- [Drew] It's crazy that this is happening.
- [Jen] Yeah.
(knocking on door)
- Hi.
- [Nurse] Can I have your first and last name?
- Jennifer Gobrecht
Try not to freak out too much.
- I'll try.
- Okay?
- [Nurse] There's gonna be
a little bump coming up, okay?
- Alright.
- You're gonna do great, okay?
- Stop crying.
It's gonna be okay.
- Okay (sighs).
- Love you.
- Love you, too.
You're gonna do great, okay?
I'll see you when you wake up.
Alright.
(steady music)
- That's a good one.
- Yeah, we got baby pictures of Drew.
- [Drew] Yeah, the baby pictures.
- [Jen] Potentially what
our future children will look like.
- [Drew] Oh, god. (scoffs)
- [Jen] You were cute.
- We've only just started
having these conversations.
The conversations of what's it gonna be like
to have kids, because it was never,
we never talked about the... after,
it was always like,
"How do we even get to that point?"
That was always the conversation.
- We understand how to keep a child alive,
(laughs) but other than that...
- (laughs) We're probably not as prepared
as we should be because we haven't thought
about that part of it.
- [Jen] I was going into
my senior year of high school
when I finally was officially diagnosed.
Because my uterus never fully formed,
I would never be able to have children naturally.
- When Jen got the diagnosis,
it wasn't, "It'll be hard."
It wasn't,
"You'll have to take extra steps."
It was, "It's not possible."
"She can't give birth."
We could have had kids through a surrogate,
we could have adopted,
but Jen would never be able
to carry children.
- To be able to have a family with Drew
in a more natural
way, I never thought that
this would ever be an option.
(mellow music)
- I see patients with uterine factor infertility,
and I was never
satisfied with the limited options
that they had.
We say, "Okay, the
best options for you are
gestational surrogacy, or adoption."
I'm very glad those
exist, but for many patients,
they didn't really satisfy
the way in which they wanted
to achieve parenthood.
So we really saw an opportunity to develop a
both clinical uterus transplant program,
and a robust research
experience for uterus transplant.
- I thought that this was an outstanding opportunity
to be able to actually take transplantation
into a new domain, and to
care for a patient population
that, prior to this, has never been served
by the miracle of organ transplantation.
- Jen and Drew really stuck out.
They had a really good understanding
of uterus transplant before we even sat down.
- [Drew] We had seen that
they were doing uterus transplants
around the world,
but we never thought of it
as a possibility.
- When I saw that Penn was doing one,
I said, you know, I'm gonna apply for it.
We're looking into these types of options,
this is another option to explore.
- They were dedicated not only to their goal,
which is to have a child,
and to have Jen carry that child,
but if it didn't work, to advance the field
of uterus transplant.
- And what Jen said to me blew my mind,
because she said,
"Even if we take part in this,
and we don't get the outcome we're looking for,
we could potentially help someone else
in the same position as us."
- This is the consent form.
So, "I, Jennifer Gobrecht, Drew Gobrecht..."
- [Dr. Porrett] It's a credit to
Jen and Drew's exceptional courage
that, when they started this,
there had not been a successful birth
from a deceased donor transplant recipient.
- It wasn't until we got a call from Dr. O'Neill
and she asked to meet with us,
that it sort of sunk home,
and then she went into great detail
and explained exactly what was going
to be involved in the study.
(slow music)
- Once they're selected
as a good candidate for the trial,
they need to undergo
in vitro fertilization to create embryos.
They have their organ transplant,
and then ideally,
6 to 12 months after their transplant,
we begin attempts
at pregnancy with embryo transfers.
If they successfully achieve pregnancy,
we monitor them until 37 weeks.
These women cannot deliver babies vaginally,
so they have to have C-Sections.
After one live born child,
if they would like to try again,
six months after their C-Section,
we try embryo transfers again.
Up to two live-born
children are provided for in our trial.
