How Uterus Transplants and Pregnancy Works

Infertility is a difficult experience to go through, yet it affects about one in six adults globally. There’s a wide range of reproductive health issues that can cause infertility and each person’s experience is different.

Medical technologies continue to advance, giving people more options when it comes to fertility medicine – one being the uterus transplant.

In 2014, the first successful uterus transplant was performed in Sweden. Not only can you get a uterus transplant, but people who have received this life-changing surgery have gone on to have healthy pregnancies. 

Who is eligible for a uterus transplant?

A uterus transplant is a major surgery and is only recommended for certain individuals. These are some of the reasons someone may undergo a uterus transplant:

• They were born without a uterus.
• They underwent a hysterectomy (uterine removal) for a cancerous or benign medical condition.
• They were diagnosed with uterine factor infertility (UFI) – affecting up to 5% of women globally.

It depends on your medical provider and where you live, but eligible candidates usually need to fall into other criteria including having otherwise good health, are non-smokers, and are between the ages of 21 to 40. 

Different hospitals will have different criteria for eligibility. For example, some require no history of diabetes or severe kidney disease, no history of cancer for at least five years, and no history of HIV or hepatitis B or C.

Some hospitals may also require participants to have been in a stable relationship for a certain amount of time before undergoing the surgery, regardless of their sexual orientation. 

How does a uterus transplant work?

The whole uterus transplant process, including pregnancy, typically takes two to five years. After being deemed an eligible candidate, which can be a rigorous process in itself, you’ll need to be matched with an eligible donor. Ideally, this is from a family member, but it’s not necessary.

A uterus donation can come from a person who is alive or deceased. Just like with patient eligibility, different hospitals have different criteria for donors. For many hospitals, living donors must be females between the ages of 30 to 50, have completed their “child bearing” years, are generally in good health, and be negative for HIV, hepatitis, gonorrhea, chlamydia, and herpes. 

Before undergoing the transplant process, patients will need to have embryos created from their eggs or donor eggs. Eggs are harvested using the IVF process which involves taking fertility drugs to produce eggs and then having them removed. Eggs are then fertilized using their partner’s sperm or donor sperm and resulting embryos are frozen for later use.

The transplantation involves removing the uterus from the donor and surgically placing it into the recipient. Patients then need to take immunosuppressive medications to help prevent rejection of the transplant uterus, and should continue taking them while the transplant placed.

Pregnancy after a uterus transplant

What sets uterus transplants apart from most other transplant surgeries, is one – that a uterus is not a medically necessary organ unless someone would like to become pregnant, and two – the uterus transplant is removed after pregnancy is complete. 

Because of this, the main goal of a uterus transplant is for people to be able to become pregnant and carry their own babies to term. Still, because this is a major surgery, patients must go through a recovery period before starting the IVF process. 

There is typically a minimum of six months recovery time between transplant surgery and when someone is able to become pregnant. After the recovery period, the patient will go through IVF using the embryos that were frozen before their transplant. Unlike traditional IVF, only one embryo is typically implanted at a time.

Patients must also continue to take immunosuppressive drugs during pregnancy. A successful implantation is still considered a high risk pregnancy and babies are born via Cesarean section (C-section), and relatively early at 35 weeks. Because most babies born via uterine transplant are premature, they may require a stay in the neonatal intensive care unit (NICU).

Uterus transplants for trans women

Another important application when it comes to uterus transplants is in gender-affirming care. According to the World Health Organization (WHO), gender-affirming care “encompasses a range of social, psychological, behavioral, and medical interventions ‘ designed to support and affirm an individual’s gender identity’ when it conflicts with the gender they were assigned at birth.  

Some trans women who were assigned female at birth (AFAB) may want the option to gestationally carry their own children – something uterus transplants can offer.

It’s important to note that gender-affirming care looks different for everyone. While some trans women may want vaginal constructive surgery and a uterus transplant, others may not. Even those who have had a vaginoplasty may not want children or don’t have a desire to be pregnant. Although there are currently no known cases of trans women receiving uterus transplants, it is possible.

Uterus transplant complications

As with any medical procedure, there are potential complications when it comes to a uterus transplant. Patients must undergo a series of medical procedures and surgeries including IVF, C-section, transplant insertion and removal. 

At many hospitals, this surgery is a minimally invasive procedure done with robotic surgery. The biggest potential risk of uterus transplants include:

• Injury to nerves
• Injury to blood vessels
• Injury to bowel, bladder, or ureters
• Reactions to immunosuppressant medications including diabetes and renal damage

How to find a uterus transplant provider

This technology is still in its early stages but has moved past clinical trials as of May 2023. As of 2020, about 100 uterus transplants have been performed globally, although that number has since grown and is available in countries like the United States, Sweden, Czech Republic, India, and Turkey.

Some people may practice medical tourism in order to find the best care at a price that’s accessible to them. Uterus transplants are most often done at research hospitals. It’s important to conduct intensive research to find the best care possible with providers that practice within a specific legal and ethical framework.

Medicine continues to improve everyday, and uterus transplants are just one revolutionary advancement in the fields of fertility and reproduction.