Womb transplants with live births: an update and the future

ABSTRACT

Introduction: Absolute uterine factor infertility, with a uterine absence or presence of a nonfunctional uterus, has during the last decades been the only remaining, major group of female infertility. Uterus transplantation (UTx) has now emerged as the first therapy for these women that have traditionally been regarded as unconditionally infertile.

Areas covered: This review summarizes the research preparations in several experimental animal species that paved the way for the clinical introduction of UTx. The article also describes the human UTx attempts that have been reported up until today and the several live births that have occurred after the initial UTx baby was born in 2014. Future developments in human UTx and efforts to create a bioengineered uterus are also discussed.

Expert opinion: UTx has already at this early phase of experimental introduction in the human setting proved to be a highly effective treatment for absolute uterine factor infertility. The UTx procedure has now been introduced at several centers worldwide within clinical research studies and with variations in techniques. The outcome and data from these studies will further optimize the UTx procedure to become a safe and highly effective infertility treatment.

KEYWORDS:

• Human
• infertility
• transplantation
• uterus

Article highlights

• Around 20,000 women (20–40 years of age) in a population of 100 million people are absolute uterine factor infertile and have up until the succesful introduction of uterus transplantation, been without treatment.

• The first live birth after uterus transplantation in any species was reported in 2003, in the syngeneic uterus transplantation model of the mouse.

• Systematic and step-by-step research in rodents, domestic species and non-human primates developed uterus transplantation further by specifically addressing uterus transplantation-related surgery, ischemia-reperfusion injury, immunosuppression, rejection diagnosis and pregnancy.

• The first reports of fertility after allogeneic uterus transplantation, with the pregnancy exposed to immunosuppression, came 2010–2011.

• After two scientifically unprepared and failed single cases of human uterus transplantation in 2000 and 2011, the first clinical trial of uterus transplantation was initiated in Sweden 2013.

• Today several children have been born from the cohort of nine Swedish women that entered the initial human uterus transplantation trial.

• New clinical trials have just started or are in the process to start in a number of centres around the world and pregnancy results from these trials can be expected from 2018.

• Uterus transplantation is an experimental, major surgical procedure and all new attempts should, for at least the coming five years, be performed within clinical trials to accumulate and publish data that can develop uterus transplantation into a safe and effective infertility treatment for absolute uterine factor infertility.

This box summarizes key points contained in the article.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

Mats Brännström is supported by the Jane and Dan Olsson Foundation for Science and the Swedish Research Council.