And then at the end, we remove the uterus,
and they stop the immunosuppressive regimen.
We waited for an
appropriate donor to become available.
What that consists of,
is unfortunately, an individual undergoes
a catastrophic event and is donating their organs.
- The phone goes everywhere,
because that organ offer can come at any time.
(upbeat music)
- We could get as little notice as 12 hours.
So you could get the call,
and have to basically
go to the hospital right away.
- I remember exactly where I was
when I got the phone call,
and how everything else just stopped.
Dr. Latif and I walked out of my office suite,
and I looked at him
and I said, "This better work."
(inspirational music)
We left the hospital to go out and procure the organ.
(phone ringing)
- The phone rings. I see that
it's Dr. O'Neill and I pick it up,
and I'm like, "Hello?"
- [Jen] It was shocking.
- [Clerk] Just sign your name right here.
Which arm would you prefer, please?
- This one.
- [Drew] It felt very urgent, in terms of emotionally,
it was like, "Oh my God,
this is happening right now, this is crazy."
But when you get to the
hospital, we were waiting
for Dr. Porrett and Dr. Latif to finish up
retrieval of the organ, the transport.
- Oh, so you did two swabs?
- Dr. O'Neill was up to her elbows
in helping make sure that
all the players were exactly
where they needed to be.
- No, we can now, yeah, that's fine.
- I was waiting for the call,
"No, unfortunately,
it doesn't look suitable for transplant."
But she called and said,
"Everything went well, we're coming back."
I was so excited to go tell Jen and Drew,
because I'm Dr. Doom.
I tell these patients, "There's no guarantee."
So to tell them
we're going to do the transplant was
really an incredible moment.
- Hi. Are you gonna walk to the stretcher?
- [Jen] Okay.
- [Drew] Putting her on the bed, walking her down,
it's sinking in for me at that moment.
- [Dr. Porrett] The family members are the people
that I actually always worry about,
because that's the time
when we take the precious cargo
away from them,
and that's when it makes it real,
and they get scared.
- You're gonna do great, okay?
- Stop crying.
- I'll see you when you wake up.
- Alright.
I definitely was nervous,
but I just kinda knew, like, "Okay, well,
it's now and it's happening."
- [Dr. O'Neill] Alright Jen, ready?
- [Jen] Ready!
- [Dr. O'Neill] Let's do it, lucky number 17.
- [Jen] Oh, this is my lucky number.
- The stakes are high in uterus transplantation
for a variety of reasons.
Roughly 25-30% of all uterus transplants done
in the world have ended in graft loss
because of a blood clot or this thrombotic event
that we don't understand much about.
There was a very real possibility
that she would go endure a long,
and potentially difficult surgical procedure
to lose the donor organ in just a couple of days,
and that's very sobering.
We had a series
of conversations between Dr. O'Neill, myself,
and Dr. Latif,
who is another key member of our team,
and my co-pilot, so to speak, my co-surgeon.
- [Dr. Latif] We knew that for
Jen's surgery to be successful,
the collaboration between
GYN oncology and transplant surgery
and the countless hours of training and practicing
had to work perfectly in sync in that moment.
- [Dr. Porrett] There's two major technical phases
for a uterus transplant in the operating room.
One is to actually sew the blood vessels
from the donor organ, to attach those
to the recipient's blood supply,
and the second other
major phase is to actually establish
the continuity between the donor vagina
and the recipient's vagina.
We have a special sterile area
where we can keep the organ on ice
to do any final surgical preparation.
Mostly ensuring that the
blood vessels were up to the task
that they had before them,
which would be to not
bleed when we reestablish that blood supply.
- Cut this here longitudinally,
right, and you just made this ellipse right here.
- [Dr. Porrett] While I was preparing the organ
with Dr. Kovach and Dr. Latif,
my surgical colleagues were working
to actually open up Jen's abdominal cavity,
and prepare the area where the uterus was gonna go.
So, we'll trim the vessels back
and get everything happy here.
