Uterine transplantation: a future possibility to treat women with uterus factor infertility?

Uterine transplantation is developed as a possible future treatment for patients with absolute uterus factor infertility. Patients with the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, patients having had hysterectomy for benign or malignant uterine/cervical diseases and patients with intrauterine adhesions are the major groups of patients, who could benefit from this procedure. There has been one attempt to transplant a human uterus, which however failed. Since then, several uterine transplantation animal models have been developed to examine various aspects of the uterus transplantation procedure and to optimize it for human use. In a mouse model, normal pregnancy rate and offspring were seen after syngeneic uterus transplantation. The tolerance for cold ischemia from the time the uterus is taken out from the donor until placed in the recipient is around 24 h, as shown in a mouse uterine transplantation model and on human uterine tissue. The rejection pattern of the transplanted uterus was tested in an allogeneic mouse model with signs of rejection after 5 to 10 days. High doses of cyclosporin A (CyA) could partly suppress rejection but pregnancies have not yet been achieved in allogeneic uterus transplants in any species. In the sheep and pig models, the vascular anastomosis technique and the tolerability to cold ischemia have been evaluated. Normal offspring have been delivered in the sheep model after autotransplantation and presently allogeneic uterine transplants in sheep treated with corticosteroids and CyA are tested. Initial studies on uterus transplantation is also now conducted in primates. It is predicted that uterus transplantation may reach a clinical stage within 2-3 years, in the event of a continuous high research activity within this field.