After 10 days being cared for in the neonatal unit, Vincent was taken home by his parents.
Of course, such treatment has been a long time coming.
The uterus transplantation research project began at the University of Gothenburg over 15 years ago. The aim of the project is to enable women without a womb to carry, and give birth, to their own children. As Professor Mats Brannstrom, leader of the Gothenburg team explained: “Our success is based on more than 10 years of intensive animal research and surgical training by our team”.
Prior to the success of the Gothenburg team there were two failed attempts at uterus transplantation in Saudi Arabia and Turkey. Doctors in many European countries, as well as Japan, are planning to attempt similar operations but using the uterus of a recently deceased woman, as opposed to a live donor.
Marvel or Menace?
As Vincent’s father explained: “It was a pretty tough journey over the years, but we now have the most amazing baby”.
Of course, for those individuals involved, or those hoping to become involved, this pioneering treatment is a medical miracle. Women who thought that they would never be able to bear their own children now have the distinct possibility before them.
Scientists too are excited by the progress that the operation represents, with Dr Allan Pacey, the chairman of the British Fertility Society, commenting: “I think it is brilliant and revolutionary and opens the door to many infertile women. The scale of it feels a bit like IVF. It feels like a step change. The question is can it be done repeatedly, reliably and safely”.
However, the transplant has caused much ethical and scientific debate. First, is the cost of the treatment. In this case, the operation, follow up and immunosuppressant drugs cost around £100,000 with the research paid for by the Jane and Dan Olsson Foundation for Science, a Swedish charity. Many have questioned how other treatments will be funded, and where such money will come from.
Further scientific reservations have been raised. As Dr Glenn Schattman, past president of the Society for Assisted Reproductive Technologies and a Cornell University fertility specialist, said, womb transplants are likely to remain very uncommon: “it requires a very long surgery and not without risk and complications.”
In the ethical debate, critics have argued that taking a womb from a living donor is unethical, and very risky for an operation that is not lifesaving. Others query the necessity when there are so many children who need adopting.
Whatever your view, it is clear that fertility treatment is fast progressing and it is important to consider what this may mean for the medical, legal and insurance world.
For the scientific sphere, it seems that this is only the beginning. Professor Mats Brannstrom has explained that, in the next decade, he hopes to have grown a womb in the laboratory. There has also been much speculation about what other transplantations may now be achievable.
For insurers, it is important to consider the ramifications that such medical advances may have. Whether it be the scope for increased claims (resulting from such complex surgery) or the need for specific and bespoke insurance, it is clear that as medicine advances, so too must the legal and insurance response.