Then you come over here,
and do the colpotomy here.
And then I think we're ready to actually sew.
- It's a stressful process.
This is the scariest part, right?
This is the part where
things could really go wrong
if they're gonna go wrong.
So I'm just trying to keep my mind off that
as best I can.
I wish I could just (laughs) be in there.
I keep telling myself
that these are the best doctors
in the world,
so that's what's keeping me okay.
- [Dr. Porrett] One of the
things we worry about a lot
in transplantation,
and specifically with this organ,
is the amount of time
that the organ is outside
of the body, not getting blood flow.
So we need to work fast
to be able to get to the point
where we can actually reestablish blood supply.
This is one of the parts of greatest risk
for the recipient,
because when we reperfuse the organ
and take the vascular clamps off,
there's the potential for significant blood loss.
I release the clamps, I'm not sure that I breathe,
I don't even remember.
The organ starts to pink up.
You guys are amazing!
- [Dr. O'Neill] When the uterus goes
from that whitish color to pink,
it was incredibly exciting.
- [Dr. Porrett] Profound relief, I think,
is probably what I was thinking,
in addition to the fact that we've got a lot more
to do in this operation yet before we're done.
The next phase is actually
to complete the vaginal anastomosis,
which is the sewing work between the vagina
of the donor and the recipient.
The pelvis is a notoriously difficult place
for a surgeon to work,
and this is where Dr. Latif's expertise
as a gynecologic surgeon was invaluable.
- [Dr. Latif] For the
transplanted uterus to be monitored,
we have to be able to do biopsies of the cervix.
My focus at that point was to make sure that
this connection between the transplanted uterus
and Jen's body is perfect.
Because I knew it's
not important just for that moment,
but it's also going to be
important for the next year and a half,
because that's the only way
we're going to monitor this organ.
- [Dr. Porrett] It really
required the three of us together to
work at it, to change our approach, to do it again.
I'm really picking your brain on whether you think
we should go here or here?
- [Dr. Latif] The issue is going
to be, if this is the anterior vaginal wall,
we're going to open here,
the vagina is going to sit here,
it's not going to be there, it's going to be, literally...
- [Dr. Porrett] So you mean
it's gonna be more anterior?
- [Dr. Latif] More anterior, yeah.
- You know, when she wakes up,
she might have a
uterus for the first time in her life.
So that's a crazy thing, that's a crazy thing.
- [Dr. O'Neill] When we
walked out of the operating room,
we knew we still had
a long road ahead of us,
but the uterus was in place,
and was perfused,
and the vaginas were attached,
and the abdomen was closed.
So that was a huge moment.
It was a moment of celebration.
It was a moment of success.
- Thanks everybody for your help.
- Thank you, everyone.
- Nice work, hard work.
- They're gonna bring
her up here to the ICU, okay?
To the bed that she's at,
and the nurses
are gonna settle her in, okay?
So it's probably gonna be an hour-ish
until you can see her.
- Okay.
- The other detail is, we
will be road tripping tomorrow
because the ultrasounds we do,
and the exam that we're going to do,
is going to be done in a
different part of the hospital.
So that's one of the ways we monitor
how the graft is doing.
- Okay.
- [Dr. Latif] I've seen so many uteri in my life,
and this is a very, very healthy uterus
before and immediately after transplantation.
If you look at it, it looked to me
as if this was a normal, natural uterus.
- Deep breath, and we'll touch base later, okay?
- [Drew] Okay, thank you all.
- [Dr. O'Neill] Of course.
(Drew exhaling)
One of the first questions she had was,
"How did it go?
Is there a uterus in there?"
And I said,
"Yes, there is a uterus in there."
- [Jen] And I think I just started crying,
and then I was so excited
that something I never
thought would happen happened.
- It was probably another hour
before I could actually go up and see her,
and they're being all somber, like,
"I'm warning you, she's
got a lot of tubes coming
out of her," and you
know, blah, blah, blah.
