Uterus transplant advances pregnancy prospects for some

Uterus transplantation is expanding from early milestones in Sweden and the U.S. to growing clinical outcomes at major centers.

A new generation of uterus transplants is turning a once-rarity into a clinical option for women who cannot carry a pregnancy—offering a path to pregnancy and parenthood where none existed before.

Absolute uterine factor infertility affects about 1 in 500 women. The condition describes cases in which a woman cannot carry a pregnancy because of the absence or dysfunction of the uterus—such as being born without a uterus, having it removed, or having a defective organ.

For many patients with this diagnosis who want to experience pregnancy, clinicians and researchers have developed uterus transplantation.. The procedure centers on transferring a uterus—taken from a living or deceased donor—into the recipient. with the goal of making gestation possible through the recipient’s own pregnancy attempts.

The history of the procedure includes early global landmarks.. In 2014, the first birth following uterus transplantation took place in Sweden.. In the years that followed, the approach moved into broader clinical practice; the first U.S.. birth was reported three years later.. Over the last decade, more than 70 babies have been born worldwide after uterus transplantation.

One of the clearest windows into how the field is maturing comes from a large case series reported in a major medical journal on May 1.. The work was led by a team associated with Baylor University Medical Center in Dallas. which the report describes as having the largest uterus transplant center in the world.

The surgeon behind the Sweden milestone—Liza Johannesson—later joined the Baylor group. She and her colleagues described outcomes in the largest case series to date, based on women who underwent uterus transplantation at Baylor from 2016 to 2026.

Across that period, 44 women received the procedure at Baylor.. Within a month of surgery, 37 had a successfully transplanted uterus.. By April 2026, 33 of those women had had embryos transferred, and 31 became pregnant.. So far. 27 have given birth. while eight experienced complications that were most commonly gestational diabetes or high blood pressure—conditions that can also occur in typical pregnancies.

Among the births, 23 women delivered one child, and four delivered two children each.. Newborn outcomes were assessed using Apgar scores. a health scoring system based on measures such as heart rate and breathing immediately after birth; all newborns had an Apgar score of at least 7 out of 10 at five minutes.

Prematurity played a role in post-birth care needs.. Eleven newborns were admitted to neonatal intensive care due to being born prematurely. with hospital stays ranging from a few days to almost two months.. The report’s detailed newborn scoring and the need for NICU support are part of how clinicians judge whether transplant pregnancies are producing outcomes comparable to other assisted reproductive pathways.

Johannesson. who has been working in this field since the early breakthrough in Sweden. highlighted the emotional and medical significance of turning “impossible” into a lived pregnancy.. She discussed the experience of patients who had been told they would never carry a pregnancy. then proceeded through pregnancy and childbirth.

In discussing why women pursue uterus transplantation, Johannesson and her colleagues pointed to prior interviews conducted at Baylor.. In a 2021 study. participants described motivation focused on the desire to carry a pregnancy and. for some. on helping advance research that could benefit others with absolute uterine factor infertility.. The aim is not only personal parenthood. but also the development of a medically workable option for the wider patient community.

Johannesson explained that uterus transplantation has progressed in reliability over time.. She said the field has shifted from an experimental stage to one that can now be offered clinically. emphasizing that most transplants are successful and that. among patients with a functioning uterus that remains viable at about 30 days after surgery. most go on to have healthy babies.

Eligibility for transplantation is also a key element of the clinical story.. Johannesson said transplants are aimed at women with absolute uterine factor infertility in which the uterus is the limiting factor.. She described general health requirements and an age range of roughly 18 to 40. with the team not being strict at 40 but aiming to avoid patients older than the mid-40s due to increased stress and risk.

The pathway from transplantation to pregnancy begins with IVF.. Recipients create and freeze embryos before surgery, and clinicians avoid transplanting patients without embryos available for fertilization attempts.. The transplant itself is described as a complex surgical procedure in which the uterus is connected to blood vessels and to the vaginal canal of the recipient.

After surgery, recipients undergo gynecological evaluation.. If everything is functioning. periods typically begin within a couple of months. which acts as an early sign that the transplanted uterus is working.. Embryo transfer generally follows around three months after the transplant, with pregnancies then monitored closely.

Johannesson said pregnancies are delivered by C-section.. She also noted that some recipients may choose not to pursue further pregnancies. or that the uterus may be removed in certain circumstances—such as reactions to immunosuppression or medical complications.. Importantly. the team takes out the uterus after the pregnancy journey is complete so recipients are not required to remain on immunosuppression drugs indefinitely.

Donor sourcing has been another point of change as the program expanded.. The report and Johannesson’s account describe both living and deceased donation.. Johannesson said the team expected a mix of donor types but found that many living donors contacted the center and wanted to donate their uterus. resulting in a program that relies almost exclusively on living donors.

She also described the motivations of donors as recurring and personal: many view the act not as donating an organ alone, but as donating the experience of pregnancy and childbirth to someone else.

When it comes to pregnancy outcomes. Johannesson suggested that when the transplanted uterus is functioning. live birth rates are broadly similar to those seen in IVF.. She said complication rates at present resemble those observed in IVF pregnancies, and that monitoring includes attention to immunosuppression levels.

For infants, the team reported good outcomes overall, with no malformations linked to the transplant itself.. Still. Johannesson indicated that the risk of prematurity appears somewhat higher than in the general population. though not beyond what is seen in IVF pregnancies or among patients in solid organ transplant contexts.

Looking ahead, the field’s next steps focus on making results consistent and building longer-term evidence.. Johannesson said the team is working on standardizing protocols across centers so outcomes are reliable regardless of where the procedure is performed. and it also needs long-term data on both mothers and children.. Since the first baby was born in 2014 in Sweden and the first in the U.S.. arrived in 2017, that timeline means recipients are approaching the age where longer follow-up becomes increasingly urgent.

Availability is also constrained by resources.. Johannesson said the procedure needs to become less resource intensive to reach more women. and emphasized that financial coverage remains a major barrier.. She noted that early institutions paid for transplants. but funding can run out. and insurance coverage has not shown the kind of interest needed to support widespread access.

She also raised the broader affordability problem: many insurance companies do not cover IVF. which means uterus transplantation cannot succeed as a public option without addressing the costs around fertility care as well.. The goal, she said, is to avoid a future where the procedure is only available to wealthy patients.

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