A uterus transplant (UTx) represents a profound medical development, offering a path to pregnancy for individuals who previously had no option to carry a child. This procedure is unique in transplantation medicine because it is temporary, intended solely to restore fertility, not save a life. The answer to whether someone who has had a hysterectomy can receive a uterus transplant is yes, provided they meet a comprehensive set of stringent medical and psychological criteria. This complex process is undertaken with the singular goal of achieving a live birth.
Understanding Uterine Factor Infertility (UFI)
Uterine Factor Infertility (UFI) is the absolute requirement for considering a uterus transplant. This condition means pregnancy is impossible due to the absence or non-functionality of the uterus. This form of infertility affects approximately one in 500 women of childbearing age globally and can be congenital, such as in cases of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
Acquired UFI, resulting from a hysterectomy, is a common indication for UTx programs. Hysterectomy, or surgical removal of the uterus for conditions like fibroids, cancer, or postpartum hemorrhage, creates an irreversible state of UFI. The prior removal of the uterus is therefore a primary reason, not a disqualifier, for seeking a transplant, provided the underlying cause does not pose an ongoing health risk to the recipient or the pregnancy.
Candidate Selection and Eligibility Requirements
Eligibility for a uterus transplant is highly restrictive and requires extensive evaluation due to the procedure’s complexity and associated risks. Recipients are typically women between the ages of 20 and 40, aligning with optimal reproductive years. A strict body mass index (BMI) limit, often below 30, is enforced to ensure the individual is healthy enough to undergo the lengthy surgery and subsequent high-risk pregnancy.
Candidates must be in excellent overall health, meaning they must have no contraindications to major abdominal surgery or the required lifelong immunosuppressive medication. They are screened for conditions like diabetes, severe kidney disease, and active infections, as these would significantly increase the health risks. A history of cancer that led to the hysterectomy may require a five-year disease-free period before eligibility can be considered.
A non-negotiable prerequisite is the creation and cryopreservation of viable embryos through in vitro fertilization (IVF) before the transplant surgery. Since the fallopian tubes are not connected, natural conception is impossible, making IVF the only method for achieving pregnancy. Most programs require a minimum number of high-quality embryos to ensure a reasonable chance of success. Furthermore, a stable social and psychological support system is required, as the process involves multiple surgeries, prolonged recovery, and intense monitoring.
Surgical Procedure and Immunosuppression
The uterus transplant involves two major surgical phases: the removal of the organ from the donor and the implantation into the recipient. Donor uteri can be procured from either living or deceased donors. Living donation allows for a scheduled surgery and a more controlled environment. The donor surgery is technically demanding, requiring meticulous dissection to ensure the longest possible vascular pedicles—the arteries and veins that supply the uterus—are preserved.
The recipient surgery, which can take six to ten hours, involves connecting the donated uterus to the recipient’s pelvic blood vessels, typically the external iliac vessels, and creating a connection to the vagina. Success hinges on establishing immediate and sufficient blood supply to the organ to prevent graft failure. The fallopian tubes are not reconnected.
Immediately following the transplant, the recipient begins a regimen of immunosuppressive drugs to prevent rejection. This medication is necessary for the entire duration the uterus remains in place, including throughout any subsequent pregnancies. Immunosuppression carries inherent dangers, such as increased susceptibility to infection and potential side effects like kidney damage or elevated blood pressure. The necessity of taking anti-rejection medication for a non-life-saving procedure underscores the temporary nature of the transplant.
Pregnancy Planning and Delivery Protocols
After the transplant, the recipient must wait a period of time, usually between six and twelve months, before any attempt at pregnancy can be made. This waiting period allows the recipient to fully recover from the major surgery and ensures the transplanted uterus is healthy, stable, and not showing signs of rejection. Once the uterus is deemed stable, an embryo that was previously created and frozen is thawed and transferred into the transplanted uterus.
Throughout the pregnancy, the mother is managed by a multidisciplinary team, including a maternal-fetal medicine specialist, due to the high-risk nature of carrying a child on immunosuppression. Regular monitoring, including cervical biopsies, is performed to check for signs of organ rejection. The delivery protocol is strictly defined: all pregnancies resulting from a uterus transplant must be delivered by a planned Cesarean section (C-section), typically around 37 weeks gestation.
This mandatory C-section is required to protect the integrity of the transplanted uterus, as the complex surgical connections may not withstand the stresses of labor. While the pregnancy is considered high-risk, live birth success rates following a successful transplant have been reported to be high, with many studies showing rates of 70% or more.
Expected Outcomes and Ethical Framework
The ultimate goal of uterus transplantation is the live birth of a healthy child, and current data suggests this is a realistic outcome for a significant number of recipients. Successful graft survival is a crucial early metric. Live birth rates per embryo transfer are comparable to those seen in standard IVF for women with native uteri.
The defining characteristic of UTx is its temporary nature. After the recipient has achieved her family-building goals, typically after one or two successful pregnancies, the uterus must be surgically removed in a procedure called a graft hysterectomy. This removal is mandatory to eliminate the need for the recipient to continue taking immunosuppressive medications and the associated long-term health risks.