So I'm expecting this horrid scene,
and her to be like half-dead,
and I walk into the room, and I'm like,
"Hey, are you doing okay?"
And you know, she's like firing off jokes,
and talking to people.
- [Jen] Maybe that could've been attributed
to the pain medicine, but then,
I was just extremely excited and happy.
- I was ready to cry, and she was like,
"You're not allowed to
cry, because if you cry,
I'm gonna cry, and that's
gonna hurt, so no crying."
(Both laughing)
- Every gesture,
and every nurse, they were so kind.
At points I was crying
over how nice they were,
and how invested they were in us.
It is refreshing to move around.
- How are you feeling?
- I was riding the surgery high,
and then yesterday
kinda came crashing down.
- The Achilles' heel of this
operation to date has been
the fact that there's, essentially,
a clot that can form in the blood vessels
that provide blood flow to the uterus,
or bring blood flow out of the uterus,
and so we do a lot of
monitoring of the organ
to make sure there's blood flow.
- How's the blood flow look?
- Great!
Nothing has changed, it all looks really nice.
- You guys are filling my
head with all this good news,
I'm worried when the
other shoe is gonna drop.
- [Dr. Porrett] Let us enjoy the moment.
In uterus transplantation, the organ is
tucked away inside
the body, and we have no biochemical
parameters, no blood test, no great test
to actually monitor the well-being of the organ.
- [Dr. O'Neill] One of the ways we measure
how the graft is doing,
is her actually having
menstrual cycles and periods,
so that's gonna be, I think,
an exciting day,
is when she has her first period.
- [Drew] That's not really embarrassing,
it's just you in your uniform.
- [Jen] I was a cute Catholic school girl.
It is weird being a teenager,
and seeing all your friends
go through their rite of passage
and womanhood,
and kinda feeling sort of left behind,
and now having it, and being like,
"Oh, so this is what
you guys were complaining
about all those years!" (laughs)
That one's my most embarrassing.
- [Drew] Yeah, that's definitely it.
- We were all thrilled, because it meant
that the uterus was perfused,
and the uterus was functioning.
I celebrated that first period
just like I did the end of the transplant surgery.
It was really exciting.
- Hi!
Hi, how are you?
- [Drew] You know, nervous. (laughs)
- Okay, I'm not nervous, I'm just excited.
- I'm excited. He can be nervous.
- So, they thawed one embryo,
and the embryo
survived the thaw, looks good.
Josh is the embryologist back there.
I don't know any information other than
that they picked the best one, so we'll see.
- My thing was,
a lot of this is not normal,
let's have one normal thing.
- Yeah, I like it.
- [Drew] We had not
wanted to know the sex of the baby,
we were waiting to be surprised.
- Being surprised was
something we could control,
and something we had for ourselves,
that just was really simple, and natural,
and not high tech or scientific.
- I just have to decide if I'm going to stay
in the dark also, or if I'm going to try
to figure it out.
- How good is your poker face, though?
- It's really good.
- Okay.
(all laughing)
- Spot on, I've done this a lot.
Jen's embryos have been in the laboratory
and were frozen,
and this morning we are going
to directly place one
embryo back in Jen's uterus.
I just wanna make sure you can see, Drew.
- [Drew] I can see.
- [Dr. O'Neill] I'm ready for lights down.
We put a small tube through the cervix,
just inside the uterus, and there's a little bit
of fluid around the embryo.
We push the fluid with
the embryo inside the uterus,
remove the tube, and Jen goes about her day.
Ready.
Do you see that little flash, guys?
- [Jen] That was crazy.
- [Dr. O'Neill] Deep breath, Drew.
- [Man] All clear.
- [Dr. O'Neill] Alright.
- [Tech] Woohoo.
See this white dot right there in the center?
That's one of the bubbles
that was beside the embryo.
- [Jen] It was very quick,
10-15 minutes and you're done.
But it was just so much anticipation
for such a short little procedure.
