Assisted Reproduction and Live Births in Uterus Transplantation—The Swedish View

Abstract

Assisted Reproduction and Live Births in Uterus Transplantation—The Swedish View Ghada Hussein1,2 , Mats Brännström2,3,* 1CLINTEC, Karolinska Institute, 14152 Huddinge, Sweden 2Stockholm IVF-EUGIN, 12030 Stockholm, Sweden 3Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Göteborg, Sweden *Correspondence: mats.brannstrom@obgyn.gu.se (Mats Brännström) Academic Editors: David H. Barad and Michael H. Dahan Submitted: 7 December 2021 Revised: 16 February 2022 Accepted: 21 February 2022 Published: 10 May 2022 Abstract Objective: Uterus transplantation (UTx) has evolved as the first true infertility treatment for absolute uterine factor infertility (AUFI), caused by a lack (congenital or surgical) of the uterus or presence of a non-functional uterus. Ever since the proof-of-concept of UTx as an infertility treatment, by the first live birth in 2014, the field has evolved with a number of ongoing clinical trials in several countries. Results are now gradually building up to estimate the efficacy of the procedure in terms of outcome of assisted reproduction, including live births. An update of these results will be presented along with our own experience. Mechanism: PubMed search for research articles with human UTx procedures. Findings in Brief: We could identify 62 UTx cases with data from research articles in peer-reviewed journals. Out of these, 51 were live donor procedures and 11 were deceased donor UTx. Surgical success was 78% in live donor UTx and 64% in deceased donor UTx. Limited data indicate a pregnancy and live birth rate per embryo transfer (ET), somewhat lower that in the general IVF population. The 24 published live births were premature (<37 gestational weeks) in 83%, with a high frequency (37%) of respiratory distress syndrome. Gestational hypertension/preeclampsia was seen in 17% and gestational diabetes in 12% of pregnancies. Post-natal health of children was fine. Conclusions: Uterus transplantation has entered the scene as the first available treatment for women with absolute uterine factor infertility. The procedure is still in an experimental phase and through ongoing clinical trials, with modifications of procedures, this type of combined infertility treatment and major transplantation surgery will improve regarding outcomes, such as surgical success, rate of pregnancy/live birth per ET, rate of term pregnancy, and rate of live births with only a minor rate of neonatal and postnatal complications. Keywords: uterus; infertility; transplantation; in vitro fertilization; embryo transfer; birth