“Livebirth after Uterus Transplantation” (2015), by Mats Brännström, Liza Johannesson, Hans Bokström, Niclas Kvarnström, Johan Mölne, Pernilla Dahm-Kähler, Anders Enskog, Milan Milenkovic, Jana Ekberg, Cesar Diaz-Garcia, Markus Gäbel, Ash Hanafy et al.

In 2015, Mats Brännström and colleagues published “Livebirth after Uterus Transplantation” in the journal The Lancet. In “Livebirth after Uterus Transplantation,” Brännström and colleagues explain that they conducted one of the first uterus transplantations that resulted in a live birth, and they detail how they did so successfully. Uterus transplantations are a surgical procedure in which surgeons transplant a uterus from an eligible donor into a recipient with uterine infertility disorders, or UFIs, such as an absent or diseased uterus. Women with UFIs can neither conceive nor carry a pregnancy to term naturally, so uterus transplantations remain one of the only treatments available that offer them the possibility to become pregnant as of 2025. Prior to 2013, researchers worldwide had performed human uterus transplantations, but the procedures had not resulted in any reported live births. “Livebirth after Uterus Transplantation” shows that uterus transplantations can allow women with uterine infertility, which affects one in 500 women of reproductive age, the opportunity to experience pregnancy.

At the time of publication in 2015, the authors of “Livebirth after Uterus Transplantation” were all doctors in reproductive and transplantation medicine. Brännström was a professor in the department of obstetrics and gynecology at the University of Gothenburg in Gothenburg, Sweden. Six of the coauthors researched with Brännström at the University of Gothenburg’s department of obstetrics and gynecology. Six additional co-authors were associated with other departments at the University of Gothenburg, including the departments of transplantation, clinical pathology and genetics, and anesthesiology and intensive care. The Swedish research team also recruited Cesar Diaz-Garcia, who was a research fellow from the University of Valencia in Valencia, Spain, and Ashraf Hanafy, a physician from the department of obstetrics and gynecology at Griffith University, Gold Coast in Queensland, Australia, to collaborate with them. The team also worked with Henrik Hagberg from the division of imaging sciences and biomedical engineering at St. Thomas’ Hospital in London, United Kingdom.

In their article, the authors discuss multiple organs and processes related to uterine transplantation. The uterus is an essential organ of the female reproductive system that enables women to carry offspring through pregnancy. Pregnancy is a term that describes the period in which an offspring develops inside the mother’s uterus, or womb. Around eight to thirteen years of age, puberty begins, and females obtain the ability to become pregnant through menstrual cycles. The menstrual cycle is a monthly series of changes the female body undergoes in preparation for pregnancy. During the menstrual cycle, several hormones, such as gonadotropin, follicle-stimulating hormone, and luteinizing hormone, stimulate ovulation, or the release of an egg from the ovaries to the fallopian tubes for fertilization. The egg remains in the fallopian tubes for twelve to twenty-four hours awaiting fertilization by sperm. If a sperm does not fertilize the egg, menstruation, or a period, occurs, during which the uterus sheds its lining through the vagina and causes a period of bleeding that can last from two to seven days. If a sperm fertilizes the egg, the egg becomes a zygote that then develops through cell division into an embryo, and eventually a fetus. During pregnancy, the fetus develops inside the uterus until childbirth, which typically occurs forty weeks after fertilization. Because it carries the fetus and provides structural support to neighboring reproductive organs, the uterus is essential for female reproduction. In women without a functioning uterus, a fertilized egg cannot implant and properly undergo development.

Prior to 2012, researchers worldwide had performed uterus transplantations with no successful live births. In 2000, Wafa Fageeh, who is an obstetrician in Jeddah, Saudi Arabia, performed one of the first recorded uterus transplantations with a live donor. The uterus remained in the patient for ninety-nine days prior to removal due to acute thrombosis, a serious condition involving blood clots. In 2011, a research team at the Akdeniz University Hospital in Antalya, Turkey, conducted the second reported uterus transplantation and the first reported uterus transplantation from a deceased donor. Following the operation, the patient underwent two embryo transfers with in vitro fertilization, or IVF, but they resulted in two miscarriages. IVF is a process of assisted reproduction in which physicians place an already-fertilized embryo into the uterus of a female with the intent to establish pregnancy.