- [Dr. O'Neill] Do you feel better?
- No.
(all laughing)
Then they hand you this microscopic picture
of the embryo, that moment was big.
Oh, gender, there we go. (laughs)
- [Jen] Oh, you saw it?
- [Dr. O'Neill] Oh no, I'm sorry.
- [Jen] I didn't see it.
- It says on the picture: gender female,
and I went, "Ohhh, they let
slip that it's a female embryo."
And the embryologist
goes, "Can I see that real quick?"
- [Doctor] That's you.
- [Jen] That's me!
(all laughing)
- I was gonna say, that's like (laughs).
(all laughing)
- And now we just get to wait ten days
to see where we're at.
- Yeah, I don't know.
- And you're gonna cry.
- (exhales) It's wild.
- We know that the uterus is at least able
to have periods, but we don't know if it's capable
of carrying a pregnancy
until we actually get that pregnancy test.
(phone ringing)
- We're calling now.
(phone ringing)
(phone ringing)
- [Dr. O'Neill] Hello?
- Hello.
- Hi.
- [Dr. O'Neill] Do I have you both?
- Yes.
- Yes.
- [Dr. O'Neill] Alright, the pregnancy test is positive.
(both gasping)
- Holy ****.
- [Dr. O'Neill] I know, I'm
gonna cut right to the chase.
- Thank you for doing that.
(all laughing)
(Jen and Drew crying)
- [Dr. O'Neill] They were so happy.
It was really a professional high.
- [Dr. Porrett] I knew how excited we were,
but I think that pales in
comparison to what it's like
to experience pregnancy as a woman
who was told she wasn't going
to be able to carry her own pregnancy.
(bright music)
- [Drew] How are you feeling?
- [Jen] I feel like I'm
totally in a dream right now,
and I'm having a lot of trouble believing it,
but I'm really happy,
and I'm just so excited
for what's gonna happen next.
- We get the pregnancy hormone level back,
and it's positive,
and then we follow to make sure
that it's rising appropriately,
and then we do an ultrasound to make sure
that we see a developing
pregnancy inside the uterus.
Oh my goodness.
So this whole thing right there,
with the little heartbeat right here,
that's the developing baby.
- That's crazy.
Oh my God.
- [Dr. O'Neill] Heart rate is 156 beats per minute.
Perfect, sweet.
- [Jen] Aww, you're so cute.
- I give you guys full permission
to be excited and take a full breath,
because this is a huge milestone.
Eight weeks and
a heartbeat is a huge milestone, so...
- I don't think he's
breathed in like six months. (laughs)
- No, (laughs) I haven't.
- Okay, I'm gonna give you a hug.
I'm so happy for you both!
It's been such a long
road, I know, for you guys.
(upbeat music)
(heart beating)
- [Tech] Do you feel
anything like flutters or anything yet?
- I feel flutters.
- We feel really lucky.
We'll just be sitting on the couch,
watching TV or whatever,
and then we look at each other,
and we're like,
"You're pregnant. Like, what?"
- It's starting to look like a baby
and not a lima bean.
Oh, the mouth just opened.
- Yeah, I saw that.
See, it's like this.
(all laughing)
- And the mouth just closed.
Did you see that?
- That's crazy.
She gets to experience some of the normal stuff
that every pregnant woman gets to experience,
which is have a shower, feel the baby kicking.
- Drew made this.
It's a sonogram.
If you'd ever asked me if I'd have a shower,
or a maternity shoot, or any of those things
like two years ago, I'd be like,
"That would take a miracle."
And we're here with our miracle today.
We were running like
30 minutes late from Transplant, so...
(machine humming)
- Okay, a little bit higher this time,
so I'm gonna let Dr. Wang know, just to...
- [Drew] It was normal this morning
when she took it.
- Yeah, I looked it up in your chart,
and I also let them know that, so
I'll just let her know really quick.
Stay put for one second.
