I was brought into this world

from the womb of my

mother…………………………
I am a female baby………..
I thought……
I am a girl……
but the thought
remained as a thought
in my life…………………
The period when she realized that she is
different from all other girls…………
She did not have something which others
had………….
The day when she knew that she had…………
MAYER ROKITANSKY KUSTER HAUSER
SYNDROME
Imagine what it is for a woman to know that she
has no uterus and no vagina….

it’s TERRIBLE………..
Named after……..

 August Franz Joseph Karl Mayer

 Carl Frieherr von Rokitansky
 Hermann Kuster
 G.A .Hauser
A rare disorder characterized by congenital
absence of uterus and vagina
You cry because of pain but they cry
because…………………….

THEY DON’T HAVE PAIN………

Will u stop menstruating if you could?????

…………………a question asked by a MRKH girl

to all normal women who complain about
menstruating……………….
Prevalence

1 in 4000-5000 female births

IS IT MY FAULT?

The cause is unknown………

a blank space still remains…..
Can you find the answer?........
Signs & Symptoms……

 Primary amenorrhea
 Complete or partial absence of cervix, uterus and
vagina
 Painful coitus
 Hormonally normal
 Enters puberty with development of secondary
sexual characteristics-adrenarche , thelarche
 Chromosomal constellation-46XX
 Ovaries intact…………ovulation
occurs………………….
But she cannot be………
A MOTHER
she cannot carry……….
A life in her womb
A life perhaps incomplete………
Forms of MRKH…..

 Only absence of vagina and uterus

 Absence of uterus and vagina +
40% kidney abnormalities
10% hearing problems
10-12% skeletal abnormalities
Solution?

 No treatment to let the woman herself

become pregnant
 Treatment available to make the intercourse
comfortable
Surgical Management

 Frank technique or perineal dilation

apply progressive pressure to the
perineum using a bicycle-seat stool to hold a
dilator in place .
…………compliance may be poor………..
McIndoe technique

Split thickness skin graft -skin from thigh or

buttocks is used……..
PROCEDURE
Pocket created between rectum and urethra
↓
Place a cylindrical stent covered with skin graft
↓
Fix graft in place by attaching cut edges of skin
incission
 ↓
Labia majora sutured loosely together
↓
1 week later remove stent
↓
irrigate vagina and cauterize areas of
granulation with silver nitrate sticks
Keep dilator in neovagina every day and night
for 3 months;
followed by
every night for next three months
………….scarring at donor site………
………….neovaginal stenosis…………
………….long term dilation……………
Williams Vaginoplasty

Uses vulval flap to make a vaginal tube

………needs long term dilation……..
Rotational Flap Procedure

Uses - pudendal thigh

- gracilis myocutaneous
- labia minora
- other fasciocutaneous flaps
………..extensive scarring at donor site……..
………...requires patient’s diligence…………...
Intestinal Neovagina

Uses isolated segment of bowel for vagina;

mostly sigmoid
………..high grade of satisfaction……….
Vecchietti Technique

Exert continuous progressive pressure…….. by

acrylic olive passed through potential
neovaginal space and abdominal wall……..
↓
Traction device placed into peritoneal cavity
↓
Draw olive upward
………done laparoscopically………..
Options…….

My baby in other’s womb………SURROGACY

 Means……

Surrogacy is an arrangement in which a woman

carries and delivers a child for another person
or couple……..
 Surrogacy varies…….

 Traditional surrogacy: woman may be child’s

genetic mother
 Gestational surrogacy: carry pregnancy to
delivery after having an embryo, with no
genetic relationship, transferred to her uterus
 Commercial surrogacy
 Altruistic surrogacy
Think of IVF if both have problem…………
Characteristics of a
surrogate mother

Relative or close friend

Between 21 and 38 yrs of age
Given birth to one or more child previously with
no complications
No history of STDs
Good health………
 Average weight for her height
 A non-smoker who lives in a smoke free room
 No illegal drug use
 Arguements

 Cost of surrogacy
 Custody
 Desperate needs home
 Long process
 Feel of Guilt
Promise of a mother……
First Major Groundbreaking
Surrogacy

Publicized issue of Melissa Stem in 1986, USA……

Biological father: William Stem
His wife : Elizabeth Stem
Surrogate Mother: Mary Beth
Whitehead
 Mary Beth Whitehead is the biological
mother………..legal mother…………

 Who is the Mother?????

Saudi Arabia sanctioned world’s first Uterus
transplant……..
 In India……

Commercial surrogacy legal in

India……Supreme Court in 2002

leader in international surrogacy……

Contact…….

www.surrogatemothers.com
www.surrogateAlternatives.com
www.GlobalDoctorOptions.com
www.indiansurrogates.com
Adoption……
I didn’t
bring
you…….
but
I will
build
you……..

You
are my
baby and
Life is Life……

Realize what you have…………

There are people on earth around you

carrying pain in heart ……….
may be more than yours…….
 A
relation
so
pure……
Thank
you……….
.