What is a uterus transplant? Experts explain the procedure, and what it means for the future of fertility.

In July 2023 the University of Alabama at Birmingham announced that the successful delivery of the first baby born from a transplanted uterus outside of a clinical trial. The birth itself occurred the previous May, with the mother, a woman in Alabama named Mallory (who did not share her last name for privacy reasons), undergoing a planned C-section.

Mallory was born without a uterus — a condition that’s known as Mayer-Rokitansky-Küster-Hauser syndrome — and she said she never thought she would be able to carry a pregnancy. “I had come to terms with knowing that, ‘OK, I won’t be able to carry my own children’; but for me, it always felt like something that was lacking,” she said in a statement.

Mallory’s sister served as a gestational surrogate for her first child but wasn’t able to have another child for Mallory and her husband due to health reasons.

Mallory discovered the University of Alabama at Birmingham’s uterus transplant program, which is only one of four in the United States and the first to open to patients outside of clinical trials. She received her uterus from a deceased donor and relocated to Birmingham. It took 18 months from transplant to the birth of her second child.

“Even through some of the tough stuff, I really embraced pregnancy as I knew it would be the only time I was going to be able to do it, and I knew how lucky I was to be able to experience it,” Mallory said. “Sharing that journey with our daughter was so special, too, with her being able to feel my belly. I just had so much gratitude to experience this.”

What’s happening

The first baby from a uterus transplant was born in 2014 in Sweden, but several medical centers around the world have since helped women give birth via uterus transplant since then. The original uterus transplants took place using donor uteruses from living relatives, but the field has expanded to use uteruses from deceased donors.

In 2017, the first baby in the U.S. was born to a mom with a uterus transplant at Baylor University in Dallas. Since then, several major medical centers have studied the procedure. However, all of the previous births have been through clinical trials, which can often be a rigorous experience.

Why it matters

Opening uterus transplants outside of clinical trials is a big step, Dr. Jessica Shepherd, an OB-GYN in Texas and founder of Sanctum Med + Wellness, tells Yahoo Life. “It shows that even outside of centers for study with rigid guidelines, this is an option that now can be offered at other hospitals and allows more women access to this option,” she says.

Dr. Alex Robles, a reproductive endocrinologist at the Columbia University Fertility Center, tells Yahoo Life that this is a “major breakthrough in the fertility world.” He continues, “It opens up the possibility for patients who previously could not carry a pregnancy due to uterine factor to carry a pregnancy. More individual cases will likely result following this case.”

Uterine transplants are a newer specialty in medicine and some medical centers have been working diligently to establish protocols, Dr. Jonathan Schaffir, an ob-gyn at the Ohio State University Wexner Medical Center, tells Yahoo Life. “The fact that it has been adopted in clinical use outside of a clinical trial suggests that the technique has been sufficiently refined for it to have acceptable outcomes and some degree of safety,” he says.

What is a uterus transplant?

Every medical center approaches this a little differently. However, a uterus transplant is what happens when a donor uterus — either from a living or deceased donor — is surgically implanted in a woman.

At Penn Medicine, which also performs uterine transplants, a woman must apply for a transplant and be screened for the procedure. If she’s selected for it, she needs to undergo IVF to retrieve her eggs, which are then fertilized and frozen. Once IVF is complete, a donor uterus is identified for the woman and implanted surgically in her body. The woman takes immunosuppressive drugs while the uterus is in place. “As with any transplant, the recipient needs to take medication to suppress their immune system to prevent rejection of the new organ, which may be ‘attacked’ by the immune system to destroy foreign tissue,” Schaffir says. “After the pregnancy is complete, the transplanted uterus would then be removed so the risk of rejection does not persist.”

The embryo is implanted anywhere from six to 12 months after the transplant. If a pregnancy occurs, the baby is delivered via C-section between 37 and 39 weeks. Once she is done having children (most centers allow for one or two pregnancies), the uterus is removed.

Who needs it?

Uterus transplants have typically taken place in women who have uterine factor infertility (UFI), a form of female infertility where a woman cannot carry a pregnancy. Uterine factor infertility can impact as many as 5% of reproductive-age women worldwide and used to be considered an irreversible form of female infertility, the University of Alabama at Birmingham says.

Women with uterine factor infertility can't carry a pregnancy to term because she was either born without a uterus or had to have her uterus surgically removed during a hysterectomy, Shepherd says.

What does this mean for fertility?

Doctors say this is promising — but stress that this is still a rare procedure. “A uterine transplant remains a difficult and challenging surgery in which another person’s uterus is surgically placed into the donor and reconnected to their own blood supply,” Robles says. “This case shows that more and more developments are arising in the field of fertility for patients who previously had been unable to conceive even with standard fertility treatments.”

But uterus transplants can be risky, Shepherd says, as there are multiple surgeries involved and an increased risk of infections and pregnancy complications. “They should be discussed in totality on how to navigate this option in reproductive health,” she says.

This is also only designed to help a small group of women, Schaffir says. “Although it is important that there is a new option to offer women with this particular condition, it is not revolutionizing the treatment of infertility,” he says. “This specific subset of patients for whom the procedure may be applicable is a very small fraction of the infertile population.” There also is “little data” available about the success rate given that these transplants have been infrequent, Schaffir adds.

While experts say it’s great to have more options in fertility, they don’t anticipate this becoming a routine procedure. “I don't think it is likely to be common, though there may be more surgeons comfortable performing the procedure as more specialists are trained,” Schaffir says.

This article was originally published on July 27, 2023 and has been updated.