Uterine transplantation (UTn) has been proposed as a possible solution to absolute uterine factor infertility (AUFI) untreatable by any other option [1
]. The inability to experience a pregnancy, give birth, and bring up a child because of infertility issues may be one of the most traumatic and devastating situations to affect a woman or couple, with the capacity to have a severely detrimental effect on the quality of life of both parties [2
]. The term “infertile” is an all-encompassing term and includes women with AUFI. Causes which render women “unconditionally infertile” are either congenital, namely, Müllerian duct anomalies, or acquired causes (such as leiomyomata, radiation damage, intrauterine adhesions, or premenopausal hysterectomy for obstetric bleeding or cervical/endometrial cancer).
Tremendous advances have been made during the last decades in the fields of transplantation and reproductive medicine, in particular, the first reports of successful transplantation of a solid organ, the kidney [5
], and live birth after IVF [7
]. Transplantation surgery today includes types of organ/tissue transplantation that will enhance the quality-of-life as exemplified by transplantation of the hand [8
], the abdominal wall [9
], the larynx [10
], and the face [11
], with the aim to add UTn to the list.
UTn was first performed in a human in 2000 on a 26-year-old female who had previously lost her uterus as a result of postpartum haemorrhage. The event granted much needed impetus for research into UTn, which since then has been a slow, methodical process within an animal setting involving multiple institutions and disciplines over several continents. Research has focused on several important areas, mainly surgical, immunological, and reproductive aspects. The second UTn attempt in a human model is anticipated in the not-too-distant future.
A major obstacle to UTn remains immunological rejection of the transplanted graft. The process of rejection in allogeneic UTn was first described by two studies in 1969 [12
], the decade in which UTn research was first published. At that time, UTn commonly involved en bloc
autotransplantation of a combination of the different reproductive organs: uterus, fallopian tubes, and ovaries. Since then, assisted reproductive technologies such as in vitro
fertilization (IVF) have addressed many of the causes of infertility. However, for women who suffer from AUFI, surrogacy, adoption, or lifetime infertility remains the only option. The hope is that, with continued advances in transplantation surgery and control of tissue rejection, UTn can bring an end to AUFI by allowing a select group of women to become mothers [14