Uterus Transplant — Procedure Guide, Recovery & Risks | MyMedicPlus

Uterine transplantation (UTx) is an experimental surgical procedure offering women with absolute uterine factor infertility (AUFI) — due to congenital absence (MRKH syndrome) or hysterectomy — the opportunity to achieve biological motherhood through IVF and uterine gestation.

Indicated for women with absolute uterine factor infertility who cannot carry a pregnancy due to an absent or non-functional uterus, who have functioning ovaries or stored oocytes, and who meet strict medical and psychological criteria under the Dallas UTx Criteria framework.

The uterus is procured from a living or deceased donor with vascular pedicles preserved. During transplantation, the uterine vessels are anastomosed to the recipient's iliac vessels. Immunosuppression (tacrolimus-based) begins immediately. Frozen IVF embryos are transferred 6–12 months post-transplant.

Lifelong vigilance for rejection episodes is required throughout the transplant period. IVF embryos are frozen before the transplant operation. After successful childbearing (typically 1–2 pregnancies by Caesarean section at 37–38 weeks), the transplanted uterus is removed to stop immunosuppression.

Risks include uterine rejection (25–30%), vascular thrombosis causing graft loss, opportunistic infection from immunosuppression, drug toxicity, and foetal growth restriction. All deliveries are by Caesarean section. Donor morbidity from the 6–8 hour procurement is a significant consideration.

Over 100 UTx procedures have been performed worldwide with more than 60 live births reported as of 2025. Living donor UTx achieves higher graft survival than deceased donor. Approximately 60–70% of successfully transplanted uteri result in at least one live birth at experienced centres.