Evaluation and Disposition of Potential Candidates for Uterine Transplantation: Experience From a Large Referral Center

Abstract Objective Uterine transplantation (UTx) is an emerging surgical treatment for absolute uterine factor infertility. Given its complexity, careful patient selection and counseling are essential. We aimed to characterize patients expressing interest in UTx and identify common reasons for exclusion at a large referral center. Methods We conducted a retrospective cohort study of individuals who self-referred for UTx and completed a standardized intake survey between April 2022 and April 2025 at a large academic center. Demographic, reproductive, medical, and psychosocial data were collected. Applications were reviewed by the transplant team, with additional phone screening when needed. The primary outcome was reason for exclusion from UTx candidacy. Results During the 3-year study period, 371 intake surveys were received; 3 (0.8%) were incomplete. Causes of infertility included prior hysterectomy (79.6%), congenitally absent uterus (16.3%), and other etiologies (4.1%). Among 368 complete applications, 96.0% (353/368) were excluded. Reasons included age ≥ 40 years, BMI ≥ 30 kg/m 2 , tobacco or illicit substance use, medical contraindications, severe mental health conditions, reproductive contraindications, self-withdrawal, and inability to comply with study requirements. The most common exclusions were medical contraindications (34%), age (18%), and BMI (17%). Conclusions Fewer than 2% of interested applicants ultimately qualify for UTx. While many criteria are nonmodifiable, addressing modifiable factors may improve candidacy and support informed counseling. Trial Registration Clinical trial registration number- NCT05263076