Feasibility study for performing uterus transplantation in the Netherlands

Area of Science:

• Reproductive Medicine
• Transplantation Surgery
• Medical Ethics

Background:

• Uterus transplantation (UTx) offers a potential solution for absolute uterine factor infertility, particularly for women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
• Currently, in the Netherlands, adoption and surrogacy are the primary options for women with MRKH syndrome to have children.
• UTx has resulted in 19 live births globally, with ongoing clinical investigations.

Purpose of the Study:

• To assess the feasibility of establishing uterus transplantation (UTx) at a tertiary center in the Netherlands.
• To explore ethical, medical, and financial support for UTx implementation.
• To evaluate patient interest and decision-making regarding UTx.

Main Methods:

• A feasibility study was conducted at Amsterdam UMC, location VUmc.
• A special interest group comprising gynecologists, transplant surgeons, researchers, and a financial advisor was formed.
• A questionnaire study was administered to potential recipients, in collaboration with the MRKH patient association, to gauge interest and identify potential live donors.

Main Results:

• A significant interest in UTx was observed among women with MRKH syndrome, with 64.8% considering it with a live donor and 69.6% having a potential donor.
• The procedure involves two complex surgeries with potential unknown risks for the unborn child.
• The estimated cost of UTx is approximately €100,000, with no medical insurance coverage, raising ethical considerations regarding non-maleficence and fair healthcare distribution.

Conclusions:

• Based on ethical, surgical, and financial considerations, uterus transplantation is not currently feasible at the hospital.
• Existing alternatives for fertility in the Netherlands, such as adoption and surrogacy, are available.
• Future collaboration with experienced international clinics offering UTx is a potential avenue for further exploration.