In 2012, the Sahlgrenska University hospital granted Brännström and his colleagues ethical permission to conduct a uterus transplantation clinical trial with live uteri donors, and that clinical trial resulted in the livebirth described in “Livebirth after Uterus Transplantation.” In the clinical trial, nine patients with uterine infertility disorders received uterus transplantation surgeries, resulting in seven patients with viable uteruses six months post-operation. One of those seven women from the clinical trial study went on to have the first recorded live birth in a patient with a uterus transplantation, and “Livebirth After Uterus Transplantation” summarizes the clinical case report for that birth. In 2015, Brännström and his colleagues published “Livebirth after Uterus Transplantation” in The Lancet, which is an international general medical journal founded in 1823.

“Livebirth After Uterus Transplantation” consists of four sections. In the first section, “Introduction,” the authors explain that the article describes the first recorded live birth after uterus transplantation. The second section, “Methods,” consists of five sub-sections, in which the authors discuss the medical history of the recipient, who was a thirty-five-year-old woman with congenital absence of the uterus, and the donor, a sixty-one-year-old woman who had two previous live births, and the procedural steps of the transplantation surgery and IVF treatment. Next, in “Results,” the authors state that the recipient had three mild rejection episodes after her uterus transplantation, all of which the surgeons treated. The authors report that the recipient underwent embryo transfer one year after the transplantation surgery, resulting in a viable pregnancy with delivery of a healthy male infant at thirty-one weeks of gestation. In the fourth section, “Discussion,” the authors state that their demonstration of the first live birth following uterus transplantation provides sufficient evidence that uterus transplantations offer women with uterine factor infertility a treatment option.

In the first section, “Introduction,” Brännström and colleagues discuss uterus transplantations as a treatment option for UFIs and explain that clinical attempts of the procedure prior to their own had not resulted in a live birth. The authors state that the majority of their recipients have a type of UFI known as absolute uterine infertility, or AUFI, which is a medically untreatable type of uterine infertility due to a complete absence of the uterus. They explain that because they do not have a uterus, women with AUFI do not experience typical menstruation and cannot conceive or give birth to a child naturally; therefore, they have previously had to turn to adoption or surrogacy to have children. Brännström and colleagues explain that after a decade of research and working with rodents and non-human primates, they started a clinical trial of uterus transplantations in 2012 with nine female patients and nine live donors, resulting in seven successful transplantations. The researchers state that “Livebirth After Uterus Transplantation” describes the clinical course of a patient from the 2012 clinical trial who achieved pregnancy resulting in the first newborn born after a uterus transplant.

The second section, “Methods,” contains five smaller sub-sections. In the first sub-section, “Patient,” the authors explain that the patient and donor were highly compatible, which increased the likelihood of a successful transplantation. Compatible organ donors and recipients have the same blood type, close geographical proximity, and similar genetic tissue. The authors state that the uterus transplantation occurred in 2013 at Sahlgrenska University Hospital with a thirty-five-year-old female recipient who lacked a uterus and a post-menopausal sixty-one-year-old donor who had previously had two successful vaginal deliveries. The donor was in menopause, which meant that the menopausal donor’s uterus no longer exhibited functional menstrual cycles and she could not become pregnant. Thus, three months prior to the procedure, the researchers treated the donor with a contraceptive pill to successfully facilitate regular bleeding to prepare the uterus for the transplant. The authors concluded that the compatibility match between the patient and donor was a success.

In the second sub-section, “In-Vitro Fertilisation,” Brännström and his colleagues discuss the IVF treatment performed between eighteen and six months prior to the transplantation surgery. The authors state that the patient’s inability to menstruate and regulate and synchronize gonadotropin levels because of AUFI made it difficult for researchers to start and monitor the gonadotropin simulation process. Gonadotropin stimulates the ovaries to produce eggs and is therefore required for pregnancy. The researchers explain that they administered three cycles of gonadotropin treatment and injected recombinant human chorionic gonadotropin, which is a hormone fertility medicine, to initiate ovulation in the patient. After initiating ovulation, the authors explain that they conducted egg retrieval through the abdomen with ultrasound guidance and then fertilized the eggs with a sperm injection. The authors explain that they transferred one of those frozen embryos into the patient approximately twelve months after the transplantation surgery.

In the third sub-section, “Surgery,” and the fourth sub-section, “Immunosuppression and Follow-Up,” the authors explain that the surgical transplantation procedures were successful. They state that there were no complications during the uterus removal surgery from the donor, and they explain that they facilitated a successful transplantation between the uterus and recipient by fitting the uterus in the pelvis and surgically connecting the uterus and pelvic veins together, which induced blood flow between them. The researchers describe that they detected bleeding in the pelvic space of the recipient on the second postoperative day, but successfully treated her with blood cell transfusions and were able to discharge both the donor and recipient six days post-operation. In “Immunosuppression and Follow-Up,” Brännström and his colleagues explain that the recipient’s immune system responded well to the transplantation surgery. Both prior to and following the surgery, the researchers treated the recipient with immunosuppression therapy, or the injection of medications to prevent and treat the body from rejecting the transplantation. The authors monitored the patient for routine health evaluations initially twice every week, then every two weeks post-operation. The authors also briefly state that the study’s funder did not have any research role in the study in the fifth sub-section, “Role of the Funding Source.”

