Uterus transplantation: Which indications?

J Gynecol Obstet Hum Reprod

Département de Gynécologie et Obstétrique, CHU Limoges, av Dominique Larrey, 87000 Limoges, France; INSERM, UMR-1248, CHU Limoges, 87000 Limoges, France. Electronic address:

Published: January 2019

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http://dx.doi.org/10.1016/j.jogoh.2018.10.003DOI Listing

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Absolute uterine factor infertility is conditioned by the congenital or acquired absence of the uterus or the presence of a nonfunctioning uterus in women who wish to become biological mothers. Uterine transplantation along with assisted reproductive techniques can provide this option for women without a uterus. In the early research period, to minimize the risk of preterm birth and other pregnancy-related complications, the uterus of a donor with a history of one to three successfully completed pregnancies was recommended for transplantation.

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Introduction: Uterine transplantation is currently intended for women with absolute uterine infertility. Since proof of the concept in 2014, many countries have started research programs and clinical activities. However, access to uterine transplantation remains limited given that only a few hundred transplants have been described worldwide compared with the 1.

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Transplantation of decellularized uterus tissue showed promise in supporting regeneration following uterine injury in animal models, suggesting an alternative to complete uterus transplantation for uterine factor infertility treatment. However, most animal studies utilized small grafts, limiting their clinical relevance. Hence, we used larger grafts (20 × 10 mm), equivalent to nearly one uterine horn in rats, to better evaluate the bioengineering challenges associated with structural support, revascularization, and tissue regeneration.

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Article Synopsis
  • Uterus transplantation is currently the only solution for women with absolute uterine infertility, such as those with Rokitansky syndrome, allowing them to experience pregnancy and childbirth.
  • There are significant challenges with uterus transplantation, including the risks of ischemia-reperfusion injury and a notable thrombotic complication rate of up to 20%, which can lead to graft rejection.
  • This protocol aims to outline the surgical steps for obtaining porcine uteruses and implementing dynamic preservation through machine perfusion, which may reduce hypoxic injury compared to traditional static cold storage methods.
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