Working Hours
- Monday - Friday
09:00 - 19:00
Contact
Ask the Experts
Uterus transplantation
Uterus transplantation is a surgical procedure where the patient is transplanted with the uterus of another woman.
The uterus is transplanted to a woman who does not have a uterus or that organ is not functional.
The ultimate goal is for the woman who receives the uterus to give birth to a child.
The woman who receives an organ transplant is the recipient, and the woman who donates the uterus is the donor.
The first child in the world was born in Gothenburg in 2014 after a transplantion that was performed in 2012. The successful transplantation and birth was preceded by 15 years of research work by Professor Mats Brännström and his team. So far, more than 70 children have been born in the world after a uterus transplantion, of which one child was born after the surgery performed in Serbia.
Since fallopian tubes are not transplanted, spontaneous pregnancy is not possible, so before transplantation in vitro fertilization (IVF) is performed and embryos/egg cells are frozen.
When is uterus transplantation performed?
Uterus transplantation is performed:
- in women who were born without a uterus (Mayer Rokitansky Küster Hauser /MRKH/ syndrome;
- in women where the uterus has been removed due to cancer, myoma, bleeding after childbirth.
- in women with uterine malformations such as a double or unicornuate uterus where pregnancy does not occur or the pregnancy ends by spontaneous abortions and early premature birth;
- in women who were treated by radiation against small pelvis;
- in women who have large fibrotic and dysfunctional tissue in the uterine cavity (Asherman syndrome).
The condition that a uterus transplantation can be performed is that the woman is younger than 40 years and has a vagina that is 7-8 cm long.
Who can be a uterus donor?
The criteria for a uterus donor are as follows:
- maximum age 55 years;
- at least one child born at term and without pregnancy complications;
- without repeated spontaneous abortions or unsuccessful IVF attempts;
- without premature births, preeclampsia and pregnancy complications;
- a maximum of 2 operations on the uterus (caesarean section, myomectomy;
- without myomas, polyps, adenomyosis;
- normal Pap smear and a negative test on human papillomaviruses (HPV) of high risk;
- good general health and no chronic diseases;
- BMI < 30 kg/m2;
- non-smoker or giving up smoking at least 6 months before transplantation.
How successful is the uterus transplantation procedure?
The success of the uterus transplantation surgical procedure, defined as the establishment of regular monthly bleeding after the surgery, is 73-100% depending on the center where the surgical method is performed (open, laparoscopic and robotic surgery).
The cumulative chance (1 or more embryo transfers) for the birth of a child is 70-85%.
Donor selection
Transplantation can be done from a living donor or a deceased person who bequeathed her organs (only possible in countries where the organ transplantation program has been developed).
The donor is most often related to the recipient or a long-time family friend.
What does the uterus transplantation procedure look like?
Before the transplantation procedure, a detailed clinical, laboratory and radiological examination of both the donor and the recipient is performed.
Psychological preparation is also done where the recipient's partner is included.
It is necessary to perform IVF and freeze the embryos. The egg cells can be frozen as well.
The couple receives detailed information about the legal aspect of the frozen embryos and egg cells.
Immediately before the surgery, an internist and anesthesiology examination is performed.
Patients do not eat or drink for 8 hours before the surgery.
The donor and the recipient come to the hospital on the day before or on the day of the operation itself.
The operation of both the donor and the recipient can be performed by an open incision (laparotomy) or by robotic surgery.
The operation of the donor where the uterus is removed lasts for 10-12 hours, and the operation of the recipient 4-6 hours.
First, the operation of the donor commences, and when the operation is nearing the end, the operation of the recipient begins.
Patients stay in the hospital for 4-6 days after the operation.
Immediately after the operation, the recipient starts first with corticosteroids, and then with immunosuppressive drugs that aim to prevent organ rejection.
Patients are given painkillers and start eating and drinking a few hours after the surgery.
Antibiotics or blood-clotting drugs are given after the operation. The antiviral drug is used for 6 months. Aspirin is taken all the time after the transplantation as well as during pregnancy.
Patients can shower on the day after the surgery with staff assistance and return to normal activities 4-6 weeks after laparotomy and 2-3 weeks after robotic surgery.
The recipient is monitored for 2 weeks for the first 3 months after the surgery. Biopsies are taken from the cervix in order to diagnose timely the possible organ rejection and correct immunosuppressive therapy. After that, the recipient will be checked once a month.
It is not necessary to control the donor.
Embryo transfer after uterus transplantation
Embryo transfer to the recipient is done after 6 months.
One embryo is always transferred. Embryo transfer can be done in a spontaneous cycle or the endometrium is prepared with drugs.
Pregnancy after uterus transplantation
Pregnancy after uterus transplantation is controlled for 2-3 weeks. It is often necessary to adjust the dose of immunosuppressive drugs. From 12-34 weeks, a preventive dose of antibiotics is given, and aspirin is taken throughout the trimester until the 34th week of pregnancy. There is an increased risk for preeclampsia and premature birth.
Childbirth after uterus transplantation
Childbirth after uterus transplantation is always performed by caesarean section. No nerves are transplanted during the operation, and the woman does not feel the movements of the baby during pregnancy, nor the contractions of the uterus.
Recovery after cesarean delivery is the same as after any laparotomy.
When is the transplanted uterus removed?
The transplanted uterus is removed after the birth of one or two children in consultation with the patient. After the removal of the transplanted organ, the woman no longer takes immunosuppressive therapy.
The transplanted uterus is not removed in the case when the transplantation was performed between monozygotic twins where there is no need for immunosuppressive therapy.
Expert advice: frequently asked questions
Answered by: Milan Milenković MD, PhD
Who are the donors for a uterus transplantation?
Donors for uterus transplantation are most often relatives or friends of the woman to whom the uterus will be transplanted. The donor must have the same blood type as the recipient.
How long does it take to prepare for a uterus transplantation?
It takes the most time to find a donor. Donor’s and the recipient’s analyses can be done within a few days. Psychological preparation of all participants in the transplantation process is required, including the partner of the recipient.
How many embryos need to be frozen before a uterus transplantation?
There is no exactly defined number of embryos that need to be frozen, but it is desirable to have more than 3 frozen embryos.
How is the IVF procedure performed before a uterus transplantation?
The IVF procedure differs from the procedure for women who have a uterus and menstrual bleeding in the way that the function of the ovaries will be blocked to prevent premature ovulation.
Can IVF be performed after uterus transplantation?
IVF can be done after uterus transplantation, but it is necessary to do it before the operation in order to rule out some other factor of infertility.
When are egg cells frozen?
Egg cells are frozen for women without a partner who are planning a transplantation and for women who want to have frozen egg cells in addition to frozen embryos. Embryos cannot be used without the consent of the partner, while the egg cells can be used with another partner.
Is the donor’s surgery risky?
The risk for complications during and after donor surgery is the same as for hysterectomy for cervical cancer and is less than 5%.
Is the operation risky for woman undergoing a uterus transplantation?
The risk of an infection and blood clot formation is less than 5%.
Is immunosuppressive therapy risky after uterus transplantation?
Long-term therapy with immunosuppressive drugs increases the risk of diabetes and some malignant diseases.
Immunosuppressive therapy after uterus transplantation has been used for a maximum of 4-5 years and no complications have been registered so far.
Is immunosuppressive therapy risky in pregnancy?
Immunosuppressive therapy has been used for decades after kidney and liver transplantation. So far, no pregnancy complications related to the anti-rejection therapy have been registered.
Are children born after transplantation healthy?
Uterus transplantation does not increase the risk of malformations or diseases in the child.
