Background The first live birth after uterus transplantation took place in Sweden in 2014. It was the first ever cure for absolute uterine factor infertility. We report the surgery, assisted reproduction, and pregnancy behind the first live birth after uterus transplantation in the Middle East, North Africa, and Turkey (MENAT) region. A 24-year old woman with congenital absence of the uterus underwent transplantation of the uterus donated by her 50-year-old multiparous mother. In vitro fertilization was performed to cryopreserve embryos. Both graft retrieval and transplantation were performed by laparotomy. Donor surgery included isolation of the uterus, together with major uterine arteries and veins on segments of the internal iliac vessels bilaterally, the round ligaments, and the sacrouterine ligaments, as well as with bladder peritoneum. Recipient surgery included preparation of the vaginal vault, end-to-side anastomosis to the external iliac arteries and veins on each side, and then fixation of the uterus. Results One in vitro fertilization cycle prior to transplantation resulted in 11 cryopreserved embryos. Surgical time of the donor was 608 min, and blood loss was 900 mL. Cold ischemia time was 85 min. Recipient surgical time was 363 min, and blood loss was 700 mL. Anastomosis time was 105 min. Hospital stay was 7 days for both patients. Ten months after the transplantation, one previously cryopreserved blastocyst was transferred which resulted in viable pregnancy, which proceeded normally (except for one episode of minor vaginal bleeding in the 1st trimester) until cesarean section at 35 + 1 weeks due to premature contractions and shortened cervix. A healthy girl (Apgar 9-10-10) weighing 2620 g was born in January 2020, and her development has been normal during the first 6 months. Conclusions This is the first report of a healthy live birth after uterus transplantation in the MENAT region. We hope that this will motivate further progress and additional clinical trials in this area in the Middle East Region, where the first uterus transplantation attempt ever, however unsuccessful, was performed already three decades ago.

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Bacillus thuringiensis is the leading microbial-based biopesticide, thanks to its parasporal crystal proteins or δ-endotoxins, which are toxic to insect larvae upon ingestion. Once in the insect larvae midgut, the crystal is solubilized by the alkaline pH and the δ-endotoxins activated by proteolytic cleavage. Thanks to its high efficiency as a biopesticide, several efforts have been made to enhance its growth and δ-endotoxins production, in various types of culture media. In this study, a culture medium based on wheat bran (WB), the by-product of cereal grain milling, was used to grow Bacillus thuringiensis and produce δ-endotoxins. Using the response surface methodology (RSM), the effects of three variables were evaluated: WB particles granulometry, their concentration, and their agitation in a 48-h shake-flask culture at 30 °C. Three response parameters were targeted: δ-endotoxins production, final culture pH, and dry-matter consumption. According to the RSM results, the optimum would be at 3.7 g WB/50 mL, with a granulometry above 680 μm and agitation between 170 and 270 rpm. This study is key to developing natural and cheap culture media that can be used at an industrial level for Bacillus thuringiensis-based biopesticides.

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