Uterus Transplant For Patients with Mullerian Agenesis

Abstract Purpose of Review This report reviews the evolution, surgical techniques, and outcomes of uterus transplant for women with Mullerian agenesis, including donor selection, surgical techniques, immunosuppression, and pregnancy and neonatal outcomes. Recent Findings Living donor transplants may show higher technical success than deceased donor transplants, although this finding may be influenced by the lower frequency of deceased donor transplants. Donor risk remains a key consideration in selecting an approach. Minimally invasive robotic techniques are improving graft survival and reducing complications, with recent studies describing 100% graft survival among 16 robotic transplants, and nine subsequent livebirths. Since 2014, at least forty live births have been achieved with uterus transplant, all delivered via cesarean section, with 70% occurring prior to 37 weeks gestation. Maternal and obstetric complications such as hypertensive disorders of pregnancy and postpartum hemorrhage are reported, with 40% of neonates requiring admission to neonatal intensive care. Early follow-up data are reassuring, with normal neurodevelopment reported in the majority of children assessed at 2 years of age. Summary Uterus transplant has developed from an experimental procedure into a viable, though resource-intensive, option for absolute uterine factor infertility. Cost, donor risk and ethical questions around access and allocation remain significant barriers, and long-term maternal and childhood outcomes are incomplete. Continued collection of standardized outcomes data through collaborative registries such as International Society of Uterus Transplantation (ISUTx) and the United States Uterus Transplant Consortium (USUTC) will be essential to guiding the field as uterus transplant moves toward broader clinical application.