Uterus transplantation: on the edge.

Uterus transplantation for absolute uterus factor infertility is moving closer to human trials. The indication for uterus transplantation is evident as is its potential to ameliorate the social and personal burdens of these patients. The extensive collaborative research efforts between animal works, advancements in transplantation medicine, and immune suppression have culminated in demonstrating its apparent feasibility. As for the concerns regarding its risk, in perspective it is similar to other high-risk pregnancies. Moving uterus transplantation toward clinical applications obviously will require a continued commitment of research and support.

Oral diindolylmethane (DIM): pilot evaluation of a nonsurgical treatment for cervical dysplasia.

OBJECTIVE: Standard surgical treatment for CIN may impair fertility generating a need for alternative treatment options. We tested the efficacy and toxicity of oral DIM in the treatment of CIN 2 or 3 lesions. METHODS: Patients with biopsy-proven cervical intraepithelial neoplasia (CIN) 2 or 3 scheduled for loop electrosurgical excision procedure (LEEP) were randomized 2:1 to receive diindolylmethane (DIM) (BioResponse-DIM, BioResponse, Boulder, CO) orally at approximately 2 mg/kg/day for 12 weeks or placebo (defatted rice bran, BioResponse). Subjects were evaluated every 3-4 months for 1 year. Analysis of data up to 1 year was assessed including Pap smear, HPV, colposcopy, biopsy and physical examination were performed at follow-up. Central pathology review confirmed all histology diagnoses. RESULTS: To date, 64 subjects (mean age 28 years, range 18-61) have been enrolled (45 in the DIM arm, 19 in the placebo arm), with 60 available for analysis. Average follow-up was 6 months. At enrollment, 58% were diagnosed with CIN 2 and 42% with CIN 3, 57% of subjects were Caucasian, 15% African American, 12% Hispanic and 17% Asian. During treatment 2 subjects (3%) complained of nausea (grade 2) at the 3- to 4-month visit. No systemic toxicities were observed (normal CBC, LFTs, comprehensive metabolic). Forty-six subjects had biopsies at first follow-up (77%). Twenty-one subjects (47%) in the DIM group had improved CIN with a decrease by 1-2 grades or a normal result. Median time to improvement was 5 months. Improved Pap smear was seen in 49% (22/45) with either a less severe abnormality or normal result. Colposcopy improved in twenty-five subjects in the DIM group (56%). Of these 25 subjects, 21 (84%) had improved colposcopic impression, 13 (52%) had a decrease in involved quadrants and 18 (72%) had a decrease in lesion number. Complete colposcopic response was observed in 4 subjects (9%). Stratifying by level of dysplasia, age, race, HPV status, tobacco use, contraceptive used did not alter the results. At median follow-up of 6 months, 85% of subjects have not required LEEP based on routine clinical triage of improving global assessment. There was no statistically significant difference in any outcome between the DIM and placebo group. CONCLUSION: Oral DIM at 2 mg/kg/day is well tolerated with no significant toxicity. We observed a high rate of clinically significant improvement in confirmed CIN 2 or 3 lesions among both treatment groups in this randomized clinical trial.

A pilot safety and tolerability study of a nonhormonal vaginal contraceptive ring.

OBJECTIVE: To conduct a pilot safety and tolerability study of the Ovaprene ring (Poly-Med Inc., Clemson University, Clemson, South Carolina) as a barrier contraceptive. STUDY DESIGN: Open-label, single-arm, observational study in a convenient sample of volunteers. Women meeting inclusion criteria and using another contraceptive method were instructed in proper insertion of the ring at the completion of their menses, with removal at their subsequent menses or 29 days. Baseline Pap smears, vaginal cultures and colposcopy were performed, with follow-up postcoital testing and acceptability questionnaires. RESULTS: Twenty women enrolled; all completed one cycle of use. Rings were inserted properly and retained in place (range, 5-29 days). Patient questionnaires revealed no pain or bleeding, and no colposcopic abnormalities were seen. Semiquantitative cultures yielded no significant changes in vaginal flora. Postcoital testing revealed nonviable sperm (motile/total, mean count/10 high power fields) 2/ > 20 in the vaginal pool and 0/0 in cervical mucus. There were no serious adverse effects. CONCLUSION: The Ovaprene device is well tolerated and acceptable to sexually active women and their partners.

Uterus transplant techniques in primates: 10 years' experience.

Preserving and restoring fertility are important quality-of-life outcomes for cancer survivors and others who cannot bear children. Transplantation has advanced sufficiently to allow nonvital organ transplant to become a reality. Together, research on reproductive organs and transplantation has resulted in live human births from ovary transplants used to treat absolute ovary factor infertility. Each year, approximately 5,000 women under the age of 25 years undergo a hysterectomy. From various other causes, approximately 9 million women of childbearing age in the United States currently have absolute uterine factor infertility due to the absence of the uterus. Research on uterus transplantation has been reported for decades from multiple institutions around the world. Our group has been involved in the area for more than 10 years. To encourage other investigations in this area, we summarize our results in primates as a proof of concept that uterus transplants can be theoretically done.