10-Year Uterus Transplant Study Reveals High Live Births
A landmark national study has evaluated a decade of uterus transplantation outcomes across four leading surgical centers in the United States. Absolute uterine factor infertility traditionally left women with no option to carry a biological pregnancy. However, rapid advancements in vascular anastomosis and transplant immunology have transformed this experimental intervention into a viable clinical treatment. Consequently, clinicians worldwide now have comprehensive long-term data to guide patient counseling and reproductive management.
Study Design and Recipient Characteristics
This prospective cohort study monitored 60 uterus transplant procedures conducted between February 2016 and December 2025. In addition, the participating centers analyzed surgical protocols, immunosuppression regimens, obstetric care, and pediatric milestones. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome served as the primary indication for 52 recipients. Furthermore, six women had undergone a prior hysterectomy, one presented with a dysfunctional uterus, and one had androgen insensitivity syndrome. Transplants involved 42 living donors and 18 deceased donors. Therefore, the dataset represents living and deceased donation experiences comprehensively.
Key Uterus Transplantation Outcomes and Success Rates
Overall, the surgical programs reported exceptional reproductive efficacy across the ten-year period. As of December 2025, 42 of 60 recipients achieved at least one live birth or maintained an ongoing pregnancy. This milestone translates to an impressive 70.0% reproductive success rate. Moreover, nine recipients successfully carried two pregnancies to term before undergoing graft hysterectomy. Notably, no maternal deaths or life-threatening complications occurred throughout the study period. These findings confirm that uterus allografts deliver reliable functional capacity under standardized protocols.
Surgical Complications and Donor Morbidity
Despite high reproductive success, surgical risks remain significant for both recipients and living donors. For instance, 17 of 60 recipients required surgical reintervention due to post-transplant complications. Vascular thrombosis represented the primary cause of graft failure and graft removal. Similarly, 6 of 42 living donors experienced complications that necessitated reoperation. Specifically, these living donor adverse events included ureteral injury and vaginal cuff dehiscence. Hence, surgical teams must maintain meticulous operative vigilance and ensure robust informed consent.
Obstetric and Pediatric Health Profiles
Obstetric teams delivered 48 neonates during the surveillance period. Importantly, the median gestational age at delivery reached 36 5/7 weeks. Approximately 58.3% of infants were born preterm, typically by planned cesarean delivery. However, neurodevelopmental evaluations remained entirely normal at nursery discharge and at 6 months of age. Furthermore, longitudinal assessments at 3 years revealed no physical growth disorders among 29 evaluated children. In addition, clinicians diagnosed autism spectrum disorder in two children, but identified no other chronic conditions.
Clinical Implications for Reproductive Medicine
These cumulative findings establish uterus transplantation as a reproducible therapeutic pathway rather than an experimental procedure. For fertility specialists in India and globally, this evidence provides concrete benchmarks when counseling patients with congenital Müllerian anomalies. Additionally, uterus transplantation represents an ethical alternative for families navigating surrogacy restrictions. Therefore, multidisciplinary coordination between transplant surgeons, reproductive endocrinologists, and high-risk obstetricians remains vital to optimize maternal and neonatal safety.
Frequently Asked Questions
Q1: What is the overall live birth rate following uterus transplantation?
In this 10-year US cohort, 70.0% of recipients achieved at least one live birth or sustained an ongoing clinical pregnancy. Furthermore, 15% of recipients completed two successful live births before graft removal.
Q2: What are the main surgical risks associated with the procedure?
Surgical reoperation occurred in 28.3% of recipients, primarily due to vascular thrombosis leading to graft loss. In addition, 14.3% of living donors required reoperation for surgical complications such as ureteral injury and vaginal cuff dehiscence.
Q3: How does uterus transplantation impact neonatal and childhood health?
Although 58.3% of neonates were delivered preterm, infants demonstrated normal neurodevelopment at hospital discharge and 6 months. Moreover, three-year follow-up showed normal physical growth, with only two children diagnosed with autism spectrum disorder.
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References
- O'Neill KE et al. Surgical, Reproductive, and Child Developmental Outcomes After 10 Years of Uterus Transplantation in the United States. Obstet Gynecol. 2026 Sep 29. doi: 10.1097/AOG.0000000000006440. PMID: 42809768.
- Testa G, McKenna GJ, Bayer J, et al. Uterus Transplant in Women With Absolute Uterine-Factor Infertility. JAMA. 2024;332(11):901-909.
- Brännström M, Dahm-Kähler P, Kvarnström N, et al. Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review. Acta Obstet Gynecol Scand. 2024;103(12):2372-2384.
