Uterus transplantation

Uterine transplantation

Stockholm IVF offers consultation, preliminary investigation, and assisted reproduction prior to uterus transplantation.

Specific surgery-related investigations, transplantation surgery and treatment after uterustransplantation are not carried out at Stockholm IVF.

Uterus transplantation is a treatment for women who are infertile due to the absence of a functioning uterus. Absolute uterine factor infertility (AUFI) may be attributable to uterine absence or a functional abnormality, which means that the woman cannot become pregnant. The absence of a uterus may be congenital (MRKH syndrome) or acquired (removal of the uterus due to cancer, myoma (uterine fibroids) or major postpartum bleeding. The reasons why an existing uterus is not functional include malformation (shape change) of the uterus, pronounced adherences inside the uterine cavity, scattered adenomyosis, and large (inoperable) uterine fibroids.

The world's first child born after a uterus transplantation was born in Sweden in 2014 and this has been followed by more than 30 births after uterus transplantation, initially in Sweden but in recent years also in the rest of Europe, North America, South America, and Asia.

Mats Brännström, professor at the University of Gothenburg and a doctor at Stockholm IVF, is regarded as a pioneer in uterus transplantation research and has also been one of the leading surgeons who has brought 15 children into the world after uterus transplantation. Associate Professor Lars Nilsson and Dr. Milan Milenkovic, formerly clinically active at Stockholm IVF, were the IVF doctor who was behind the assisted reproduction of world's first eight children after uterus transplantation. The fictional and exciting book "The Road to Vincent" (Mondial Publishers) reflects the long journey, taken by parents and doctors, who undertook the world's first delivery of a child after uterus transplantation.

Step-by-step

1. Investigation

The investigation for uterus transplantation is an important process for the donor, recipient and the partner of the recipient of the transplanted uterus. The purpose of the investigation is to ensure that conditions for a successful transplant are good and to ensure a subsequent uncomplicated pregnancy in the transplanted uterus. At the same time, it is important to ensure that the recipient's egg cells are of good quality and that the man's sperm can fertilize the eggs. This is done by that the recipient and her partner undergoing IVF well in advance of the transplant. This IVF treatment can be done at Stockholm IVF, which has considerable and extensive experience of the complicated conditions involved with IVF before and after uterus transplantation.

2. Uterus transplantation

Uterus transplantation is only carried out when the investigation has concluded that all three individuals (the recipient, the recipient's partner and the donor) are suitable for the procedure. The surgical interventions (donor hysterectomy and uterus transplantation) are not carried out by the staff at Stockholm IVF, as we only provide an advisory function during the initial investigation. We also perform assisted reproduction before and after transplantation. The surgical procedures can only be performed at larger hospitals that have a large and long-established organization with experience of advanced gynaecological surgery and transplant surgery. Normally, both the donor and the recipient will not arrive at the hospital until the morning of the transplant. At the hospital, a team of gynaecologists and transplant surgeons stand ready to perform today's two operations as illustrated below.

Stage 1 Donor surgery. Uterus with blood vessels are dissected free and released from surrounding organs, including oviducts and ovaries

Stage 2: Flushing of the blood vessels of the donor’s uterus with cooling and preservation fluids

Stage 3: The vessels of the transplanted uterus are connected to those of the recipient

3. After transplantation

Both the donor and the recipient are cared for at the postoperative unit during the night and then transferred to a hospital ward for approximately one week of postoperative care after the transplant. Just before the transplant, the recipient has started immunosuppressant treatment to prevent organ rejection and this treatment has to continue during the time the uterus is carried.

Menstrual periods usually come within one to two months and then continue regularly. In the first year after the transplantation, it is important to examine the uterus at frequent intervals to ensure that blood flow is normal and that the organ is not rejected. Approximately 10 months after the transplantation, it is time to start to introduce embryos in order to get pregnant. Embryo transfer is then carried out in the usual way as with the transfer of frozen embryos after regular IVF. Pregnancy follow up is carried out be a doctor in cooperation with the transplantation unit.

Delivery takes place by caesarean section. This is done in the usual way approximately three weeks before the pregnancy has reached its full normal course (40 weeks). The transplanted uterus may be kept to allow for future pregnancies. A possible new pregnancy can begin about 6 months after childbirth.

Efter en kirurgiskt lyckad livmodertransplantation är chansen till att få barn drygt 80%.

After surgically successful uterus transplantation, the chance of having children is slightly greater than 80%.