Live Birth After Uterus Transplantation

In the 3 decades since the birth of the first in vitro fertilization baby in 1978, there have been remarkable advances in infertility treatment. Until now, however, absolute uterine factor infertility remained the only major type of female infertility viewed as untreatable. Absolute uterine infertility is caused by absence of the uterus or the presence of a nonfunctional uterus. Major causes include congenital absence of the uterus (Rokitansky syndrome), previous hysterectomy, and severe intrauterine adhesions. A uterine transplant is the only hope for women without a uterus or a nonfunctioning uterus who wish to become pregnant. Eleven human uterus transplantation attempts have been done worldwide including 9 by the authors, but no live birth was achieved. This report describes the first live birth in a woman with absolute uterine infertility who became pregnant following a uterine transplant from a live donor. The mother was a 35-year-old woman with Rokitansky syndrome who underwent transplantation of the uterus in 2013 at Sahlgrenska University Hospital, Gothenburg, Sweden. The donor was a family friend, a 61-year-old, 2-parous woman with 2 previous vaginal deliveries. The recipient and her partner underwent in vitro fertilization prior to the transplant, and 11 embryos were cryopreserved. Following the transplant, both the recipient and the donor had essentially uneventful postoperative recoveries. The first menstruation in the recipient occurred 43 days after transplantation, and thereafter, she menstruated regularly every 26 to 36 days (median, 32 days). One year after the womb transplant, the first single embryo transfer was performed and resulted in pregnancy. She then began taking triple immunosuppression medications (tacrolimus, azathioprine, and corticosteroids), which was continued for the remainder of the pregnancy. Three episodes of mild rejection occurred, one of which occurred during pregnancy; all were reversed by corticosteroid treatment. Blood flows of the uterine arteries and umbilical cord as well as fetal growth parameters were normal throughout pregnancy. At 31 weeks 5 days’ gestation, the patient was admitted to the hospital with preeclampsia. Because the baby's heart rate was abnormal, a cesarean delivery was performed 16 hours later. A male baby was delivered with a normal birth weight for gestational age (1775 g) and Apgar scores of 9, 9, 10. This report of the first live birth after uterus transplantation in a woman with absolute uterine infertility is a proof of concept for this procedure. The results demonstrate the feasibility of live-donor uterus transplantation, even from a postmenopausal donor.