Uterus transplantation is a highly specialized, temporary procedure developed to treat Absolute Uterine Factor Infertility (AUFI). This condition is defined by the absence of a uterus or the presence of a non-functioning uterus that cannot sustain a pregnancy. The innovative surgery offers a pathway to pregnancy for affected individuals. The procedure is complex, multi-stage, and currently performed only at a limited number of medical centers, often within clinical trials.
Answering the Core Question: Eligibility After Hysterectomy
The answer to receiving a uterus transplant after a hysterectomy is generally yes, provided all other eligibility criteria are met. A prior hysterectomy is one of the most common acquired causes of Absolute Uterine Factor Infertility (AUFI), the condition the transplant is designed to address. The surgical removal of the uterus, which prevents pregnancy, is a direct indication for the procedure and accounts for a significant portion of transplant candidates.
For a patient to be considered, the hysterectomy must typically have been performed for benign reasons, such as managing severe bleeding or fibroids. Crucially, the ovaries must remain healthy and functional to produce eggs for In Vitro Fertilization (IVF). The medical team must also confirm the patient is free from severe systemic health problems that could compromise the surgery or the subsequent need for anti-rejection medications.
Contraindications, or reasons for ineligibility, are strictly enforced to minimize risk in this complex procedure. These include a history of uterine cancer, severe obesity (often defined as a BMI over 30 or 35), or uncontrolled conditions like diabetes or severe kidney disease. A patient must also be a non-smoker and typically fall within a reproductive age range, often between 20 and 40 years old.
The Surgical and Medical Process of Uterus Transplantation
The journey begins with an extensive screening process, including medical, psychological, and fertility evaluations. The transplant is a dual surgical event involving two teams: one to procure the uterus from a living or deceased donor and another to implant it. The recipient’s complex surgery typically lasts six to eight hours, as surgeons carefully connect the donor uterus’s major blood vessels to the recipient’s pelvic circulation.
Establishing a successful blood supply to the transplanted organ is the most important factor for graft survival. After surgery, the recipient immediately begins a regimen of powerful immunosuppressive drugs. These medications must be taken continuously to prevent the immune system from recognizing and attacking the new organ, and they are necessary for the duration of the organ’s presence.
The long-term use of these medications increases susceptibility to infections and may raise the risk of developing certain cancers or kidney damage (nephrotoxicity). Close monitoring is maintained post-operatively to watch for signs of rejection, such as graft failure or thrombosis (blood clots). The patient must remain stable and the graft must show signs of viability before any attempt at pregnancy can be made.
Achieving Pregnancy and Delivery Post-Transplant
Once the transplanted uterus has stabilized, achieving pregnancy is possible only through assisted reproductive technology. Natural conception is not an option because the transplanted uterus is not surgically connected to the patient’s fallopian tubes. Therefore, the recipient must have previously undergone In Vitro Fertilization (IVF) to harvest and fertilize eggs, creating frozen embryos.
The medical team requires a significant waiting period after the transplant surgery before attempting an embryo transfer, typically six to twelve months. This delay is mandatory to allow the surgical site to fully heal, ensure the transplanted uterus is functioning properly, and confirm the immunosuppression regimen is stable. Once these conditions are met, a single frozen embryo is thawed and transferred into the transplanted uterus.
If the pregnancy is successful, it is considered high-risk and requires meticulous monitoring by a maternal-fetal medicine specialist. Delivery is mandated to be a Cesarean section (C-section) in all cases, performed at about 37 weeks gestation or earlier. This surgical delivery protects the structural integrity of the transplanted uterus, preventing the strain and potential complications a vaginal delivery could impose on the new organ.
Long-Term Management and Planned Organ Removal
The most unique characteristic of a uterus transplant is its temporary nature; the organ is not intended to remain in the recipient for life. Unlike transplants of organs like the heart or kidney, the uterus is removed once the recipient has completed their family-building goals, typically after one or two successful pregnancies. This second, planned hysterectomy is a definitive step in the overall treatment plan.
The primary reason for the organ’s removal is to eliminate the need for continued immunosuppressive drugs. Stopping these medications removes a major health burden from the recipient, as they carry long-term health risks. Once the transplanted uterus is removed, the patient can safely discontinue the anti-rejection therapy.
Throughout the time the uterus is in place, the patient is under constant surveillance to monitor for signs of organ rejection, which may include frequent biopsies of the cervix. Managing the long-term side effects of the anti-rejection medication, such as monitoring kidney function and blood pressure, remains a part of post-transplant care. The medical team will continue to follow the patient’s health for several years after the final hysterectomy.