Restoration of Reproductive Function in Uterine Factor Infertility: Clinical Evaluation of Uterus Transplantation

Background/Objectives: According to the World Health Organization, approximately one in six couples experience infertility during their lifetime, accounting for about 15-17% of the reproductive-aged population worldwide. Absolute uterine factor infertility is a condition in which a woman is unable to conceive due to the absence of the uterus or irreversible impairment of its function. Uterus transplantation has emerged as a novel treatment option enabling affected women to achieve biological motherhood. Aim of the study was to review current evidence on uterus transplantation as a treatment for absolute uterine factor infertility, focusing on clinical outcomes, surgical aspects, patient selection, and associated risks. Methods: A structured narrative review informed by a literature search was conducted using PubMed, Web of Science, and Scopus databases. Publications addressing clinical outcomes, surgical techniques, donor and recipient selection, immunosuppressive therapy, and ethical aspects of uterus transplantation were analyzed. Publications published between 2016 and 2025 addressing uterus transplantation were reviewed. The selected studies comprised clinical trials and case series, systematic reviews, clinical and methodological analyses, and ethical publications. Results: The most common indication for uterus transplantation is MRKH syndrome, although acquired causes such as hysterectomy for oncologic or benign gynecological conditions are also relevant. Patient selection is based on strict medical and psychosocial criteria. Graft survival rates reach approximately 74%, with vascular complications, particularly thrombosis, being the leading cause of graft loss. By 2025, more than 130 uterus transplantations and over 70 live births had been reported worldwide. Clinical pregnancy rates approach 70% among recipients with a functioning graft, while at least one live birth has been achieved in approximately 43% of recipients. Pregnancies following uterus transplantation are considered high-risk and are associated with increased rates of hypertensive disorders, gestational diabetes, preterm delivery, and neonatal complications. Immunosuppressive therapy remains essential but is associated with nephrotoxicity and infectious risks. Conclusions: Current evidence indicates that uterus transplantation can restore reproductive function in carefully selected women with absolute uterine factor infertility. Despite encouraging reproductive outcomes, the procedure remains associated with substantial surgical complexity, vascular complications, and immunosuppression-related risks, limiting its broader implementation in clinical practice.