Next, in “Results,” the researchers explain that after the uterus transplantation surgery, the recipient experienced typical menstruation and underwent IVF, ultimately resulting in the birth of a male infant. The researchers state that the recipient began menstruating forty-three days post-transplantation and continued having regular cycles in the following months. During the clinical trial, the authors discovered three transplantation rejection episodes in the recipient and treated the episodes with corticosteroid treatment that has anti-inflammatory and immunosuppressive properties. One year after the transplantation surgery, the doctors transferred one preserved embryo into the patient, resulting in a positive pregnancy test. The authors monitored the pregnant recipient throughout the pregnancy and detected normal fetal growth and development. The researchers performed a cesarean section, or C-section, thirty-one weeks into the pregnancy due to preeclampsia, which is a pregnancy condition characterized by high blood pressure that can be fatal to the mother and infant. The authors monitored the neonate and mother post-delivery. The mother was discharged three days post-delivery, and the researchers concluded the newborn was healthy for discharge sixteen days following the birth.

In “Discussion,” the authors explain that their clinical trial and the resulting livebirth raised multiple considerations for using uterus transplantation to treat individuals with AUFI. The researchers explain that family members should be the first preference for uterine donors since genetic compatibility is more likely among individuals who are related, but they say that it is not essential as the patient from their study received a donor uterus from a family friend because the patient’s mother, who was the patient’s first choice, was not compatible. The researchers then discuss the different benefits of using live and deceased donors. Uterine donation from a deceased individual reduces the risk of surgery to a live donor. They evaluate the previous uterus transplantation attempt in Turkey in 2011, which used a brain-dead patient with no prior history of pregnancies, and the researchers used a younger uterus, which could have helped with the transplant process. However, they argue that live donors have histories of previous successful pregnancies to test the known functionality of the uterus to carry a pregnancy. The researchers conclude that uterus transplantations enable treatment for women with uterine fertility disorders worldwide.

In “Discussion,” the authors explain the IVF treatment process used in the study and suggest that uterus transplantations require removal after live births to avoid implications for the recipient’s health. The authors explain that they performed IVF prior to the transplantation to assess the fertility of the recipient and her partner. The authors explain that the patient achieved pregnancy following the first attempt at embryo transfer and had one mild uterus rejection episode during the pregnancy. The authors state that the patient developed preeclampsia at thirty-one weeks of pregnancy due to an unknown cause. However, they propose that it could have been due to either her rejection episode and immunosuppression therapy or the age of the donor uterus at sixty-one years old. The researchers write that uterus transplantations are not intended for lifelong use and recommend that future researchers remove the uterus after one to two deliveries to reduce the side effects of the immunosuppression drug therapy, which include fetal risks such as prematurity, low birth weight, and fetal defects. Finally, they assert that their demonstration of a live birth following uterus transplantation has the potential to help more women with AUFI experience pregnancy and have children.

Brännström and his colleagues received mixed reactions to “Livebirth After Uterus Transplantation” after its publication, as some researchers worldwide criticized the ethics of the study, while others began conducting their own uterus studies and transplants in an attempt to have more live births. Some researchers from the scientific community criticized the author team’s choice of using a family friend as a donor. They argued that the personal relationship between a donor and recipient could cause the donor to feel socially pressured to consent to the operation. Despite the criticism, the article launched further research exploration of uterus transplantations, including experiments with deceased donors, resulting in the publication of “First Birth From a Deceased Donor Uterus in The United States: From Severe Graft Rejection to Successful Cesarean Delivery” in 2020. By 2021, just six years after its publication, four European countries, four Asian countries, and the USA had conducted their own uterus studies, and researchers estimated that surgeons had performed at least eighty uterus transplantations, resulting in more than forty live births. As of 2025, researchers have cited the article over 900 times, primarily in other studies on the treatment for uterine fertility and succeeding attempts at uterus transplantations.

“Livebirth after Uterus transplantation” established that among women with uterine fertility disorders, uterus transplantations can allow successful conception and pregnancy. The article influenced other scientists to perform experiments on uterus transplantation research worldwide. As of 2025, surgeons have performed over one hundred uterus transplantations, and they continue to perform the surgeries to allow women with uterine infertility disorders to experience pregnancy.

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