If you were born without a uterus or have some other type of uterine factor infertility, it used to be true that you didn’t have a single option if you wanted to carry your own baby. Now, that’s no longer the case. Uterus transplants, while still rare, are slowly gaining in popularity as researchers and physicians work toward making them safer and more effective. Here, we’ll discuss what’s involved in a uterus transplant, where you can get one if you are a candidate, and how people feel about having a baby with a donated uterus.
What’s Involved in a Uterus Transplant?
Women with genetic anomalies that mean that a uterus does not grow, who have had a hysterectomy, or who have a uterus that doesn’t function in a way that allows it to be able to safely grow a baby may be eligible for a uterus transplant. There are four sites in the United States where uterus transplants are available, largely as part of ongoing clinical trials, including Baylor University Medical Center in Texas, the University of Pennsylvania, the Cleveland Clinic, and the University of Alabama at Birmingham. There are also several programs around the world including in Sweden and Spain.
Each of these programs has extensive screening criteria to determine whether people qualify to move forward with transplantation. If you do qualify, you would first do an egg collection, so that embryos can be created with in vitro fertilization. Then you’d receive a uterus in a transplant operation, either from a living or deceased donor. It is therefore possible to donate your uterus either during life or after death if you meet the health-related criteria.
Once you receive the uterus and live with it for a while (usually about a year), an embryo will be transferred to your uterus. If your pregnancy is successful, your baby will be born via cesarean section. At some sites, you may have the option to try for a second child starting as early as six months after your baby is born, or you may have a hysterectomy shortly after your birth, during which the donated uterus is removed.
When you have any organ transplant, it’s necessary to stop your immune system—the part of your body that protects from invaders—from attacking the donor organ. It’s therefore necessary to take immune suppressant drugs from the time that you receive your donor uterus until it is removed after childbearing.
Despite the challenges of organ donation, transplantation, and subsequent pregnancy, there have been several babies born to mothers who received uterus transplants. In a particularly touching story from Penn Medicine News, two women—Chelsea and Cheryl—will be connected forever, as Chelsea received Cheryl’s uterus and then had a healthy baby boy, Telden. 
Why not surrogacy?
In countries where it is legal to be a gestational carrier—that is, to grow and birth a baby for someone else—some people wonder why someone would choose uterine transplantation instead. The truth is that sometimes surrogacy doesn’t work out because it’s hard to find a surrogate or is prohibitively expensive. And sometimes, the biological desire to carry one’s own baby is just too strong. In a review article published in Transplantation in 2018, physician scientist Mats Brännström, who is the leader of the group doing uterus transplants in Sweden, and colleagues write that a survey from Japan suggests that uterine transplantation is preferable to gestational surrogacy for many people. 
In a study published in January 2021 in JAMA Network Open, researchers surveyed 182 transgender women and found that they overwhelmingly felt that vaginal and uterus transplant would improve their sexual experiences and quality of life. The majority of these women also desired children and would consider uterus transplant in order to carry them themselves.  The safety and feasibility of such a surgery has not yet been evaluated, but it may be possible in the future.
- Kluthe, “After Penn Medicine’s First Living Donor Uterus Transplant, Donor Meets Baby Carried in Her Transplanted Womb,” Penn Medicine News, 2021.
- Brännström et al., “Uterus Transplantation: A Rapidly Expanding Field,” Transplantation, 2018.
- P. Jones et al., “Perceptions and Motivations for Uterus Transplant in Transgender Women.” JAMA Network Open, 2021.