Anastasiia SOLOVIOVA, Valentyna OLEKSIIENKO
Experimental and Clinical Transplantation - 2026;24(6):437-443
Objectives: Absolute uterine factor infertility is a condition characterized by the absence of a functional uterus, resulting in the inability to achieve or maintain pregnancy. Uterus transplantation has emerged as an experimental therapeutic option aimed at restoring reproductive capacity in women with absolute uterine factor infertility. Here, we reviewed the current clinical experience with uterus transplantation, focusing on surgical approaches, donor sources, reproductive outcomes, and ethical considerations. Materials and Methods: We conducted a narrative review of the literature using the PubMed, Scopus, and Google Scholar databases. We screened publications from 2000 through 2025 using the keywords "uterus transplantation," "absolute uterine factor infertility," and "MRKH syndrome." We included 42 relevant publications that described clinical outcomes, surgical techniques, and ethical aspects of uterus transplantation. We focused on reports of successful pregnancies and births following uterus transplantation. Results: Uterus transplantation has progressed from experimental animal models to clinical application. To date, more than 90 transplants have been performed worldwide, resulting in over 50 live births. The procedure involves complex microsurgical vascular anastomoses and requires long-term immunosuppression until childbirth. All pregnancies are achieved through in vitro fertilization with cryopreserved embryos. Both living and deceased donors have been successfully used, each associated with specific ethical and surgical considerations. Conclusions: Uterus transplantation represents a promising experimental therapy for women with absolute uterine factor infertility. Although encouraging reproductive outcomes have been reported, the procedure remains technically demanding and associated with substantial ethical, surgical, and immunological challenges. Further multicenter studies and long-term follow-up are required to establish standardized protocols and evaluate long-term maternal and neonatal outcomes.
