Uterus transplants are becoming more successful
Since the first baby was born from a transplanted uterus in 2014, what was once considered a science-fiction experimental procedure has steadily moved into the medical mainstream.
In just over a decade, more than 100 women globally have undergone uterus transplants, a procedure in which surgeons implant a donor uterus into someone who cannot carry a pregnancy because they either lack a uterus or the organ is not functioning properly. Worldwide, the procedure has resulted in more than 60 births, offering new possibilities to women with what doctors call absolute uterine factor infertility, a condition estimated to affect roughly 1 in 500 women of reproductive age.
A new study reviewed uterine transplants conducted at Baylor University Medical Center, the largest uterus transplant center in the world and found that the procedure may be becoming both safer and more successful as the field matures.
How uterus transplantation works
Uterus transplants are generally reserved for women facing infertility because they were born without a uterus, lost it to disease or have a nonfunctioning uterus. Candidates typically must be between the ages of 18 and 40 and be healthy enough to undergo major transplant surgery and pregnancy, said Liza Johannesson, the surgeon who helped pioneer the procedure in Sweden before joining Baylor University.
Before receiving a transplant, patients first undergo in vitro fertilization to retrieve eggs to create embryos. Then, during the transplant surgery, surgeons connect a donor uterus — from either a living or deceased donor — to the recipient’s blood vessels and vaginal canal. If the transplant is successful, patients typically begin menstruating within a few months, a sign that the uterus is functioning normally.
Doctors then transfer embryos into the transplanted uterus and closely monitor the pregnancy, which is delivered by cesarean section to prevent damage to the new uterus. Like other transplant patients, women who receive a new uterus take immune-suppressing drugs to prevent organ rejection, so the uterus is usually removed after one or two pregnancies to avoid lifelong immunosuppression.
Between 2016 and 2026, Johannesson and her colleagues conducted 44 uterus transplants. Of those, 37 were successful. By the time the researchers published their findings, 33 women had undergone embryo transfer, resulting in 47 pregnancies among 31 women. Seven pregnancies ended in the first trimester — a rate broadly comparable to miscarriage rates as a whole — while four ended in the second trimester, a somewhat higher rate than is typically seen in the general population. In all, 27 women gave birth to 31 babies, including four sets of twins.
Eight of the 27 women who delivered experienced medical complications during pregnancy, most commonly gestational diabetes and high blood pressure — conditions that also occur in conventional pregnancies. Researchers additionally reported complications, including preterm labor and premature rupture of membranes, both of which contributed to a relatively high rate of preterm birth.
Neonatal outcomes were generally favorable. All newborns had five-minute Apgar scores of at least 7 out of 10, indicating they were in good overall condition shortly after birth. Eleven infants were admitted to neonatal intensive care units, largely because they were born prematurely, with stays ranging from several days to nearly two months.
The next challenge: Access and cost
Johannesson said researchers are now focused on standardizing the procedure across medical centers and continuing to track the long-term health of both transplant recipients and the children born from transplanted uteruses. But as science advances, another challenge is emerging: Uterus transplantation remains extraordinarily expensive, and most insurance companies do not cover the procedure — much like many insurers still do not routinely cover IVF for infertility treatment — leaving many patients to shoulder significant out-of-pocket costs.
The latest findings come amid broader national attention on fertility care and reproductive medicine. President Donald Trump has recently implemented policies aimed at expanding access to IVF and reducing treatment costs, moves that could eventually open the door to wider conversations about insurance coverage for advanced fertility procedures like uterus transplantation.
“We have a lot of work to do there because right now it’s a costly procedure and a lot of the patients have to pay a lot for themselves,” Johannesson said. “We don’t want this to only be for the wealthy.”
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Ella Rae Greene, Editor In Chief
