Uterus transplantation: from mice to human clinical procedure

Uterus transplantation (UTx) emerged as a groundbreaking solution for women facing absolute uterine factor infertility (AUFI), offering hope for childbearing since the first proof-of-concept of UTx in 2014 by the first live birth from a woman with uterine graft. This review provides a comprehensive overview of the evolution of UTx from foundational animal research to current clinical trials and cases. Recent advancements in surgical techniques, including a shift towards robotic approaches, have improved graft removal and transplantation, though challenges persist in optimizing immunosuppressive strategies and rejection monitoring. Given the absence of Fallopian tube transplantation in UTx, in vitro fertilization (IVF) is an integral part of the process. This review delves into the intricacies of combining UTx with IVF, addressing crucial questions about the timing of oocyte retrieval, cryopreservation of oocytes or embryos, and the optimal timing for the first embryo transfer post-UTx. The significance of the International Society Uterus Transplantation (ISUTx) registry is highlighted for evaluating overall success rates, complications, and live births. Examining the long-term health outcomes for donors, recipients, partners, and children born from transplanted grafts, the review acknowledges the life-giving nature of UTx. Cost considerations are explored, anticipating a potential decrease in costs with enhanced efficiency. The discussion emphasizes the evolving landscape of UTx, proposing a scheme for program setup and outlining future directions. This comprehensive analysis marks a significant milestone in the field, transitioning UTx from experimental to mainstream clinical practice. As criteria widen and outcomes improve, UTx is poised to become a realistic and accessible alternative for treating AUFI, representing a significant advancement in reproductive medicine worldwide.