Reproduction Abstracts

The last frontier to conquer in female infertility is absolute uterine factor infertility (AUFI), affecting more than 10 000 women in the UK. Uterine transplantation (UTx) is now the first available treatment for this large group of women. Adoption and gestational surrogacy are other means to obtain motherhood, but the acceptances of these arrangements in the society vary greatly between societies.

Our research group initiated a step-by-step developmental animal-based research approach on UTx in 1999 and have optimized all aspects of the procedure in several animal species. Today 11 human UTx ttempts have been made, with the last nine of them performed by our team. The first two human UTx-attempts, which were unsuccessful, were done in Saudi Arabia in 2000 and in Turkey in 2011.

In early 2013 our team completed the surgeries of a series of totally nine human UTx, with live uterus donors. Eight recipients were MRKH patients and one had undergone a hysterectomy because of cervical cancer. The mean age of the recipients was 31.5±3.9 years. Five donors were mothers and others were close relatives and in one case family friend. The mean age of the donors was 53.0±7.0 years. IVF treatments were done before transplantation. The donor surgery involved uterine isolation with pedicles of the uterine arteries and veins and including large parts of the internal iliacs.

In the recipient bilateral end-to-side anastomosis was accomplished between the uterine artery and one major uterine vein on each side. None needed perioperative blood transfusion and the hospital stays were 3–9 days. The recipients received two ATG treatments perioperatively and corticosteroids for 4 days. They were then only on double immunosuppression with tacrolimus and MMF and the plan was tapered doses of tacrolimus and omission of MMF after 6 months, to avoid possible teratogenic effects of MMF.

Two patients had to be hysterectomized during the initial months due to uterine complications. The other seven patients have shown regular menstruations from 2 months after UTx. The first live birth after UTx occurred in September 2014, when a baby was delivered by c-section in week 31+5 because of maternal preeclampsia (PE) development. Since then two more births have taken place and these mothers did not develop PE. A fourth recipient is expected to deliver in July 2015.

The four successful pregnancies after UTx are proofs-of-concept of UTx as an effective method to treat uterine factor infertility.