- Early after transplant,
we could see the effects of the medications,
the immunosuppression medications she was on,
so it made her pregnancy more high risk,
so we were suspicious that
she might develop preeclampsia
towards the end of her pregnancy.
- So I'm gonna acknowledge your nervousness,
because I have the same nervousness.
- [Drew] Maybe this is a dumb question,
but you guys keep saying we should watch
for these warning signs.
Is that, like, does it typically come on suddenly?
- In someone who has gestational hypertension,
there's a 2-3% risk of a seizure,
and that's eclampsia.
And eclampsia, in Greek, is lightning.
And so, literally, out of the blue, it could happen.
(heart beating)
- Finally I'm talking to Dr. O'Neill and she said,
"You know, I think we
might wanna have Drew come,
I think, just in case."
I'm still not thinking like, labor or anything like that.
And then I got the headache.
- In the end, she developed preeclampsia
that could not be managed further,
and the decision was made for her health,
and for the health of the baby,
to deliver her prior to 37 weeks.
- All this was such a long process,
and every part of it has been so planned,
and regimented, and this is when it's happening.
But the two big moments,
the transplant and the
delivery were like...
No, now!
- [Jen] And it was like,
"Oh! Oh, okay. We're doing this."
- [Dr. Latif] As a GYN oncologist, I've done countless
pelvic surgeries for cancer,
and I've done C-Sections before,
but we didn't know how the
transplanted uterus would behave,
especially when Jen has preeclampsia.
So we have to move very efficiently
for the baby's safety and Jen's safety.
- [Drew] You're in the operating room,
and there's so many people in there,
and then it happens so fast.
The C-Section takes
almost no time at all, it seemed like.
Once they started, it was a few minutes.
- Baby's out!
Drew, what is it? What is it?
It's a boy!
(team cheering)
- We have a boy!
- Hi guy!
- It's a boy. We have a little boy!
and I love that.
(Drew laughing)
- [Dr. O'Neill] I will never have the same feeling
that I did in that operating room.
Drew cried, and was
so appreciative of that baby.
It was an incredible, incredible moment.
(bright acoustic music)
- I had to wait a whole 24 hours
before I could actually
go and see him in the NICU,
and so, I cried a lot, having him
in my arms and doing well and being there.
It's just something I'll never forget.
When we first started this journey,
I really thought that there was such a small chance
that I'd be here.
- We feel really lucky.
What I think we want out of this,
as much as anything else, is for other people
to get the opportunities that we got,
because everybody deserves to start a family,
if that's what they want.
And if we can contribute in any way
towards other people being able
to have that opportunity...
It's hard to explain how much that would mean,
because it's
it's so special.
So everyone should get that chance.
- I couldn't say it better myself.
- The joy that I saw in Jen and Drew's eyes
when they had their baby was out of this world.
- When I saw Jen and Drew's reaction to that child,
I think, in addition to love,
what I bore witness to
was a sense of accomplishment
that they had reached the finish line
of a place that they never would have thought
that they could get to.
- [Dr. O'Neill] I felt incredibly proud of the team,
that everybody worked together to do this
for this couple.
- [Drew] People talk about miracles,
and it's like this weird ethereal thing.
We got to not only have one,
but witness the people making a miracle happen.
- That we were able to help them get there,
is professionally and personally satisfying.
- There was this sense of "job well done",
but at the same time, "Oh my God,
we need to offer this
option to so many women out there."
- You get a taste for what that is like,
and you realize that, it's not enough
to be able to help one patient,
it needs to happen over and over and over again.
- I think we like being parents.
I love it.
I think you like it.
- (laughs) Yeah, I do.
- [Drew] We definitely had
a different path to take than most
and now we're here
and we get to just enjoy it,
and I'm trying to enjoy every moment of it.
- [Jen] That first bath, and that first bottle,
and that first holiday.
They're little things, but it's cool to be able
to experience them.
- [Drew] I don't know what the future holds,
but the present is pretty great.
