Blooming flower within a transplanted uterus, symbolizing fertility and medical innovation.

Uterus Transplantation: A New Frontier in Fertility for Women?

Soraya Malik in Health & Wellness August 2025 • 4 min read.

"A breakthrough study reveals successful livebirths from deceased uterus donors, offering renewed hope for women with uterine infertility."

The field of reproductive medicine has witnessed a significant leap forward with the advent of uterus transplantation. Since 2015, marked by the first livebirth following uterus transplantation from a living donor, numerous success stories have emerged, transforming the landscape of fertility options for women facing uterine factor infertility.

Uterine transplants, once considered a distant possibility, have now seen roughly 50 procedures completed, utilizing both living and deceased donors. This increase highlights the growing interest and investment in this area, signaling a shift in how we approach infertility.

A recent study in The Lancet by Danielle Ejzenberg and colleagues has marked a new milestone by demonstrating a healthy livebirth using a uterus from a deceased donor. This breakthrough addresses the critical issue of organ availability, paving the way for more women to access this life-changing procedure.

Deceased Donor Uterus Transplants: Overcoming Challenges and Expanding Possibilities

Blooming flower within a transplanted uterus, symbolizing fertility and medical innovation.

One of the most pressing challenges in uterus transplantation involves refining the criteria for both donors and recipients. Balancing the need to maximize success rates while minimizing risks for all involved parties, and simultaneously expanding organ availability, requires careful consideration. This balance is crucial for making the procedure more accessible without compromising patient safety.

The report by Danielle Ejzenberg sheds light on the viability of using uteri from deceased donors. In their case, the donor was a 45-year-old woman who had experienced a subarachnoid hemorrhage, and the recipient was a 32-year-old woman with Rokitansky syndrome. The recipient had a normal ovarian reserve, demonstrated by the successful generation of eight high-quality embryos through in vitro fertilization.

Extended Ischemia Time: The study demonstrated that a human uterus could remain functional after being subjected to cold ischemia for a period four times longer than what has been previously observed with living donors (7 hours 50 minutes versus 1 hour 18 minutes).
Surgical Approach: The surgical approach used in the study differed from previous successful cases involving living donors. Rather than relying solely on uterine or ovarian veins, the venous outflow was duplicated through both sets of veins.
Challenging Traditional Timelines: The authors also challenged the conventional practice of waiting at least one year post-transplantation before attempting pregnancy, initiating embryo transfer earlier than typically recommended.

While some data suggests that perinatal outcomes might be compromised during the first year after solid organ transplantation, it is crucial to consider that adverse outcomes might stem from the underlying conditions that necessitated the transplantation in the first place, rather than the transplant itself. More analysis is needed to determine whether to make firm conclusions about the pregnancy timeline.

Looking Ahead: Standardizing Techniques and Expanding Access

As uterus transplantation evolves, standardizing surgical techniques, refining post-operative controls, and assessing the impact of new technologies such as preimplantation genetic screening are essential. Furthermore, discouraging iatrogenic interventions like planned preterm deliveries and recording long-term offspring outcomes will contribute to safer and more effective procedures. With increasing standardization, exploring indications for more controversial groups and new sources of uteri is vital for the future of this field. Collaborative networks and societies play a crucial role in promoting education, guidance, and transparent reporting of procedures to ensure the safe and ethical advancement of uterus transplantation.

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Everything You Need To Know

What is the significance of livebirths from deceased donors in uterus transplantation?

The achievement of livebirths using uteri from deceased donors, as demonstrated in the study by Danielle Ejzenberg, marks a crucial step forward in expanding access to uterus transplantation. It addresses the challenge of organ availability, which has been a significant hurdle. The use of deceased donors offers a potentially larger pool of available uteri, thereby increasing the possibility for women with uterine factor infertility to undergo this procedure. This could revolutionize the landscape of fertility treatments and give more women the opportunity to experience pregnancy and childbirth.

How does the surgical approach in deceased donor uterus transplantation differ from living donor procedures?

The surgical approach employed in the study by Danielle Ejzenberg and colleagues deviated from previous methods, particularly in managing venous outflow. Instead of relying solely on uterine or ovarian veins, the venous outflow was duplicated through both sets of veins. This change is significant because it may provide a more robust vascular supply to the transplanted uterus, potentially improving its chances of success. This highlights the ongoing refinement of surgical techniques in the field of uterus transplantation and its evolution.

What are the challenges and considerations associated with uterus transplantation?

Several challenges and considerations are associated with uterus transplantation. One major issue is the availability of uteri, which is partially addressed by using deceased donors. Another crucial aspect is refining the criteria for both donors and recipients to maximize success while minimizing risks. Balancing these factors is crucial. Standardizing surgical techniques and post-operative care and assessing long-term outcomes, including those of the offspring, are also essential steps towards improving the safety and efficacy of uterus transplantation. Ethical considerations are also at the forefront, particularly regarding donor consent and the allocation of scarce resources.

Why is it important to study the pregnancy timeline after uterus transplantation, and what are the implications of initiating embryo transfer earlier?

Studying the pregnancy timeline is important to determine the optimal time to attempt pregnancy after uterus transplantation. Traditionally, there has been a waiting period of at least one year after the procedure before attempting pregnancy. However, the study by Danielle Ejzenberg and colleagues initiated embryo transfer earlier than typically recommended. Although data suggests that perinatal outcomes might be compromised in the first year after solid organ transplantation, it's crucial to consider whether adverse outcomes stem from the transplant or the underlying conditions. More analysis is needed to determine the best timing to optimize the chances of a healthy pregnancy and delivery.

What future developments are expected in the field of uterus transplantation?

The field of uterus transplantation is expected to continue evolving with advancements in several areas. Standardizing surgical techniques, refining post-operative controls, and assessing the impact of new technologies are crucial. Further research into pregnancy timelines is also needed. Expanding access to the procedure by exploring the use of uteri from diverse sources and by including more controversial groups is vital. Collaborative networks play a significant role in promoting education and transparent reporting to ensure the safe and ethical progression of uterus transplantation. The focus will be on making the procedure safer, more accessible, and more effective for women with uterine factor infertility.