Uterus Transplantation: An Overview

Todays, and by advent of ART, most infertile couples are treatedsuccessfully. However absoluteuterine factor infertility (AUFI)is so far untreatable. By far, the two feasible solutions are eithergestationalsurrogacy or adoption. The possibility of gestationalsurrogacy or adoption is notaccessible in many countriesdue to legal, religious or ethical consideration. Uterustransplantation(UTx) is the only quality of life enhancing method aswell as a life-givingtransplantation in women with AUFI. After۱۲ years of research, the first human case of UTxwas performedin Saudi Arabia in ۲۰۰۰, and the first baby resultingfrom a transplanted uteruswas born in ۲۰۱۴ in Sweden. In auterus transplantation procedure, there are two options foruterusdonors, living or deceased, both of which have advantagesand disadvantages. Thecandidates of uterus donor & recipientgo through a detailed work up prior to the transplantationregardingboth the physical and psychological and all laboratorytests. Ovarian stimulation, ARTand embryo freezing should beperformed one year before transplantation. UTx surgicalprocedureincluding procurement of the uterus (Radical Hysterectomyincluding preservation oflong vascular pedicles up-tointernal iliac vessels, round and uterosacal ligaments, and a flapofbladder peritoneum). This part takes about ۱۴ hours. Immunosuppressionmust be induced atthis point. The next procedureis anastomosis of all preserved part of the uterus to recipient.Anastomosis takes ۵ hours. From the ethical pint of view, UTxis highly experimental procedure,not life -saving, is an ephemeraltransplant, needs immune-suppression, and there is alsoadebate concerning the application of this option in countries orregions that gestational surrogacyis permitted.