Potential candidates for uterine transplantation an assessment of need

Abstract

To estimate the minimum number of potential candidates for uterine transplantation in the United States. English language literature search and review. Prime candidates for human uterine transplants are those with absolute uterine factor infertility (UFI). These include women: with congenital absence of uterus (e.g. Mayer Rokitansky Kuster Hauser Syndrome); women who have lost their uterus secondary to obstetrical complications (e.g. post-partum hemorrhage); women who have lost their uterus for benign causes (e.g. pelvic inflammatory disease, fibroids, pelvic tuberculosis); or early invasive cervical/ovarian malignancies at an early age. Patients with UFI including polyps, septums and less severe forms of the above conditions that did not require hysterectomy are not included. Potential candidates for uterine transplant (UT) were calculated based on number of women in reproductive age group (rep. age gp 15–44yr, US Census Bureau) with the above factors. This number (no.) was multiplied by fecundity rate (FR) as reported by the National Statistics for Family Growth. Potential candidates for UT are calculated and expressed whenever possible as an absolute number, crude annualized incidence and prevalence. Total annual number of hysterectomies for ages 15–24 is about 5000 (0.2/1000/yr). Fecundity rate for this age group is 85.4%. Therefore the number of women possibly interested in conception and hence potential uterine transplantation in this age group alone is estimated to be 4,250 each year. The total number of reproductive age women who had hysterectomy in US in 2004 was 233,843. Current fecundity rate in the US for this age group is about 64%. Using the national fecundity rate, the number of women who might be interested in conception is around 151,530. Congenital absence of uterus occurs in about 1/5000 newborns. Using current US population of reproductive age group women (62,073,767) approximately 12,414 women may be affected by congenital absence of uterus and 8,069 interested in conceiving. About 1200 surrogate pregnancies occur each year in US, which is consistent with our estimates. A significant number of women may be candidates for uterine transplant in the US. Worldwide, many more potential patients may also exist.