Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Abstract

Importance: Uterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy.

Objective: To determine whether uterus transplant is feasible and safe and results in births of healthy infants.

Design, setting, and participants: A case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019.

Intervention: The uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure.

Main outcomes and measures: Uterus graft survival and subsequent live births.

Results: Of 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.

Conclusions and relevance: Uterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children.

Trial registration: ClinicalTrials.gov Identifier: NCT02656550.

Figure 1.. Potential Uterus Transplant Recipients and Donors Considered, Evaluated, and Enrolled in the Dallas Uterus Transplant Study

Exclusion causes for evaluated potential recipients and living donors are shown in the respective categories. HSV indicates herpes simplex virus; IVF, in vitro fertilization; and STI, sexually transmitted infection.

Figure 2.. Timeline of Events After Uterus Transplant

The bars are medians with box ends representing first and third quartiles with whiskers extending to upper and lower boundaries and dots representing more extreme data.