Abstract
Uterine transplantation (UTx) is an experimental sterility treatment method in women with absolute uterine factor infertility. This article describes the current trends and risks in UTx and provides an overview of our experience with this method, to date. Based on our experience with the Czech UTx trial and the published results of other trials, we describe the possibilities and risks of this perspective method in the treatment of absolute uterine factor infertility (AUFI). Twelve healthy babies were born in 2014-2018 after more than 40 uterine transplantations. There is no general consensus whether it is more suitable to transplant uteri from living or deceased donors, and nulliparous or parous women (with proven obstetrical functionality). Most centers prefer to collect at least ten frozen embryos from in vitro fertilization (IVF) cycles before transplantation. The serious complication of a surgically successful uterine transplantation is posttransplant partial stenosis of the uterine-vaginal anastomosis that may be a technical problem for embryo transfer, outflow of menstrual blood, and sexual satisfaction due to the narrowed and shortened vagina. This paper concludes that, currently, procurement of the uterus and the transplant procedure are surgically feasible and that none of the transplanted uteri have been lost due to rejection but only because of graft thrombosis or infection. Uterine transplantation, after optimization of surgical methods, selection of suitable donors, standardization of immunosuppressive therapy, adjustment of assisted reproductive technologies and obstetrical proceedings might be an effective therapeutic method for women with AUFI who wish to have their own biological child.
Highlights
Uterine transplantation (UTx) is proposed as a sterility treatment method in women with absolute uterine factor infertility (AUFI)
Centers specialized in assisted reproductive technology (ART) were focused on in vitro fertilization (IVF) methods for a long time; only after 2000 was the idea of uterus transplantation (UTx) revitalized, and research was initiated with animal-based studies[2,3,4,5]
The purpose of this paper is to provide information gleaned from Czech experience with ten UTx cases and the published results of other trials and case reports, on the possibilities and risks of this so far experimental but perspective method of treatment of AUFI that enables delivery of a biological child to women without uteri whose only options available so far were adoption and gestational surrogacy
Summary
Uterine transplantation (UTx) is proposed as a sterility treatment method in women with absolute uterine factor infertility (AUFI). Uterine transplantation (UTx) is an experimental sterility treatment method in women with absolute uterine factor infertility. Based on our experience with the Czech UTx trial and the published results of other trials, we describe the possibilities and risks of this perspective method in the treatment of absolute uterine factor infertility (AUFI). There is no general consensus whether it is more suitable to transplant uteri from living or deceased donors, and nulliparous or parous women (with proven obstetrical functionality). After optimization of surgical methods, selection of suitable donors, standardization of immunosuppressive therapy, adjustment of assisted reproductive technologies and obstetrical proceedings might be an effective therapeutic method for women with AUFI who wish to have their own biological child
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