Uterus Transplantation as a Treatment of Infertility

written by iana malasevskaia md Mar 03, 2025

A Breakthrough for Women Facing Infertility

Infertility affects approximately one out of six couples which translates to about 6.7 million people each year who have trouble getting pregnant. Various causes contribute to infertility, including hormonal imbalances and structural issues in the reproductive system. One important type of infertility is absolute uterine factor infertility (UFI), which affects women who are born without a uterus (womb) or who have lost theirs due to conditions like fibroids, cancer, or congenital issues. Uterus transplantation has emerged as a promising solution, providing new hope for those who wish to experience pregnancy and childbirth.

What is Uterus Transplantation?

Uterus transplantation is a surgical procedure that involves removing a healthy uterus from a living or deceased donor and placing it into a recipient who is unable to conceive due to the absence or dysfunction of the uterus. This innovative approach aims to restore the ability to carry a pregnancy to term, providing a viable option for women who have previously faced limited reproductive choices.

The Evolution of Uterus Transplantation

The concept of uterus transplantation dates back several decades, but it gained significant traction in the early 21st century. The first successful live birth following a uterus transplant occurred in Sweden in 2014, marking a pivotal moment in reproductive medicine. Since then, numerous centers across the globe have initiated uterus transplantation programs, with several successful pregnancies reported.

The Procedure

The uterus transplantation procedure is complex and involves several key steps:

Assessment and Selection: Candidates undergo thorough evaluations to determine their suitability for the procedure. This includes psychological assessments and medical evaluations conducted by a selection committee.
Surgical Transplantation: The surgery typically lasts several hours and involves connecting the blood vessels and ligaments of the transplanted uterus to the recipient's body.
Post-Transplant Care: Recipients require lifelong immunosuppressive therapy to prevent rejection of the transplanted organ, similar to kidney or heart transplant recipients.

Recent Advances in Uterus Transplantation

Significant advancements in uterus transplantation procedures have been documented globally. Key findings include:

Global Clinical Activities: Uterus transplantation procedures have been performed in several countries, including Sweden, the Czech Republic, Germany, Spain, Saudi Arabia, India, China, Lebanon, Brazil, and the USA. At least 80 procedures have been completed worldwide, resulting in over 40 live births by 2022.
Surgical Success Rates: The overall surgical success rate for this procedure is approximately 76%.
Complication Rates: Serious post-surgical complications requiring invasive or radiological intervention occurred in about 18% of living donors and 19% of recipients, indicating the need for careful monitoring post-transplant.
Live Birth Rates: The cumulative live birth rate in successful uterus transplantation procedures is estimated to exceed 80%. However, many of these births have been associated with preterm deliveries and respiratory distress syndrome in newborns.

Surgical Innovations: Robotic-assisted surgeries are becoming more prevalent, improving outcomes and reducing recovery times.
IVF Integration: Since uterus transplantation does not include the Fallopian tubes (which carry eggs from the ovaries to the uterus), in vitro fertilization (IVF) is necessary. This process involves taking mature eggs from the ovaries, fertilizing them in a lab, and then placing the embryo back into the new uterus. Techniques for retrieving eggs and transferring embryos have been improved to increase the chances of success.
International Registry: Establishing the International Society Uterus Transplantation (ISUTx) registry allows for comprehensive tracking of procedures outcomes, complications, and live births.

Advances in Uterus Transplantation: Key Findings

Recent studies highlight significant progress in uterus transplantation, a groundbreaking option for women with absolute UFI. For instance, The Dallas Uterus Transplant Study reported an impressive 71.4% pregnancy rate among women who had successful transplants. Live births occurred, on average, within 7.3 months of pregnancy.

In a long-term follow-up published in Human Reproduction, recipients and living donors reported a quality of life above the general population average five years after transplantation. While some recipients faced marital satisfaction challenges, overall mental health remained stable, showcasing resilience even after graft failures.

Additionally, an observational study from Biomed Papers followed two children born to mothers with transplanted uterus. Both children were delivered via cesarean sections and showed healthy growth and normal neurodevelopment at ages 2 and 3, despite being born prematurely.

These findings underscore the effectiveness of uterus transplantation, offering hope and improved quality of life for women seeking to conceive.

Challenges and Future Directions

Despite the significant advancements represented by uterus transplantation in reproductive health, several challenges remain. One of the primary concerns is the need for optimal immunosuppressive therapies and effective strategies to monitor graft rejection. Ongoing research is focused on identifying the best approaches to ensure the long-term success of transplanted uteri while minimizing risks to recipients.

Ethical considerations are also paramount in this evolving field. Questions surrounding donor selection, informed consent, and the long-term health outcomes for both donors and recipients must be addressed. As more programs begin to offer this procedure, these ethical guidelines must be strictly adhered to, ensuring the safety and well-being of all parties involved.

Looking ahead, the future of uterus transplantation appears promising. Research is actively aimed at refining surgical techniques, expanding donor and recipient criteria, and enhancing overall success rates. As more medical centers adopt this innovative procedure, the potential for this procedure to become a mainstream option for women facing absolute UFI increases, providing renewed hope for many.

Comprehensive studies are needed to evaluate the long-term outcomes and psychosocial implications of uterus transplantation. The ongoing collection of data from both published and unpublished cases will be crucial in shaping future protocols and improving patient outcomes. As the field continues to grow, strict governance and ethical considerations must guide the expansion of uterus transplantation programs, ensuring that this transformative procedure can be safely and effectively integrated into reproductive healthcare worldwide.

Conclusion

Uterus transplantation is revolutionizing the landscape of reproductive medicine, offering new possibilities for women who previously had limited options for childbearing. With continued advancements and dedicated research, uterus transplantation is poised to become an integral part of reproductive health care globally, providing a viable solution for those longing to experience pregnancy and childbirth.

Written by Iana Malasevskaia, MD

Edited by Susan Egbert, PharmD

References