Uterine Transplantation as a Fertility Restoration Technique: A Prospective Observational Study of Clinical Outcomes, Surgical Challenges, and Reproductive Success Rates

Abstract

Introduction: Uterine transplantation (UTx) has emerged as a novel fertility-restoring option for women with absolute uterine factor infertility (AUFI). Despite being in its developmental stage, successful live births following uterine transplantation have demonstrated its potential as an alternative to surrogacy and adoption. However, data regarding surgical feasibility, perioperative challenges, graft survival, and reproductive outcomes remain limited.

Aims and Objectives: To evaluate uterine transplantation as a fertility restoration technique in AUFI, focusing on clinical outcomes, surgical challenges, graft survival, and reproductive outcomes including pregnancy and live birth rates.

Materials and Methods: This prospective observational study was conducted over 9 months in the Department of Obstetrics and Gynaecology, Deben Mahato Government Medical College, MS. A total of 150 women with absolute uterine factor infertility undergoing uterine transplantation were included and evaluated for clinical, surgical, and reproductive outcomes.

Results: Out of 150 patients, 120 (80%) had successful uterine transplantation outcomes. Highest success was in age 26–30 years (84%) with no significant association (p = 0.49). MRKH syndrome showed better outcomes (87.5%) (p = 0.20). Living donor transplantation had significantly higher success (85%) than deceased donor (70%) (p = 0.03). Menstrual recovery occurred in 78.70% (p = 0.02), and pregnancy was achieved in 46.70% with live birth in 36.70% (p = 0.01).

Conclusion: Uterine transplantation is an emerging fertility restoration technique for women with AUFI, showing encouraging reproductive outcomes in selected cases. However, it is a complex procedure with significant surgical and immunological challenges. Larger studies with long-term follow-up are needed to standardize protocols and improve outcomes.