WHEP Scholar Alyssa Calder
Drexel University College of Medicine, Class of 2021

Uterus transplantation (UTx) is a fairly new and experimental option for women with absolute uterine factor infertility (AUFI), in which a woman has an absent or abnormal, either anatomical or functional, uterus. Reports estimate that 1 in 500 women of childbearing age are affected by AUFI. Women who meet the criteria of AUFI and who still wish to bear children may be eligible.

Women may be more familiar with other parenting opportunities including adoption and surrogacy, but surrogacy is prohibited or lacks regulation in many countries. Therefore, it is important for physicians to present patients with all of their options, understand their hopes for having children and educate them. If a woman decides to pursue UTx, there are multiple considerations. She must understand the procedure, complications of the surgery, optimal timing of pregnancy after transplant, management of immunosuppression during pregnancy, and follow-up after pregnancy, among other things.

UTx involves a donor, either living or deceased, who gives her uterus to a recipient. At the time of transplant, the recipient begins immunosuppressant medications—tacrolimus, azathioprine and steroids—for 6 to 12 months prior to implantation of an embryo. Based on data from other organ transplantation, this immunosuppressive therapy regiment is safe in pregnancy. Over these 6 to 12 months, the recipient is monitored for rejection and graft failure. If the uterus graft is continuing to function as expected, an embryo is implanted with the goal of pregnancy. The recipient delivers her baby via cesarean section, and if no other children are desired, the uterus is removed to prevent the recipient from taking lifelong immunosuppressant therapy. Unlike other organ transplant surgeries, UTx is life-enhancing and not life-saving. Due to its experimental nature, UTx has several associated ethical considerations. All parties—the donor, recipient, recipient’s partner and future child—must be considered as well as the cost analysis and future direction, which makes UTx extremely complex.